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Introduction
Globally, UNAIDS estimated that there were approximately 42 million people living with
HIV/AIDS in 2002.2 Of these, 19.2 million were women and 3.2 million were children under
15 years old. In 2002 alone, a total of 5 million people were infected with HIV, with 2 million
women and 800 000 children under 15 years old being infected. Sub-Saharan African is the
region worst affected by HIV/AIDS with 29.4 million people living with HIV/AIDS and 3.5
million new infections in 2002.
South Africa has experienced one of the fastest growing HIV/AIDS epidemics in the world.
It is estimated that 3.2 million women aged between 15-49 years are living with HIV/AIDS in
South Africa. The 2001 National HIV Survey estimated that 24.8% of pregnant women
attending public health facilities were infected with HIV. HIV is transmitted from mother to
child in three distinct ways: during pregnancy, childbirth or during breastfeeding. According
to recent estimates, where there is no prevention of mother-to-child transmission (PMTCT)
intervention, between 25-40% of babies born to HIV-infected mothers will contract HIV
during pregnancy and through breast-feeding. Thus the mother-to-child transmission of HIV
is a major problem particularly in developing countries.
One of the goals of South Africas HIV/AIDS strategic plan is to reduce mother-to-child
transmission of HIV, through implementing clinical guidelines to combat the transmission of
HIV during childbirth and labour and by improving access to HIV testing and counselling in
antenatal clinics. A programme offering a short-course of Nevirapine to HIV-positive
pregnant women was introduced in South Africa in 2000, with two pilot PMTCT sites in each
of the nine provinces. The Nevirapine regimen has been reported to reduce HIV transmission
rates to 12% at 6 weeks post-delivery.
The policy is that antenatal care and the PMTCT programme, including Nevirapine is
provided free of charge in all public health facilities in South Africa. According to the
national PMTCT protocol, HIV- positive pregnant women who are 28 weeks or more in their
gestation period are to be given Nevirapine for self-administration when they go into labour.8
Furthermore, a baby born to an HIV-infected mother should be given a single dose of
Nevirapine within 72 hours of being born. However, for pregnant women to receive the
PMTCT service, they have to undergo HIV counselling and testing. Thus the delivery of
PMTCT services requires a strong and well-functioning health system, space and time for
counselling and testing, HIV test kits, Nevirapine, adequately trained staff, and management
support all need to be available. In addition to health systems-related issues, there are many
individual and community factors that may facilitate or hinder womens access to the PMTCT
service. A recent evaluation of the PMTCT pilot sites identified some sites that required extra
support, particularly relating to improving HIV test uptake rates that were found to be less
than 20%.
Although the immunological and nutritional benefits of breastfeeding are well-recognised, the
knowledge that HIV can be transmitted through breastmilk necessitates that infant feeding
advice highlights both risks and benefits of breast and formula feeding. The World Health
Organization (WHO) recommends that exclusive replacement (formula) feeding be
encouraged in HIV-positive women if it is safe, feasible, acceptable, accessible and
sustainable. Where this is not possible, exclusive breastfeeding should be promoted. In line
with this recommendation, the South African PMTCT programme offers free formula to HIVinfected
women who choose to exclusively formula feed for a period of up to six months. |
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