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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Report on the global <strong>HIV</strong>/<strong>AIDS</strong> epidemic – June 2000Some of these difficulties are being overcome. Studies in Thail<strong>and</strong> in early 1998showed that a relatively simple drug regimen – a short one-month course of the antiretroviraldrug zidovudine (AZT) – given to <strong>HIV</strong>-infected mothers late in pregnancycould halve the rate of <strong>HIV</strong> transmission to their infants so long as the women alsoavoided breastfeeding. In Côte d’Ivoire <strong>and</strong> Burkina Faso, it was shown that ifwomen took the drug in the same way but then went on to breastfeed, the rate oftransmission to their infants was still reduced by a third. In late 1999, a study inUg<strong>and</strong>a showed that similar results could be achieved by giving nevirapine to themother at the onset of labour <strong>and</strong> then to the infant after delivery. This regimen costsabout US$ 4 per <strong>HIV</strong>-infected woman – less than a tenth of the cost of a one-monthcourse of AZT. As a result, nevirapine has been included in the WHO Model List ofEssential Drugs as a drug <strong>for</strong> decreasing mother-to-child transmission of <strong>HIV</strong>. Whilethere is debate about the toxicity of antiretroviral drugs <strong>and</strong> the effects they mayhave on the course of <strong>HIV</strong> infection in the mother, the evidence available today is thatthe benefits largely outweigh any risks linked to their use.Several developing countries have recently set up pilot projects to help <strong>HIV</strong>-infectedwomen give birth to healthy children, <strong>and</strong> are actively tackling some of the challengesinvolved. These experiences will also identify how to overcome the hurdles toimplementing prevention programmes on a large scale in developing countries.The first hurdle to be overcome is the lack of awareness that <strong>HIV</strong> can be transmittedfrom an infected mother to her child <strong>and</strong> that measures exist to reduce the risk oftransmission. This means that counselling staff at antenatal clinics have to spend timeexplaining the options to their clients be<strong>for</strong>e offering them the possibility of beingtested <strong>for</strong> <strong>HIV</strong>. Finding enough time <strong>for</strong> this kind of counselling is difficult in busy clinicsettings. But this problem can be overcome: in Botswana, <strong>for</strong> example, a large in<strong>for</strong>mationcampaign was launched to ensure that women were aware of the possibilities<strong>for</strong> preventing transmission from mothers to infants be<strong>for</strong>e attending a clinic, thusdecreasing the amount of counselling time needed to relay basic in<strong>for</strong>mation.A second challenge is women’s reluctance to be tested <strong>for</strong> <strong>HIV</strong> infection. This reluctancemay be driven in part by their fear of stigma <strong>and</strong> in part by fear that they willnot get the social or medical <strong>support</strong> they need if they are found to be infected.When testing is offered, women show their reluctance in two ways: either they refuseto be tested, or they agree to be tested but do not come back <strong>for</strong> the test results.Nevertheless, the initial uptake of <strong>HIV</strong> testing is already relatively high, <strong>with</strong> rates of46% in Botswana, 80% in Côte d’Ivoire <strong>and</strong> 92% in South Africa. While no data areavailable from Botswana on the proportion of women who returned <strong>for</strong> their testresults, in Côte d’Ivoire <strong>and</strong> South Africa most <strong>HIV</strong>-infected women (60% <strong>and</strong> 92%,respectively) did so. The willingness to be tested increased in parallel <strong>with</strong> awareness<strong>with</strong>in the general population that <strong>HIV</strong> infection in infants can be prevented. Itshould not be overlooked that knowing one’s <strong>HIV</strong> status benefits not only <strong>HIV</strong>infectedwomen <strong>and</strong> their infants, but also, <strong>and</strong> perhaps more importantly, thewomen who turn out to be <strong>HIV</strong>-negative, who may be better enabled to remainuninfected.82