Care and support for people living with HIV/AIDS

Opening new doors with counselling and testingamong prevention approaches. As with family planning, no single method will workfor all people at all stages of their lives. The more preventive methods available, thebroader the choice for individuals and couples and the greater the likelihood that allwill find at least one acceptable approach to preventing the spread of HIV.Preventing mother-to-child transmission of HIVSince the start of the HIV epidemic, it is estimated that 3.8 million children have diedof AIDS before their 15th birthday, nearly 0.5 million of them in 1999 alone. Another1.3 million children are currently living with HIV, and most will die before they reachtheir teens. The vast majority of these children were born to HIV-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 HIV-infected women have uninfected babies. In the absence ofany intervention, around a third of HIV-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 HIV frominfected mothers to their babies. This knowledge has been applied in high-incomecountries, where most HIV-positive pregnant women choose to take antiretroviraldrugs that reduce the risk of transmission and afterwards avoid breastfeeding theirnewborn. These two measures, in combination with delivery by caesarean section,have dramatically decreased mother-to-child transmission of HIV.The developing world, and especially sub-Saharan Africa, stands to gain even morefrom large-scale programmes for reducing mother-to-child transmission becausewomen have more children and have far higher rates of HIV infection. Over ninetenthsof all children worldwide infected before birth or during infancy in 1999 wereborn in sub-Saharan Africa. Making HIV counselling and 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 thousands 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 HIV and of childbearing mean that preventionprogrammes have to reach a much larger number of women. Secondly, there arefewer HIV counselling and testing facilities available. Thirdly, breastfeeding is almostuniversal, and safe alternatives to breast milk are harder to come by. Finally, the drugregimens used in high-income countries for reducing HIV transmission to infants aretoo expensive and complicated to be practical for widescale use in poor countries.81