What Works for Women and Girls

the current pregnancy. The study also found that 23% of women were aware of theirHIV status before conception and did not seek medical care until the third trimester.Of 455 women providing data on delivery, 56.9% delivered vaginally, 25.7% underwentcesarean sections for reasons not related to HIV and 17.4% had emergency cesareansections. Of 244 women who provided follow-up data, 80% experienced an increase inCD4 cell count and of 211 women who provided data on viral load, 80.5% experienced adecrease in viral load over 15 weeks. All infants born HIV-positive were born to womenwho received seven or fewer weeks of HAART. “Recent data suggest that pregnancy isassociated with a lower risk of HIV disease progression, and experience with the ANCARV cohort supports this finding” (Tai et al., 2007 as cited in Black et al., 2008: 279).This study was constrained by a national policy restricting viral load testing to twice ayear. Among women who did have viral load testing, 75.6% had an undetectable viralload (Black et al., 2008). (Gray III) (treatment, HAART, pregnancy, South Africa)A study assessing perinatal transmission in Botswana from 2006 to 2007 found an HIVtransmission rate of approximately 3.6% for women receiving antiretrovirals either forprophylaxis for PMTCT only or as indicated for the mother’s health. Pregnant womenwith CD4 counts above 200/μl received zidovudine starting at 28 weeks of gestationuntil labor along with a single dose of nevirapine at the onset of labor. Women with CD4counts below 200/μl initiated HAART before or during pregnancy. Uptake of eithershort-term treatment or HAART was 90%. Dried blood spot HIV testing was completedfor 10,516 children born to HIV-positive mothers during the study period. Mothers whoinitiated HAART before pregnancy were the least likely to transmit HIV to their infantas opposed to women who initiated HAART during pregnancy, women who received ashort course of zidovudine and a single dose of nevirapine, women who received onlyzidovudine, women who received only single dose nevirapine, and women who receivedno treatment. The added benefits of a single dose of nevirapine for mothers who hadreceived zidovudine for more than four weeks was found to be negligible, although formothers receiving no treatment a single dose nevirapine reduced MTCT by 40% (Tlaleet al., 2008). (Gray III) (HAART, PMTCT, Botswana)A study from 1999 to 2005 of 551 infants born to HIV-positive women seen at GHESKIO,Haiti, found that prior to HAART availability in 2003, infant mortality was 23 per 100live births per year. Following the introduction of HAART for HIV-positive women,infant mortality fell to 7 per 100 live births in 2005. In the cohort of 399 women givenexclusively single drug prophylaxis, the perinatal transmission rate was 10%. In the 60women who received HAART the perinatal transmission rate was 1.9%. (Noel et al.,2008). (Gray III) (HAART, PMTCT, Haiti)A prospective cohort study from 2002 to 2006 enrolling HIV-positive pregnant womenin Latin America and Caribbean countries found that MTCT rates were very low, mostwomen had viral loads below 1000 copies/mL, almost all women were receiving antiretroviraltreatment either for prophylaxis or for the mother’s health, and many women238 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION