A Mother's Fight

More than 900 children are infected with HIV every day. We can reduce the risk of mother-to-child transmission of HIV drastically by providing counseling, testing and access to treatment services and medicines for expectant mothers.

Testing is a key component of HIV prevention, and testing pregnant women is one of the most effective ways to reduce mother-to-child transmission of HIV. If a woman finds out she is HIV-positive, she can begin treatment that can reduce the risk of passing HIV to her baby to less than two percent.

The Foundation works to ensure that more pregnant women promptly receive the treatments they need by improving the availability of HIV testing and counseling during pregnancy, as well as CD4 testing to determine treatment eligibility and assess women’s overall health status.

Over the past 15 years, an estimated 350,000 new HIV infections have been averted through prenatal treatment and the use of antiretroviral drugs. Expanding this program can help prevent infections and ensure that mothers and their children can lead healthy lives.

High-quality treatment and prevention regimens for pregnant women living with HIV drastically reduce the risk of mother-to-child transmission. In accordance with the World Health Organization’s 2010 recommendations for antiretroviral therapy (ART) for HIV-positive individuals, the Foundation supports:

• Treating HIV-positive pregnant women earlier to decrease maternal death and disease, and mother-to-child transmission of HIV;
• Enhancing services for HIV-positive pregnant women not receiving ART to help prevent mother-to-child transmission of HIV;
• Administering antiretroviral (ARV) drugs to HIV-exposed infants after delivery to help protect them from HIV infection, particularly during the breastfeeding period.

Many women in sub-Saharan Africa and other parts of the world lack access to a health care facility. Without access to facilities, too many women give birth at home, adding potential risk to both mother and baby. Having the option of giving birth in a facility can protect new mothers and their infants by providing supplies and services to ensure a healthy delivery.

The Foundation strives to ensure that pregnant women have access to a full package of services, including prenatal care, HIV prevention counseling, screening and treatment for sexually-transmitted infections, family planning, nutrition support, and malaria prevention. Health worker training and infrastructure improvements are also part of the Foundation’s work to improve the quality of prenatal care and to encourage clients to continue accessing services.

The Foundation also promotes healthy pregnancies and safe deliveries by working to increase the number of women who delivery in a health care facility. This includes:

• Strengthening referral networks and promoting facility-based delivery;
• Working to reach more people in under-served populations;
• and providing supplies (including plastic sheeting, disinfectants and gloves) to ensure safe delivery at maternity units.

HIV-infected infants need special attention. With a higher susceptibility to infections, the first few months of a child's life are especially fragile. HIV treatment is a life-long commitment. For the more than 2.5 million children living with HIV, access to treatment and doctor care is critical.

Routine health care should be provided for all children. Such care should include assessment of child growth, nutrition, development and mental health; immunizations; evaluation and management of illnesses; guidance for the prevention of injury and disease; dental referrals; and screening for hearing and vision.

In addition to routine care, HIV-positive infants and children, and children born to undiagnosed HIV-positive mothers, require additional assessments and treatment for health support. HIV is a chronic disease that requires regular and careful monitoring. Families affected by HIV need ongoing counseling, support, and referrals for health and community services to meet ever-changing health needs.

Mothers also require critical routine health support following childbirth and throughout their lives. Follow-up care for mothers should include postpartum care, infant feeding counseling, and family planning counseling, along with many other general health topics. As Teleza in Malawi says, “To be HIV-positive is not the end of a life. All you have to do is get educated, follow the rules, and take care of yourself. That way, you can take care of your family.”

All over the world, breastfeeding is the primary method for mothers to nurture their newborns. Yet for HIV-positive mothers, precautions need to be taken to ensure that their children continue to be protected from infection. Continued ARV treatment coupled with exclusive breastfeeding (no other foods or liquids, including water) can protect infants from birth onward.

In resource-limited settings, an infant who is fed with formula or with breast milk substitutes often faces greater health risks than an infant who is exclusively breastfed, even if the child's mother is HIV-positive.

Breastfeeding, especially early and exclusive breastfeeding, is one of the most valuable interventions for improving child survival. Exclusive breastfeeding for the first six months of life and continued breastfeeding for up to 18 months is the single most effective preventive child survival intervention. The dilemma has been to balance the risk of infants acquiring HIV through breastfeeding with the risk of death from causes other than HIV, in particular malnutrition, diarrhea and pneumonia among non-breastfed infants.

The Foundation aims to prevent mother-to-child transmission of HIV caused by breastfeeding and to promote the healthy, HIV-free survival of all children born to HIV-positive mothers. Providing ARVs to a mother or child during breastfeeding can help reduce the risk of mother-to-child transmission of HIV. Continued counseling and education along with community support are critical for both mothers and infants throughout their lives.

The responsibility of preventing mother-to-child transmission of HIV during pregnancy and childbirth does not end when an infant is born. To achieve the Foundation's mission of eliminating pediatric AIDS, all of our programs must strive to ensure that infants who are uninfected at birth remain uninfected, and that infants with HIV survive and grow into healthy children. Promoting and supporting optimal infant and young child feeding (IYCF) practices is necessary to achieve this goal.

Fighting pediatric AIDS starts with an accurate diagnosis. By providing testing options for children of HIV-positive mothers, we can catch infections early and start children on treatments that will keep them healthy well into adulthood.

Accurately diagnosing HIV in infants and children is a major challenge. Children who are infected with the virus - before birth, at birth, or during breastfeeding - may not initially exhibit any symptoms of HIV infection or AIDS.

HIV can be diagnosed in adults by testing blood for antibodies to HIV. In children, however, an antibody test is not effective, because a mother's maternal antibodies are passed to her child as a natural means of protection while the infant is developing its own immune system. As a result, antibody tests for infants may yield false positive results for up to 18 months.

Without diagnosis and treatment, 50 percent of HIV-infected infants will die before their second birthdays. But if a baby receives prophylactic antibiotics soon after birth and antiretroviral therapy (ART) as soon as is medically indicated, he/she has a good chance of surviving childhood and living a long, healthy life.

The test used to diagnose babies born to HIV-positive mothers in developed countries, Polymerase Chain Reaction (PCR), tests directly for HIV DNA rather than the HIV antibody. It requires sophisticated, expensive equipment not available in rural settings. Traditionally, the test requires a liquid blood sample, which if taken in a rural area and transported to a testing facility, needs to be kept refrigerated.

However, a new technology has emerged that allows PCR to be performed on small spots of dried blood. The Dried Blood Spots (DBS) are easy to prepare in a resource-limited setting and can be stored and shipped to testing facilities without refrigeration.

The introduction of early infant diagnosis innovations is an important step in the fight against pediatric HIV/AIDS. By identifying infants who need services as early as possible, these children will have a better chance of maturing into healthy adults.

Fighting pediatric AIDS, a disease which affects more than 2.5 million children worldwide, requires intensive treatment with lifesaving medications. For children who begin the process early, the survival rates are promising. We need to ensure that children have ongoing access to the medicines that will allow them to thrive.

There is no cure for HIV infection. However, early infant diagnosis is critical in helping HIV-positive children lead longer, healthier lives through antiretroviral therapy (ART). Taken every day, these medicines can drastically reduce the amount of HIV in the bloodstream and allow the body to fight off other infections, thereby dramatically slowing the progression of the virus. Sadly, most children still do not have access to these lifesaving medications.

In addition to ART, a number of other proven interventions support the health and well being of children living with and affected by HIV. These include a range of age-appropriate interventions that cater to children's specific needs, such as counseling and peer support activities, appropriate infant and young child feeding practices, care and prevention of opportunistic infections, and educational assistance.