Preventing Mother to Child Transmission of HIV

As HIV spreads through countries in the Asia Pacific region increasing numbers of young women of reproductive age are becoming infected with HIV. Because HIV can pass from an infected woman to her baby the number of children infected with HIV is also rising. The HIV epidemic threatens the survival of children in several ways. They may become infected during pregnancy, childbirth or through breastfeeding. Uninfected children of infected mothers are also more likely to die than children of uninfected mothers in the same settings.Women with HIV may be advised, or choose, not to breastfeed. Unless they have good advice and reliable supplies of infant formula their babies have a high risk of death from diarrhoea and other infectious diseases. As the epidemic ages more parents are dying, leaving vulnerable orphans. In addition, children are usually most affected by the worsening poverty that inevitably accompanies the spread of HIV in communities. It has been suggested that promoting a "child survival" approach will be helpful in addressing the impact of the epidemic on mothers and children.This will lead to broader responses, emphasising the need for balance in counselling women about infant feeding so that they can make the safest choice for their circumstances and the need to provide follow up care and support for mothers found to be positive to enable them to live longer and happier lives and to care for their children. Thailand has been able to scale up their program of voluntary and confidential antenatal counselling and testing, access to anti-retroviral prophylaxis, infant formula and follow up care for the mother and baby. As a result of this program, 2,225 babies are escaping HIV infection each year. The program is being monitored and evaluated showing improvements leading to impressive increases in acceptance and coverage, with some increase in couple counselling.

The program has also been able to provide an entry point for further care and support services for positive women. India, Cambodia, Myanmar, Vietnam, PNG and China have begun pilot implementation studies. These interventions do have the potential for harm as well as benefit. They relate to areas of life that have great cultural and social significance - sexual behaviour, the desire to have babies, pregnancy, childbirth, infant feeding and childcare. They are areas of intimate concern to women, yet often governed by men. A diagnosis of HIV is associated with stigma, which seems to spread in advance of the epidemic. Careful preparation is needed before they are introduced, taking into account the social and cultural context, and the associated attitudes, knowledge and behaviours. There has been an emphasis on interventions that depend on testing during pregnancy - but there are other strategies that can also contribute to reduction in the numbers of children infected with HIV. Dr Isabelle de Zoysa, Director of the Department of HIV/AIDS (prevention) at WHO, described the Ôthree-prong strategy' now being recommended by the UN agency task force: first, prevent HIV infection in young people and women of childbearing age, secondly, prevent unwanted pregnancy among women with HIV infection; and thirdly, prevent transmission of HIV from an infected mother to her infant.