GABORONE, 28 August: The southern African country of Botswana has reduced the rate of HIV transmission rate from mother to child to less than 4 percent, providing fresh evidence that several hundred thousand babies in the developing world can be saved annually from acquiring the deadly virus.
The success in Botswana recorded this year is due to political support and several policy decisions, including the testing of all pregnant women for HIV unless they refuse; providing HIV test results in 20 minutes to the expectant mothers; and for those woman who are HIV-positive, giving dual drug treatment – four weeks of AZT, and then a single dose of nevirapine at birth to mother and child.
It represents the first time that a developing country with a high prevalence of HIV has lowered transmission rates to levels approaching those in rich nations.
In the US and Europe fewer than 2 percent of babies born to HIV-positive pregnant women have the virus. Parts of Thailand and the Western Cape Province in South Africa also have recorded extremely low HIV transmission rates.
The challenge for Botswana is especially pressing: 34 percent of its pregnant women, roughly 14.000 people, are HIV-positive.
Ambassador Mark R. Dybul, the US global AIDS coordinator, said Botswanas results were “extremely impressive. That’s getting down to what we have be able to do in the United States and Europe. It ss a great model of how you can do it” in Africa.
The US government is encouraging other countries to adopt parts of the Botswana model; already, Cameroon, Kenya, and Zambia, among others, have started testing all pregnant women for HIV, unless the women specifically decline the test.
With no interventions, the risk for an HIV-positive woman to pass on the virus to her baby is 30 to 35 percent. With a single dose of nevirapine, that risk is cut roughly in half.
In the cases where a mother passes HIV to her child, roughly two-thirds occur during birth and one-third during breast-feeding. Botswana provides free infant formula for one year in hopes of lessening HIV transmission, but many specialists argue that HIV-positive mothers should breast-feed because mother’s milk protects babies from a host of infectious diseases.
On the basic question of protecting children at birth, though, there is no debate about the lack of services. UNICEF estimates that just 11 percent of HIV-infected pregnant women have access to medicine that would prevent the transmission of the virus.
Worldwide, roughly 500.000 babies annually contract the virus from their mother – the vast majority in Africa – totaling 12 percent of the new HIV infections last year, according to UNAIDS.
A 2006 study in the KwaZulu-Natal province of South Africa, a nation that boasts the strongest economy in sub-Saharan Africa, found a 20,6 percent HIV transmission rate from mother to child. Researchers blamed the high transmission rate on low rates of HIV testing and poor prevention and support services for pregnant women.
Dr. Catherine M. Wilfert, scientific director of the Elizabeth Glaser Pediatric AIDS Foundations prevention of mother-to-child transmission program, said one major reason for the difference between Botswana and KwaZulu-Natal is that Botswanas government made stopping HIV transmission at birth a priority and the South African province did not.
– Botswana has had the political will to roll out a national program, said Wilfert, whose organization supports programs stopping HIV transmission from mother to child in 17 countries, which does not include Botswana.
– There are not many African nations that have done likewise, concluded she.
Kilde: The Push Journal
