Preventing Mother-to-Child Transmission of HIV/AIDS in Developed Countries: What You Need to Know

 

Hi, my name is [PRESENTER NAME]. IŐm [PRESENTER ROLE]. Welcome to ŇPreventing Mother-to-Child Transmission of HIV/AIDS in Developed Countries: What You Need to Know.Ó

If a woman is HIV positive and becomes pregnant, there is a risk that her child will contract HIV during the pregnancy, more commonly during childbirth or while breastfeeding. If an HIV positive woman takes no steps to protect her child from HIV and does not breastfeed, there is a 15-30% chance that her child will contract HIV. If she also breastfeeds, the risk of transmission increases to 20-45%.

However, if an HIV positive woman follows her doctorŐs instructions, which will include use of appropriate antiretroviral medications, it is possible to reduce the risk of the child contracting HIV. If you are pregnant or thinking about having a baby, the information in this video could save your childŐs life, so please watch the whole video and listen carefully.

This video is intended for women who are in developed nations such as the United States and Western Europe. Women in these countries who are HIV positive can usually get access to medical treatment they need to decrease mother-to-child transmission of HIV. There is a separate video on this site for women in developing countries who may not have access to health care services or medications.

See a Doctor

If you know you are pregnant or are thinking about having a baby, see a doctor. They can give you health advice that will maximize your chances for a safe pregnancy and a healthy baby whether or not you have HIV.

Get Tested for HIV

The next step to protecting your baby from HIV/AIDS is to get tested and find out if you are HIV positive. You may be HIV positive and not know it. The U.S. Public Health Service recommends that all pregnant women be tested for HIV and even that HIV testing become part of a routine medical check-up.

Even if you are already well along in your pregnancy or nearing delivery, you should still be tested for HIV, if you had not been tested before. The sooner you are tested, the better your chances of protecting your child from HIV, so donŐt delay. You canŐt protect your child if you donŐt know your HIV status.

In most countries this test is available free of charge.

If YouŐre HIV Negative, Stay That Way

If you are pregnant and have tested HIV negative, you can reduce your risk of becoming positive during your pregnancy by staying mutually faithful to one partner or using condoms. Pregnant women need to be just as careful as anyone else to avoid contracting HIV.

If YouŐre HIV Positive, See a Doctor Right Away

If you are HIV positive, do not despair. With modern antiretroviral medications, it is now possible for HIV positive individuals to remain healthy for years, even decades. If you are pregnant and follow your doctorŐs instructions, you can also reduce your childŐs chance of contracting HIV.

The rest of this video will tell you about some of the steps your doctor may recommend to protect your infant if you are pregnant. Remember, different people have different needs, and watching a video is no substitute for seeing a doctor and getting personal advice thatŐs right for you.

Antiretroviral Medications (ARVs)

HIV is a virus. Antiretroviral Medications known as ARVs can interfere with the virusŐs ability to reproduce and infect new cells within your body. Your doctor will suggest using ARVs to protect your baby.

Starting ARVs Immediately

Your doctor may recommend that you start taking antiretroviral medications immediately if you are not already on them. Your doctor is especially likely to recommend this if you are showing symptoms of clinical AIDS, your T cell count (immune cells) is low, or the amount of virus in your body is high. Going on ARVs can improve your own health as well as reducing the chance that your child will contract HIV during pregnancy, or, more commonly, during childbirth. If you are already on ARVs, your doctor will keep you on them, except for Sustiva, which has been shown to cause problems for a developing fetus. If your doctor prescribes ARVs, itŐs extremely important to take every dose of the medications on schedule. A separate video on this web site called ŇPrevention for PositivesÓ explains more about why taking every dose of ARV medications on schedule is so important.

Starting ARVs After the First Trimester

Even if your doctor doesnŐt recommend that you start ARVs immediately, they will recommend going on ARVs after the first trimester. The reason for this is to minimize the effects of ARVs on a fetus while they are in the most critical early development stages in the womb. Many studies have been done on the safety of ARVs during pregnancy, so protect the health of your baby by taking ARVs according to your doctorŐs instructions.

Scheduled Caesarian Section

There is evidence that the risk of mother-to-child HIV transmission may be lower if the child is delivered via a scheduled Caesarian section rather than by a natural vaginal delivery. Additionally, if a woman is on ARV and her viral load – or amount of virus in the body is less than 1,000, vaginal delivery is as low a risk as Caesarian section – approximately 1%. Of course, Caesarian sections carry their own increased risks of infection for the mother and possible respiratory complications for the child. Talk with your doctor as early in your pregnancy as possible about what the best approach may be for your situation.

Intravenous (IV) ARVs During Labor and Delivery

In standard medical practice, every HIV positive woman should receive IV AZT during delivery, once her water has broken.

ARVs for the Child After Delivery

It is possible to further reduce the risk that the baby will become HIV positive by giving the infant oral antiretroviral medications after delivery. The U.S. Public Health Service recommends that babies born to HIV positive mothers be given AZT in liquid form every 6 hours for six weeks after birth and itŐs critical that you give the child every dose of medication on schedule.

Feeding the Child Formula Instead of Breastfeeding

If the mother is HIV positive and breastfeeds her baby, this increases the risk of mother-to-child HIV transmission. As a result, if the mother is HIV positive, ŇThe CDC recommends that in areas where safe drinking water and infant formula are available (such as the United States), [HIV positive] women should not breastfeed in order to avoid transmission of HIV to their infants through breast milk.Ó

Testing the Baby for HIV

All babies born to HIV positive mothers should be tested to determine whether they are HIV positive. ŇBabies born to HIV positive mothers are tested for HIV differently than adults. Adults are tested by looking for antibodies to HIV in their blood. A newly born infant keeps antibodies from its mother, including antibodies to HIV, for many months after birth. Therefore, an antibody test given before the baby is 1 year old may be positive even if the baby does NOT have HIV infection. For the first year, babies are tested for HIV directly, and not by looking for antibodies to HIV. When babies are more than 1 year old, they no longer have their motherŐs antibodies and can be tested for HIV using the antibody test. If after 1 year, the baby tests negative, they are considered HIV negative.

If Your Child is HIV Positive

If your child turns out to be HIV positive, do not despair. Talk with your doctor about what treatments are right for your child. With appropriate treatment, HIV positive infants may be able to live a healthy life. There are already college students today who were born as HIV positive infants. If your child is HIV positive, talk with your doctor about how to keep them healthy and make sure to follow the doctorŐs instructions exactly.

Important Things to Remember

LetŐs close by reviewing some of the most important lessons from this video.

á  If you are suspect you are pregnant or want to become pregnant, see a doctor and get tested to determine if you are HIV positive.

á  If you are pregnant and HIV positive, there are many things you can do to reduce the risk of mother-to-child transmission. ItŐs important that you talk to your doctor about what to do to keep the risk as low as possible and follow the doctorŐs instructions exactly.

 

For AIDSvideos.org, this is [PRESENTER NAME].

 

Script written by Becky Kuhn, M.D. of Global Lifeworks and Eric Krock of AIDSvideos.org.

This script was reviewed for accuracy and approved by Becky Kuhn, M.D. on August 29, 2006.