Molly Ferguson: Preventing HIV Transmission from Mother-to-Child

Mother-to-child transmission of HIV is a significant and preventable public health problem in sub-Saharan Africa. HIV can be passed from a mother to her child during pregnancy, delivery, or breastfeeding. In 2008, about 90% of new HIV infections in children occurred in Africa, mainly through mother-to-child transmission. In some areas of southern Africa, 30% or more of pregnant women are HIV positive. Without treatment, 25-30% of babies born to HIV positive women will become infected through mother-to-child transmission.

430,000 African children under the age of 15 contracted HIV through mother-to-child transmission during 2008. This is particularly astounding because of the distinct disparity between the rates of mother-to-child transmission in African nations versus high-income countries throughout the world. In the United States, HIV is transmitted from a mother to her baby in 100-200 out of the 40 million US births per year. In Tanzania, it is estimated that mother-to-child transmission occurs in up to 7 out of every 100 children. HIV transmission from mothers to their children has been all by eliminated in the United States and other wealthy nations as a result of access to antiretroviral therapy, early detection and testing practices, and widely available access to safe breast-milk substitutes. These prevention strategies are fairly simple and low-cost, and are effective methods of preventing the spread of HIV from mothers to their babies.

There are several ways to prevent mother-to-child HIV transmission. First and foremost, there is a need for widespread availability of HIV testing for potential parents and other adults. In addition, it is important to address the stigma attached to testing positive for HIV infection, and substantial work is needed to understand the barriers that lead to discrimination associated with being HIV positive. Contraception also plays an important role in mother-to-child HIV transmission because of its ability to protect HIV-positive women from unintended pregnancies. Another effective method is the use of antiretroviral drug therapy. For HIV positive women who become pregnant, increased availability of and access to antiretroviral drugs and other preventive measures is a safe and effective way to prevent the spread of HIV from a mother to her baby. Last but not least, comprehensive counseling, education, and support are needed for HIV positive women and their families before, during, and after pregnancy.

Women in Tanzania often rely on their husbands financially, and are thereby at an increased vulnerability to financial difficulty if they are diagnosed as HIV-positive. Many women in Tanzania have found support through organizations including the Mother-to-Child Transmission of HIV/AIDS program, which has been piloted by the Tanzanian Government and UNICEF. Despite the existence of such programs, many HIV positive women do not utilize the services due to perceived stigma, rejection, and denial from husbands on whom they are financially dependent. As a result, the promotion and supply of contraceptive resources for use among women is a strong prevention strategy because it prevents almost 30% more HIV-positive births than antiretroviral therapy for the same cost.

Photo credit: USAID Africa Bureau Photo Library.  A child health nurse consults with a mother at a maternal child health clinic in Iringa, Tanzania.

Molly Ferguson has a Masters in Public Health and conducts research on evidence-based practice at Northwestern University.