By Abdallah el-Kurebe
Mother-to-child transmission (MTCT) of HIV infection is defined as the transmission of HIV from an infected mother to her child during gestation, labour, or post-partum through breastfeeding.
Available reports say up to 90% of all infants and children with HIV are infected through vertical transmission and there has not been interventions to prevent the transmission. As a result, between 15-45% of infants will be infected with the virus, and currently more than half of these infants who do not receive treatment die before their second birthday.
UNAIDS 2010 report says that the transmission of HIV from mothers to their infants contributes substantially to global morbidity and mortality for children under-5 years of age. Approximately 1,000 HIV-infected infants are born every day, mostly in sub-Saharan Africa, amounting to nearly 370,000 new paediatric infections annually.
UNICEF says that in 2011, about 900 children were newly infected with HIV per day, over 90% occurring in Sub-Saharan Africa.
Some key interventions that have been used to reduce mother-to-child HIV transmission from 35% to <5% include Routine HIV testing and counselling of all pregnant women; provision of antiretroviral drugs (ARVs) to all HIV-positive women during pregnancy, birth, and after delivery; preventive therapy with ARVs for infants born to HIV-positive mothers and safe infant feeding to minimize transmission.
These interventions have reduced mother-to-child transmission in the United States to <1% (CDC, 2007); in Botswana to 3.6% (Tlale J, 2008) and in South Africa to 3.5% (MRC South Africa, 2011) in infants 4-8 weeks of age.
New York was once the highest reported number of children with AIDS. A sero-prevalence study in 1990 demonstrated that 1,898 HIV¬-positive women gave birth in New York State (NYS), with an estimated 475 to 760 (25 percent – 40 percent transmission rate) of their infants infected through MTCT. Twenty years later, in 2010, fewer than 500 HIV¬-positive women gave birth in NYS, with three (0.7 percent; actual rate) of their infants infected.
Among the strategies that NY used were ascertainment of HIV status by all women of childbearing age know their HIV status; provision of access to HIV prevention and preconception health information, messages and supplies (e.g., male and female condoms, sterile injection equipment, formula for HIV-exposed infants); recruitment, engagement and retention of all pregnant women in prenatal and primary care, and HIV-positive pregnant and postpartum women in HIV care as well; engagement and retention of HIV-exposed and HIV-positive children in HIV care; identifying and addressing the barriers that may lead to limited or no care for women and children.
Other strategies were heightening the focus on prenatally-infected young people to address their unique needs; involvement of both behaviourally and prenatally-infected young people in primary and secondary activities for the prevention of HIV and other sexually transmitted infections; educating women and their families regarding the stigma and discrimination that may surround an HIV-positive diagnosis; and providing counselling and support.
According to UNAIDS, Report on the Global Epidemic, 2012 and UNAIDS, Together We Will End AIDS, 2012, In 2011, globally there are 330,000 children newly infected with HIV and there are approximately 1.5 million pregnant women living with HIV. Out of these, only 26% of children in need started antiretroviral treatment.
Use of unorthodox methods
These strategies are working out tremendously. Prevention of mother-to-child HIV transmission (PMTCT) are being accomplished by effective, accessible, and scalable interventions within existing maternal and child health services. But in order to further assert efforts to prevent this needless transmission of HIV to infants, a number of other 'unthought-after' effective interventions could be introduced. These include tradition and religion. other methods including the application of traditional and religious belief systems, should be employed in order to save the innocent child from dying.
In the African continent, most decisions, opinions and actions are shaped by either or both tradition and religion. For example, it is often said that Nigeria, which is in Africa, is the most religious country. People in this part of the world tend to listen more to their 'spiritual fathers' than even their parents.
Today, the elimination of polio in Nigeria is successfully being achieved through the involvement of traditional rulers, religious leaders and other opinion moulders. And, because of the place of the traditional institution in Nigeria, the polio scourge has greatly been tackled to appreciable level.
CDC's four prongs aimed at prevention of mother-to-child-transmission of HIV are good steps towards eliminating MTCT. The prongs: Prevent new HIV infections among women of reproductive age; Prevent unwanted pregnancies among women living with HIV/AIDS; Prevent HIV transmission from women living with HIV/AIDS to their infants using ARV prophylaxis and Provide appropriate treatment, support and care to mothers living with HIV/AIDS, their children, partners and families and all important.
However, the first prong, which “activities will focus on behaviour change through training religious leaders, teachers and other key influential members of the community to become advocates of HIV prevention,” to me, is more appealing especially as the “specific project sites will also benefit from Income Generating Activities (IGAs) programs directed towards empowering women, such as the future launch of a local-led bakery in Ruhiira, Uganda.”
Therefore, employing the 'Nigerian polio' eradication methods (where traditional and religious leaders have been engaged) for the elimination of MTCT will help tremendously.