Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
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Opening new doors <strong>with</strong> counselling <strong>and</strong> testingamong prevention approaches. As <strong>with</strong> family planning, no single method will work<strong>for</strong> all <strong>people</strong> at all stages of their lives. The more preventive methods available, thebroader the choice <strong>for</strong> individuals <strong>and</strong> couples <strong>and</strong> the greater the likelihood that allwill find at least one acceptable approach to preventing the spread of <strong>HIV</strong>.Preventing mother-to-child transmission of <strong>HIV</strong>Since the start of the <strong>HIV</strong> epidemic, it is estimated that 3.8 million children have diedof <strong>AIDS</strong> be<strong>for</strong>e their 15th birthday, nearly 0.5 million of them in 1999 alone. Another1.3 million children are currently <strong>living</strong> <strong>with</strong> <strong>HIV</strong>, <strong>and</strong> most will die be<strong>for</strong>e they reachtheir teens. The vast majority of these children were born to <strong>HIV</strong>-infected mothers:they acquired the virus in the womb, around the time of childbirth or during breastfeeding.For many years, not enough was known about transmission from mother to child totake steps to help <strong>HIV</strong>-infected women have uninfected babies. In the absence ofany intervention, around a third of <strong>HIV</strong>-positive mothers pass the virus to their newborns.In the late 1990s, it was found that around half of all these infections occurduring breastfeeding.In recent years, much has been learnt about how to prevent transmission of <strong>HIV</strong> frominfected mothers to their babies. This knowledge has been applied in high-incomecountries, where most <strong>HIV</strong>-positive pregnant women choose to take antiretroviraldrugs that reduce the risk of transmission <strong>and</strong> afterwards avoid breastfeeding theirnewborn. These two measures, in combination <strong>with</strong> delivery by caesarean section,have dramatically decreased mother-to-child transmission of <strong>HIV</strong>.The developing world, <strong>and</strong> especially sub-Saharan Africa, st<strong>and</strong>s to gain even morefrom large-scale programmes <strong>for</strong> reducing mother-to-child transmission becausewomen have more children <strong>and</strong> have far higher rates of <strong>HIV</strong> infection. Over ninetenthsof all children worldwide infected be<strong>for</strong>e birth or during infancy in 1999 wereborn in sub-Saharan Africa. Making <strong>HIV</strong> counselling <strong>and</strong> testing services widelyavailable so that infected women can decide whether to take preventive drugs duringpregnancy is a measure that could save the lives of hundreds of thous<strong>and</strong>s ofchildren while offering broader benefits as well, as discussed on page 78.However, the challenges in developing countries are also greater than in the highincomecountries. First, higher rates of <strong>HIV</strong> <strong>and</strong> of childbearing mean that preventionprogrammes have to reach a much larger number of women. Secondly, there arefewer <strong>HIV</strong> counselling <strong>and</strong> testing facilities available. Thirdly, breastfeeding is almostuniversal, <strong>and</strong> safe alternatives to breast milk are harder to come by. Finally, the drugregimens used in high-income countries <strong>for</strong> reducing <strong>HIV</strong> transmission to infants aretoo expensive <strong>and</strong> complicated to be practical <strong>for</strong> widescale use in poor countries.81