Global Strategies for Mother-to-Child HIV Transmission Prevention

Women and children account for over half of those living with HIV throughout the world. Despite the growing list of HIV prevention methods (condoms, needle exchange, treatment of sexually transmitted diseases, use of maternal anti-HIV therapy, elective C-section, etc.), the number of HIV-infected women and children continues to rise dramatically. The Second International Conference on Global Strategies for the Prevention of HIV Transmission from Mother to Infants, held in September 1999 in Montreal, Canada, asked why -- given the many advances in HIV prevention and treatment -- women and children suffer from the greatest disparities in this epidemic.

The Conference emphasized scientific, social, ethical, political and economic issues affecting HIV transmission and treatment. It highlighted areas where HIV knowledge is adequate or growing, but its benefits are unevenly felt. Perhaps nothing encapsulates this quandary more than the growing number of HIV-positive children that comprise the mounting "orphan crisis."

In addition to the focus on simpler, more cost-effective treatments for preventing mother-to-child HIV transmission, considerable attention focused on the risks and benefits of breast-feeding. While it's discouraged in the United States due to risk of transmitting HIV, breast-feeding provides nutritional, economical and cultural advantages in developing nations.

The nutritional and immune benefits breast-feeding provides infants are well-known and persist in the presence of HIV infection. Breast-feeding is also an inexpensive source of infant food and is socially and culturally expected in many settings. Given these issues, new approaches that prevent transmission during breast-feeding are needed.

Proposals for HIV prevention during breast-feeding were discussed at length, including the need to:

• better understand the timing of HIV infection through breast-feeding and related risk factors;

• bolster the nutritional health of the mother;

• optimize use of anti-HIV therapy during breast-feeding;

• treat breast lesions and other maternal illnesses; and

• monitor and treat oral lesions in the infant.

Advances in these areas would help HIV-positive women make more informed decisions around breast-feeding infants, particularly where alternatives to breast-feeding are sparse.

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