Report on the Global HIV/AIDS epidemic

Opening new doors with counselling and testing

among prevention approaches. As with family planning, no single method will work /p
for all people at all stages of their lives. The more preventive methods available, the /
broader the choice for individuals and couples and the greater the likelihood that all
will find at least one acceptable approach to preventing the spread of HIV.
Preventing mother-to-child transmission of HIV
Since the start of the HIV epidemic, it is estimated that 3.8 million children have died
of AIDS before their 15th birthday, nearly 0.5 million of them in 1999 alone. Another
1.3 million children are currently living with HIV, and most will die before they reach
their teens. The vast majority of these children were born to HIV-infected mothers:
they acquired the virus in the womb, around the time of childbirth or during breastfeeding.
For many years, not enough was known about transmission from mother to child to
take steps to help HIV-infected women have uninfected babies. In the absence of
any intervention, around a third of HIV-positive mothers pass the virus to their newborns. In the late 1990s, it was found that around half of all these infections occur
during breastfeeding.
In recent years, much has been learnt about how to prevent transmission of HIV from
infected mothers to their babies. This knowledge has been applied in high-income.:/
countries, where most HIV-positive pregnant women choose to take antiretroviral
drugs that reduce the risk of transmission and afterwards avoid breastfeeding their
newborn. These two measures, in combination with delivery by caesarean section,
have dramatically decreased mother-to-child transmission of HIV.
The developing world, and especially sub-Saharan Africa, stands to gain even more
from large-scale programmes for reducing mother-to-child transmission because
women have more children and have far higher rates of HIV infection. Over ninetenths of all children worldwide infected before birth or during infancy in 1999 were
born in sub-Saharan Africa. Making HIV counselling and testing services widely
available so that infected women can decide whether to take preventive drugs during pregnancy is a measure that could save the lives of hundreds of thousands of
children while offering broader benefits as well, as discussed on page 78. /
However, the challenges in developing countries are also greater than in the highincome countries. First, higher rates of HIV and of childbearing mean that prevention
programmes have to reach a much larger number of women. Secondly, there are
fewer HIV counselling and testing facilities available. Thirdly, breastfeeding is almost
universal, and safe alternatives to breast milk are harder to come by. Finally, the drug
regimens used in high-income countries for reducing HIV transmission to infants are
too expensive and complicated to be practical for widescale use in poor countries.
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