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[procaare] Mother to child transmission - summary from meetings

  • From: ProCAARE <procaare@usa.healthnet.org>
  • Date: Tue, 26 Nov 2002 10:33:00 -0500 (EST)

Mother to child transmission - summary from meetings
-[AFRO-NETS] (11.16.02)

Summarised from the report of The African Regional Meeting on Pilot Projects for the
Prevention of Mother-to-Child Transmission of HIV in Gaborone, Botswana, March

To obtain a copy of the report go to the UNAIDS website at:

The HIV/AIDS epidemic is resulting in more than 600,000 infants be-coming infected each
year, and in many countries the epidemic has be-come a major cause of infant and young
child mortality. From a human rights perspective, governments and UN agencies have an
obligation to support action to prevent infants from becoming infected.

It has become clear from the increasing scientific evidence and re-cent results from
countries such as Botswana, Côte d'Ivoire, Uganda, Rwanda and Zimbabwe, that it is
possible to make a difference. There is an urgent need for more countries to start
implementing PMTCT interventions on a national scale in order to have a meaningful impact.

It is not necessary to wait for everything to be in place, but countries should build on
what is already on the ground. Community consultation and participation is important. It
is important to involve PLWAs. VCT is the cornerstone of MTCT.

Counsellors should be well trained, supervised and supported. Health workers need
training on infant feeding. Mothers need support and follow-up, especially with respect
to infant feeding. Studies and interventions are needed on the psychosocial care of
people with HIV and their families. MTCT should be integrated into routine health care

These considerations can serve as a checklist for countries that are planning to initiate
or expand projects. The summary of conclusions and recommendations included:

Countries should be supported in accelerating implementation of PMTCT programmes. Clearer
advice and support of infant feeding options should be given to HIV-infected women.
Programmes should ensure political commitment and create demand for VCT/PMTCT at the
community level. Access to VCT should be expanded rapidly. Efforts should be made to
streamline testing and to maintain quality control. Countries need continual guidance in
the provision of ARVs for PMTCT.

Countries should ensure that in PMTCT programmes, HIV-infected mothers have access to the
best available care. Reliability of the provision of drugs, test kits and breast-milk
substitutes should be improved. PMTCT implementation needs to be monitored and documented
so that lessons can be learned and experiences shared to ensure more effective scaling-up.

While governments have the primary obligation to monitor their programmes, UN agencies
also have a responsibility for adequate funding and technical support during the
development and early implementation phase.

In the year 2000 alone, approximately 600,000 children worldwide acquired HIV. Over 90% of
these children were born to mothers in Africa who in the first place did not know their

In the absence of any intervention to reduce mother to child trans- mission, 25-40% of HIV
infected women in Africa will pass the virus to their babies during pregnancy, at the time
of labour or delivery or after birth through breastfeeding.

A number of governments in collaboration with the Inter Agency Task Team on the prevention
of MTCT and other partners are undertaking pilot programmes to assess the feasibility of
integrating PMTCT interventions in routine antenatal services. Many lessons have been
learned, particularly about the capacity of health care systems to deliver the services.
But it is sad to note that while most women accept to undergo the HIV test, significantly
lower percentages (less than 50% in Cote d'Ivoire, for example) return to collect their

The limited or complete lack of knowledge about mother to child transmission of HIV of the
majority of participants, including SWAA members is highlighted. The fear, denial and
stigma, which still surrounds HIV/AIDS within communities. The marginalisation of male
involvement in PMTCT interventions at the levels of health service delivery and

Inadequate or lack of proper communication strategies between service providers and
clients. Marginalisation of the mothers. HIV positive mothers may be victimised as a
result of the intervention's apparent lack of emphasis on the possible role of men in the
mother to child transmission of HIV.

There is a need to develop locally appropriate and culturally sensitive PMTCT
communication strategies that address denial, stigma, fear, gender roles and
victimisation. The development of such strategies should have the active participation of
all stakeholders in the community, particularly the men, partners of women living with
HIV/AIDS, community leaders and NGOs. --

Claudio Schuftan
Email: aviva@netnam.vn

Cross posted: AFRO-NETS: afro-nets-help@usa.healthnet.org
Information and archives: http://www.afronets.org

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