Prevention of mother to child transmission – PMTCT

Between 21.4–25.7 million adults live with HIV in Sub-Saharan Africa. 87% of HIV-positive children of the world also live in Sub-Saharan Africa. Many of these innocent children get the disease from their mothers who are affected by HIV. In 20-40 % of cases, transmission occurs in-utero during pregnancy, either before or after delivery. Presence of other sexually transmitted diseases, anemia, high viral load or low CD4 count can enhance the risk of transmission. Transmission also occurs through breast milk in 10-17 % of cases. As breast feeding is done regularly, this risk increases. PMTCT technically implies the measures to prevent transmission of human immune deficiency (HIV) virus from a pregnant woman to her child. The first step involved in this includes testing pregnant women for HIV. Pregnant women unsure of their status should be tested for HIV. If seropositive, their CD4 count is measured to know the immunological status. In case of low CD4 count, triple therapy (using 3 anti retroviral drugs) is started immediately. If it is good enough, ARV is started from 28th week of pregnancy, to prevent transmission of HIV virus from mother to child and a single drug may be used. Doing a caesarean section to deliver the baby prevents the prolonged rupture of membranes which increases risk of transmission. This strategy has been shown to be very effective in preventing the transmission by up to 30%, as shown by various studies. Regarding breast feeding, it must be discouraged. This may be difficult for many poor women because of high cost of formula, lack of good hygiene in preparing formula feeds enhancing risk of diarrhea and other illness, and fear of disclosure of HIV-positive status by not breast feeding. The World Health Organization recommends that when bottle feeding is feasible, affordable, sustainable and safe, breast feeding should not be done. If bottle feeding proves difficult, it can be carried out for the first three months, after which time the infant must be weaned as soon as possible. Continuing ARV after delivery where breast feeding is unavoidable reduces risk of transmission of the virus to the breast-fed infant. Also if the baby is given ARV while suckling, chances of acquiring the infection become less. That is the technical aspect of PMTCT, but it does not end there. It also includes care of the pregnant mother, improving her nutritional status and taking care of other infections. Even if there is no transmission of the virus to the infant, he will be orphaned if his parents die of AIDS-related illness. This poses another huge set of risk factors for the child as dangerous as HIV itself. There are social, economic and gender barriers which prevent optimum utilization of the PMTCT services. Denial of HIV infection is a major factor. Many people who test positive refuse to believe the results. In many cases men in particular do not want to be tested and also prevent their wives from doing the same. In known cases, husbands sometimes even prevent their wives to come for ARV services. Not coming back after testing seropositive for further management, or giving birth at home also deprives one of the benefits of PMTCT services. Fear of disclosure of HIV status is yet another factor which prevents women from making use of this service. They come to seek these services only when very sick, and by that time it is often too late. Poverty is also a huge reason for underutilization of this or any other health promoting programme. In a family where there is struggle for daily bread, health of the women and children are automatically not the top priorities. However, there is increasing awareness among people of the need for extra care for pregnant HIV-positive people. Today more women than men are seen attending ARV clinics, particularly when pregnant. It is high time that the stigma attached to HIV is removed from peoples’ minds. It should be considered a disease like any other serious disease, such as cancer or diabetes. Then not only will these services be utilized fully, but incidence of HIV on the whole will be reduced. One can very well see the future after optimum use of PMTCT – If all HIV-positive women take preventive measures to avoid passing infection to their off spring, there would be far fewer HIV-positive children. If these children grow up as sensible, disciplined adults learning from their parent’s or parents’ examples and avoiding risks of HIV exposure, the spread of HIV could be greatly reduced. E-mail – rachna212002@yahoo.co.uk