AFRO-NETS> Mother to child transmission - summary from meetings

[Claudio Schuftan <aviva@netnam.vn>]

Mother to child transmission - summary from meetings
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MEETING ON PREVENTING MOTHER TO CHILD TRANSMISSION

Summarised from the report of The African Regional Meeting on Pilot 
Projects for the Prevention of Mother-to-Child Transmission of HIV in 
Gaborone, Botswana, March 2000.UNICEF/UNAIDS/WHO/UNFPA.

To obtain a copy of the report go to the UNAIDS website at:
http://www.unaids.org/publications/documents/mtct/Gaberone_meeting_MTCT.doc

The HIV/AIDS epidemic is resulting in more than 600,000 infants be-
coming infected each year, and in many countries the epidemic has be-
come a major cause of infant and young child mortality. From a human 
rights perspective, governments and UN agencies have an obligation to 
support action to prevent infants from becoming infected.

It has become clear from the increasing scientific evidence and re-
cent results from countries such as Botswana, Côte d'Ivoire, Uganda, 
Rwanda and Zimbabwe, that it is possible to make a difference. There 
is an urgent need for more countries to start implementing PMTCT in-
terventions on a national scale in order to have a meaningful impact.

It is not necessary to wait for everything to be in place, but coun-
tries should build on what is already on the ground.
Community consultation and participation is important.
It is important to involve PLWAs.
VCT is the cornerstone of MTCT.
Counsellors should be well-trained, supervised and supported.
Health workers need training on infant feeding.
Mothers need support and follow-up, especially with respect to infant
feeding.
Studies and interventions are needed on the psychosocial care of peo-
ple with HIV and their families.
MTCT should be integrated into routine health care services.

These considerations can serve as a checklist for countries that are
planning to initiate or expand projects.
The summary of conclusions and recommendations included:

Countries should be supported in accelerating implementation of PMTCT
programmes.
Clearer advice and support of infant feeding options should be given 
to HIV-infected women.
Programmes should ensure political commitment and create demand for
VCT/PMTCT at the community level.
Access to VCT should be expanded rapidly.
Efforts should be made to streamline testing and to maintain quality
control.
Countries need continual guidance in the provision of ARVs for PMTCT.
Countries should ensure that in PMTCT programmes, HIV-infected moth-
ers have access to the best available care.
Reliability of the provision of drugs , test kits and breast-milk 
substitutes should be improved.
PMTCT implementation needs to be monitored and documented so that 
lessons can be learned and experiences shared to ensure more effec-
tive scaling-up.
While governments have the primary obligation to monitor their pro-
grammes, UN agencies also have a responsibility for adequate funding 
and technical support during the development and early implementation 
phase.

In the year 2000 alone, approximately 600,000 children worldwide ac-
quired HIV. Over 90% of these children were born to mothers in Africa 
who in the first place did not know their sero-status.

In the absence of any intervention to reduce mother to child trans-
mission, 25-40% of HIV infected women in Africa will pass the virus 
to their babies during pregnancy, at the time of labour or delivery 
or after birth through breastfeeding. A number of governments in col-
laboration with the Inter Agency Task Team on the prevention of MTCT 
and other partners are undertaking pilot programmes to assess the 
feasibility of integrating PMTCT interventions in routine antenatal 
services. Many lessons have been learned, particularly about the ca-
pacity of health care systems to deliver the services. But it is sad 
to note that while most women accept to undergo the HIV test, sig-
nificantly lower percentages (less than 50% in Cote d'Ivoire, for ex-
ample) return to collect their results.

The limited or complete lack of knowledge about mother to child 
transmission of HIV of the majority of participants, including SWAA 
members is highlighted.
The fear, denial and stigma which still surrounds HIV/AIDS within
communities.
The marginalisation of male involvement in PMTCT interventions at the 
levels of health service delivery and communities.
Inadequate or lack of proper communication strategies between service
providers and clients.
Marginalisation of the mothers.
HIV positive mothers may be victimised as a result of the interven-
tion's apparent lack of emphasis on the possible role of men in the 
mother to child transmission of HIV.
There is a need to develop locally appropriate and culturally sensi-
tive PMTCT communication strategies that address denial, stigma, 
fear, gender roles and victimisation. The development of such strate-
gies should have the active participation of all stakeholders in the 
community, particularly the men, partners of women living with 
HIV/AIDS, community leaders and NGOs.

--
Claudio Schuftan
Hanoi, Vietnam
mailto:aviva@netnam.vn

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