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IRIN
HIV-AIDS WebSpecial : GLOBAL CRISIS GLOBAL ACTION
| FACT SHEET: |
Mother-to-Child Transmission of HIV |
The
transmission of HIV from mother to child is responsible for
over 90 percent of infections among children under the age
of 15. The effects are dramatic. AIDS is beginning to reverse
decades of steady progress in child survival. But effective
and feasible interventions to reduce mother-to-child transmission
are now available and could save the lives of 300,000 children
each year.
| Children at risk |
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In 2000 alone, an estimated 600,000 infants acquired
HIV - over 90 percent of them through mother-to-child
transmission (MTCT). About 90 percent of those infections
occurred in sub-Saharan Africa.
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HIV can be transmitted to an infant during pregnancy,
labour and delivery or breastfeeding. The risk of transmission
varies between 15 percent and 30 percent among infants
who are not breastfed. Breastfeeding increases the risk
of transmission by 10-15 percent.
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Mother-to-child transmission in the developed world
has been virtually eliminated thanks to effective voluntary
counselling and testing, access to combination antiretroviral
therapy or use of long-term regimens of MTCT prevention,
safe delivery practices (including elective caesarean
sections), and the widespread availability of breast-milk
substitutes.
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| Preventing infection |
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A
three-fold strategy is needed in order to prevent
MTCT. It requires that women be protected against
infection, and that unwanted pregnancies be avoided
among HIV-infected women and women at risk. It also
entails preventing transmission of the virus from
HIV-infected women to their infants during pregnancy,
labour and delivery, as well as during breastfeeding.
Voluntary counselling and testing are an essential
part of the strategy.
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It
is clear that short-term antiretroviral prophylactic
treatment is an effective and feasible method of preventing
MTCT. When combined with infant feeding counselling
and support, and the use of safer infant feeding methods,
it can halve the risk of infant infection.
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These
regimens are mainly based on the use of nevirapine
or zidovudine. Nevirapine is administered in one dose
to the mother at delivery, and in one dose to the
child within 72 hours of birth. A typical short-course
zidovudine regimen is administered daily to the mother
from the 36th week of pregnancy up to and during delivery.
MTCT programmes supported by a United Nations Inter-Agency
Task Team provide these drug regimens free of charge.
In 2000, the manufacturers of nevirapine, in partnership
with the UN system, offered the drug free of charge
to developing countries for a period of five years.
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Most
HIV-infected women live in deprived conditions and
lack access to clean water and sanitation. This limits
their ability to employ safe breast milk substitutes.
Research on how to make breastfeeding safer is a high
priority. Results from one study suggest that exclusively
breastfed children are less likely to acquire HIV
than those receiving breast-milk and other foods.
But these results need to be confirmed in other settings.
Meanwhile, studies are under way to determine whether
antiretroviral drugs provided to a mother or infant
during the breastfeeding period can prevent HIV transmission.
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| Major challenges remain |
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There
is a need for greater awareness of the facts that
HIV can pass from an infected mother to her child,
and that measures exist to reduce the risk of transmission.
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Access
to voluntary counselling and testing must be improved.
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The
reluctance of many women to be tested for HIV infection
must be addressed. That unwillingness is often a response
to stigma and is associated with women's concern that
they will be deprived of social or medical support
if found to be infected.
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Reproductive
health services remain inadequate and must be bolstered
if they are to accommodate MTCT prevention programmes.
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Women's
access to antenatal and delivery care should be improved.
Safer infant feeding options should also be developed.
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Ultimately,
if infants are to be better protected from the virus,
women's vulnerability to HIV infection must be reduced.
Such an approach should include HIV-negative women
who are pregnant and lactating, in order to protect
them and children they may subsequently have.
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The
focus should always be on women themselves, regardless
of their HIV status, rather than on the women's potential
for transmitting the virus to their infants.
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| Building on successes |
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The UN Inter-Agency Task Team on MTCT is supporting
an ongoing programme to prevent mother-to-child transmission.
The programme, which is being enlarged, currently
includes pilot projects in Botswana, Burundi, Cambodia,
Côte d'Ivoire, Honduras, Kenya, Rwanda, Uganda, Tanzania,
Zambia and Zimbabwe.
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By the end of 2000, the team's projects had already
served about 81,000 pregnant women, two-thirds of
whom had been counselled and tested for HIV. A third
of those found to be HIV-positive were provided with
antiretroviral regimens and were counselled on safer
infant feeding practices. While some projects are
still in their early stages, the experience gained
in countries such as Brazil, Thailand, Barbados and
the Bahamas shows that MTCT prevention programmes
can and should be scaled up to achieve national coverage.
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The
above information supplied by UNAIDS
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