Conference Summary [Conference on Global Strategies for the Prevention of HIV Transmission from Mothers to Infants (1997)]

* Reducing secondary risk factors could help reduce perinatal HIV
transmission. For example, research has shown that HIV-infected pregnant
women who are infected with other STDs may be more likely to transmit HIV
to their babies. Also, intravenous drug use can also raise the risk of perinatal
transmission. And improved prenatal health care has been shown to reduce
the risk.
* More research is needed to determine exactly when HIV transmission takes
place between mother and infant in order to develop effective intervention
and to administer treatment at the optimal time.
* Criteria for an intervention to work well in the developing world: it must be
cheap, easy to administer (no intravenous), and administered for a limited
time. An ideal intervention would be applicable to breastfeeding and nonbreastfeeding women.
* Certain factors need to be considered in developing HIV transmission
interventions. What is the long-term safety of the intervention, for both the
child and the mother? If a mother has been treated with AZT or other
antiretroviral therapies before she became pregnant, will she have developed
resistance to the therapy?
Primary Prevention of Infection in Women
* The best way to prevent mother-to-infant transmission is to prevent HIV
infection in the woman. In developing countries, there are certain cultural and
societal factors that make a woman more vulnerable to infection:
SHigh-risk behavior of sex partner.
~ Sex partner often transmits other STDs to woman, which makes her
more vulnerable to HIV infection.
= Women often do not have the ability to choose safer sex or to refuse
sex.
= Detrimental cultural practices, such as wife inheritance.
= Sexual abuse.
SLack of employment opportunities and low education level for women.
* Some studies have shown that women with STDs who receive aggressive
treatment for those infections have lower HIV incidence.
* Scientists are doing research to develop an effective microbicide, a
substance that could destroy HIV during sexual transmission. An ideal
microbicide for a woman would interfere with HIV transmission, while at the
same time allowing conception (unlike condoms); would have long duration of
effect, so it would not have to be used immediately before intercourse; would
have no odor or taste so a woman could use it without her partner's
knowledge. To date, microbicides, such as nonoxynol 9, have not proven

effective in clinical trials. Some researchers say using specific antiviral
compounds as topical microbicides should be studied.
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