Thousands of babies are still being infected with HIV by mothers
Kerry Cullinan - Health-e
2007-06-11
Shocking figures about HIV infection in babies and high AIDS-related child mortality have made the transmission of HIV from mothers to babies a key focus of third South African AIDS conference.
South Africa
has had a prevention of mother-to-child
HIV transmission
(PMTCT) programme since 2003, yet it is only reaching an estimated one-sixth of
pregnant, HIV positive women.
This
means that thousands of babies are being infected each year as at least one in
three pregnant women nationally was HIV positive by 2005 and around a third of
HIV positive mothers transmit HIV to their babies.
"
South Africa
is one of only nine countries in the world where the child mortality rate is
increasing instead of decreasing, mainly as a result of HIV-related
deaths," revealed Professor Nigel Rollins, head of the Centre for Maternal
and child health at the
University
of
KwaZulu-Natal
.
"In
KwaZulu-Natal
alone, 20 000 to 30 000 children are being infected with HIV each year and half
of them will need antiretroviral drugs by the age of 12 months.
"There
is no way that the health system will be able to meet the treatment and care
demand for these children if this infection rate continues," Rollins told a
session convened by the United Nations children's organisation, Unicef.
The
health system is already failing to treat HIV positive children. By last year,
only 21 000 children were getting ARVs out of an estimated 123 000 children who
needed the medicine, according to Farai Dube from Enhancing Children's HIV
Outcomes.
Over
six out of 10 children under the age of five who died in
Durban
last year showed clinical signs of HIV infection, yet "the vast
majority" did not have access to PMTCT or ARV treatment, according to Dr
Kimesh Naidoo of
King
Edward
Hospital
.
The
new National HIV/AIDS Strategic Plan aims to reduce the rate of mother to child
transmission to 5% by 2011.
To
do so, government needed to prioritise pregnant women with a low CD4 count
(measure of immunity in the blood) who were most likely to transmit HIV to their
babies, said Rollins.
These
women should be treated with at least two antiretroviral drugs to reduce their
infectiousness and ensure that they were well enough to look after to look their
babies, he added.
At
present, the PMTCT programme gives one dose of nevirapine to women when they are
in labour and to their babies within 72 hours of birth.
"We
will never cut the transmission rate to 5% with one dose of nevirapine.
In
the
US
and
Europe
, mother-to-child transmission has been reduced to around 2% with the use of two
to three antiretroviral drugs," said Dr Francois Venter, head of the SA HIV
Clinicians' Society.
"If
we fix PMTCT, we don't have to expand child HIV treatment."
A
wide range of conference delegates pleaded for government to change the way that
PMTCT was being implemented to reach more women. Among the proposals put forward
were that:
*
PMTCT should be integrated into antenatal clinics and run by midwives and nurses
instead of being a stand-alone programme run mainly by lay counsellors.
*
All antenatal clinics and hospitals should stock nevirapine.
*
Clinic staff should be involved in developing locally appropriate messages to
encourage women to have HIV tests.
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