PETRA: Module 1, Chapter 4

Vertical Transmission of HIV from Parent to Child

The terms used to describe HIV transmission from parents to their children include

Mother-to Child-Transmission (MTCT)
Parent-to-Child-Transmission (PTCT)
Vertical Transmission

HIV can be transmitted from an infected mother to her child during pregnancy, during labor and delivery, or through breastfeeding. Without intervention, such as antiretroviral therapy, the percentage of infected women’s children who are not breastfed and who become HIV+ ranges between 15% and 30%. Among children who are breastfed by HIV+ mothers, the percentage that becomes HIV+ increases to 25-45% (4). In other words, breastfeeding increases the chances of HIV transmission from an HIV+ mother to her child.

Worldwide Vertical Transmission Rates

Vertical transmission of HIV has been virtually eliminated in the developed world. But rates remain high in resource-constrained countries, particularly sub-Saharan African countries, where the vast majority of HIV-infected women of childbearing age reside. These high rates are largely due to these women’s lack of access to existing prevention interventions, including voluntary counseling and testing (VCT), replacement feeding (that is, using formula instead of breast milk), selective Caesarean section (which reduces the chances of HIV transmission by eliminating labor and delivery), and antiretroviral drug therapy (5).

Human Rights Issues for Women Relating to Parent-to-Child Transmission

Most young children with HIV/AIDS acquire the virus through their mothers. The main reason to test women for HIV during pregnancy or childbirth is to prevent transmission from mother to child by using antiretroviral therapy. However, it is often the case that with the focus so intently on the child, the mothers receive far from adequate or appropriate care. In many cases, no one explains to the mothers why they are being tested for HIV, and no one gives them information after the test (1). Women who are found to have HIV are sometimes stripped of their rights by being coerced into abortion or sterilization (1).

Informed consent for testing during pregnancy, for the HIV prevention intervention itself, and for termination or continuation of the pregnancy
Provision of adequate pre-test counseling and pre-intervention counseling
Counseling on how to feed their infants, so as not to increase the risk of transmitting HIV
Provision of breast milk substitutes
Provision of money for fuel, water, and other resources necessary for supporting a family
Contraceptive and family planning advice
Provision of care and treatment, apart from the intervention to prevent transmission to the baby (among other reasons to ensure adequate care and treatment for the mother is that the baby’s chances at survival are greatly diminished if the mother dies)
Protection of confidentiality
Access to legal provisions, health service practices, and community/NGO support
Consideration of the potential adverse effects of taking antiretroviral therapy

References:
GENDER-AIDS eForum 2003. Women “often blamed” for virus. AEGiS Digest Volume 1159, Number 7, http://www.aegis.org/news/bp/2003/BP031003.html, October 10 2003.

2. Feinstein, N. & Prentice, B. The UNAIDS Gender and AIDS Almanac. Fact Sheet: The Female Condom. Los Altos, CA: Sociometrics Corporation, 2001.

3. World Health Organization (WHO). New data on the prevention of mother-to-child transmission of HIV and their policy implications: conclusions and recommendations. WHO Technical Consultation on behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on Mother-to-Child Transmission of HIV. Geneva, Switzerland: WHO, 2001.

4. Joint United Nations Programme on AIDS (UNAIDS). Children and young people in a world of AIDS. Geneva, Switzerland: UNAIDS, 2001

5. Family Health International (FHI). Reducing Mother-to-Child Transmission (MTCT) of HIV. Retrieved on December 3, 2003 from http://www.fhi.org/en/HIVAIDS/FactSheets/reducingmtct.htm.

6. World Health Organization (WHO). Human Rights, Women and HIV/AIDS. (Fact Sheet No. 247). Geneva, Switzerland: World Health Organization, 2000. (Fact sheet can be found on the web at: http://www.who.int/inf-fs/en/fact247.html.)