Research, Maternal, Child and Reproductive Health

HIV-Positive Pregnant Women in Malaria-Endemic Zones: A Vulnerable Population

World Malaria Day is an appropriate occasion to call attention to a neglected issue: the risks posed by malaria to HIV-positive pregnant women


HIV and malaria, two of the world's most widespread infections, overlap considerably in their geographical distribution, especially in sub-Saharan Africa. In the countries of Eastern and Southern Africa most affected by these diseases, which include Mozambique, Malawi, Zambia, Tanzania, and Kenya, over 90% of the population is exposed to malaria, the prevalence of HIV among adults exceeds 10%, and it is estimated that more than one million HIV-positive women at risk of contracting malaria become pregnant every year.

Co-infection with HIV and malaria leads to an exponential increase in the negative effects of both infections, has an adverse effect on prognosis, and complicates both prevention and treatment. Pregnant women with HIV/AIDS have an increased risk of developing severe malaria with complications, and the evidence indicates that children whose mothers have malaria are more likely to acquire HIV infection from their mothers. Despite these risks, the current recommendations for the prevention of malaria in pregnancy are not applicable to African women with HIV infection since the recommended preventive treatment is contraindicated in these patients. As a result, malaria prevention is, paradoxically, less effective in pregnant African women with HIV/AIDS, the group that has the highest risk for both infections and is most vulnerable to their effects.

Greater coordination between the programmes undertaken to prevent HIV/AIDS and malaria and to promote reproductive health is certainly needed. More crucially, however, this hugely important global public-health issue needs to be addressed scientifically so that safe, effective antimalarial drugs can be made available to HIV-positive pregnant women, particularly in sub-Saharan Africa.

Source: OMS/WHO -