Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000Some of these difficulties are being overcome. Studies in Thailand in early 1998showed that a relatively simple drug regimen – a short one-month course of the antiretroviraldrug zidovudine (AZT) – given to HIV-infected mothers late in pregnancycould halve the rate of HIV transmission to their infants so long as the women alsoavoided breastfeeding. In Côte d’Ivoire and 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 inUganda showed that similar results could be achieved by giving nevirapine to themother at the onset of labour and then to the infant after delivery. This regimen costsabout US$ 4 per HIV-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 for decreasing mother-to-child transmission of HIV. Whilethere is debate about the toxicity of antiretroviral drugs and the effects they mayhave on the course of HIV 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 HIV-infectedwomen give birth to healthy children, and 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 HIV can be transmittedfrom an infected mother to her child and 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 before offering them the possibility of beingtested for HIV. Finding enough time for this kind of counselling is difficult in busy clinicsettings. But this problem can be overcome: in Botswana, for example, a large informationcampaign was launched to ensure that women were aware of the possibilitiesfor preventing transmission from mothers to infants before attending a clinic, thusdecreasing the amount of counselling time needed to relay basic information.A second challenge is women’s reluctance to be tested for HIV infection. This reluctancemay be driven in part by their fear of stigma and in part by fear that they willnot get the social or medical support 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 for the test results.Nevertheless, the initial uptake of HIV testing is already relatively high, with rates of46% in Botswana, 80% in Côte d’Ivoire and 92% in South Africa. While no data areavailable from Botswana on the proportion of women who returned for their testresults, in Côte d’Ivoire and South Africa most HIV-infected women (60% and 92%,respectively) did so. The willingness to be tested increased in parallel with awarenesswithin the general population that HIV infection in infants can be prevented. Itshould not be overlooked that knowing one’s HIV status benefits not only HIVinfectedwomen and their infants, but also, and perhaps more importantly, thewomen who turn out to be HIV-negative, who may be better enabled to remainuninfected.82