Children at risk
• In 2000 alone,
an estimated 600,000 infants acquired HIV—over 90% of them through mother-to-child
transmission (MTCT). About 90% of those infections occurred in sub-Saharan
• HIV can be
transmitted to an infant during pregnancy, labour and delivery or breastfeeding.
The risk of transmission varies between 15% and 30% among infants who
are not breastfed. Breastfeeding increases the risk of transmission
by 10-20%. In breastfeeding populations, roughly 20% of infants carrying
the virus are infected during pregnancy, about 50% become infected during
labour and delivery, and 30% during breastfeeding.
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.
• 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.
• 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.
• 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 United
Nations system, offered the drug free of charge to developing countries
for a period of five years.
• 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
• 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.
• Access to voluntary
counselling and testing must be improved.
• 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.
health services remain inadequate and must be bolstered if they are
to accommodate MTCT prevention programmes.
• Women’s access
to antenatal and delivery care should be improved. Safer breastfeeding
options should also be developed.
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.
• 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.
Building on successes
• 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
projects in Burundi, Botswana, Côte d’Ivoire, Kenya, Rwanda, Uganda,
the United Republic of Tanzania, Zambia, Zimbabwe, Honduras and Cambodia.
• 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
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