What Works for Women and Girls

HIV-positive mothers, mortality was 27% as infants, 46% for those under five years, and49% for those under ten years of age. For those with HIV-negative mothers, mortalitywas 11% as infants, 16% under the age of five, and 17% under the age of ten (Crampinet al., 2003). (Gray III) (PMTCT, child mortality, Malawi)Children left motherless are 3 to 10 times more likely to die within two years than childrenwho live with both parents (UNFPA, 2000a). (Gray IV) (orphans, child mortality)4. National scale-up of HAART in pregnancy improves maternal and infant outcomes.A retrospective review of clinical records of 571 HIV-positive pregnant women in antenatalcare in Jamaica between 2002 and 2006 found that national scale up of HAARTimproved maternal and infant outcomes. Acceptance of HAART increased: from 2002–2004, HAART was used by 2 to 3% of pregnant women; by 2006, 62% of HIV-positivewomen accessed HAART during pregnancy. From 2002 to 2005, zidovudine and/ornevirapine were used. For all four years, 24 maternal deaths occurred. Of these, 23 or96% occurred in those who took zidovudine/nevirapine, with only one death or 4%occurring in those who accessed HAART. By bringing viral load to an undetectable level,HAART has minimized the “chance of perinatal transmission to under 2% in Kingstonand under 5% islandwide” (Johnson et al., 2008: 221). Between 2002 and 2005, only 1%received HAART despite 8% of patients having been clinically assessed as warrantingHAART. In 2008, “we offer four-drug HAART…. to all HIV-infected women who arediagnosed early in pregnancy, with island-wide uptake consistently approaching 90%regardless of the woman’s individual disease stage” (Johnson et al., 2008: 221). Recentisland-wide upgrade of lab facilities allowing wide availability of CD4 counts and viralloads has “already minimized peripartum deaths in pregnant women with HIV infection”(Johnson et al., 2008:220). (Gray III) (HAART, treatment, PMTCT, Jamaica)A review of PMTCT programs in Ukraine found substantial improvements in MTCT ona national level. MTCT rates decreased from 15.2% in 2001 to 7% in 2006. By January2008, 3,356 mother-child pairs had received PMTCT services. Among women receivingno ARV prophylaxis, the PPT rate was 26.7%, decreasing to 15.7% for women whoreceived single dose nevirapine, 7% for women receiving zidovudine; 9.2% for womenwho received both zidovudine and single dose nevirapine and 3.9% among women whoaccessed HAART. Maternal HIV clinical disease stage (WHO clinical stages 1 and 2) ascompared to WHO clinical stages 3 and 4 were not significantly associated with PMTCT.PMTCT rates more than halved between 2001 and 2006, with a PMTCT rate of one in14 in 2006. Use of HAART is planned for all HIV-positive women in Ukraine’s nextPMTCT program. Most women received their first HIV diagnosis in pregnancy (Thorneet al., 2009). (Gray III) (PMTCT, treatment, HAART, Ukraine)242 CHAPTER 9 SAFE MOTHERHOOD AND PREVENTION OF VERTICAL TRANSMISSION