Preventing Mother-to-Child Transmission of HIV

 

Hi, my name is [PRESENTER NAME]. I’m [PRESENTER ROLE]. Welcome to “Preventing Mother-to-Child Transmission of HIV.”

Are you pregnant or thinking about having a baby? Then this video is for you.

If you are HIV positive, it is entirely possible to have an HIV negative baby. However, your child may become infected with HIV during pregnancy, childbirth or while breastfeeding. If you take NO steps to protect your child from HIV and breastfeed the baby, there is between one chance in five and almost one chance in two that your child will become HIV positive.[1] If you take NO steps to protect your child and do not breastfeed, there is between one chance in six and one chance in three that your child will become HIV positive.[2]

But if you follow your doctor’s instructions, including the use of AIDS medications, the World Health Organization estimates that you can reduce the risk that your child will become HIV positive to less than one chance in twenty.[3] The United States Centers for Disease Control and Prevention estimates that the risk can be reduced to one chance in fifty or less.[4] If you are pregnant or thinking about having a baby, the information in this video could save your child’s life, so please watch the whole video and listen carefully.

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 give you the best chance of a safe pregnancy and a healthy baby whether or not you have HIV.

Get Tested for HIV and Other Sexually Transmitted Infections

No matter how far along you are in your pregnancy, get tested for HIV and other sexually transmitted infections right away. The United States Centers for Disease Control and Prevention recommend that all pregnant women be tested for HIV and other sexually transmitted infections including chlamydia, Hepatitis B, and syphilis.[5] The World Health Organization recommends that all pregnant women be tested for HIV and syphilis and asked about symptoms of other sexually transmitted infections.[6] You may be HIV positive or have another sexually transmitted infection and not know it.

In most places, testing for HIV and other sexually transmitted infections is free.

If You’re HIV Positive or Have Another Sexually Transmitted Infection, See a Doctor Right Away

If you are HIV positive or have a sexually transmitted infection, do not despair. With modern AIDS medications, HIV positive people may remain healthy for years or decades. Many other sexually transmitted infections can be cured with antibiotics.

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 and HIV positive. Remember, different people have different needs, and different medications and treatment options are available depending upon where you live. Watching a video is no substitute for seeing a doctor and getting personal advice that’s right for you.

AIDS Medications

HIV is the virus that causes AIDS. AIDS medications known as Antiretroviral Medications (ARVs) can prevent HIV from reproducing within your body. Your doctor will recommend that you take AIDS medications to protect your baby. When your doctor prescribes AIDS medications, it’s extremely important to take every dose of the medications on schedule. A separate video called “Adherence for Life” explains why this is so important.

If You're Already Taking AIDS Medications, Talk With Your Doctor and Keep Taking What They Recommend

If you are already taking AIDS medications, your doctor will keep you on AIDS medications in order to protect both you and the baby.[7]

Starting AIDS Medications Immediately

Your doctor may start you on AIDS medications immediately if you are not already on them.[8] Your doctor is especially likely to do this if you are showing symptoms of clinical AIDS, your CD4 immune cell count is low, or the amount of HIV in your body is high.

Starting AIDS Medications Later During Pregnancy

Even if your doctor doesn’t recommend that you start AIDS medications immediately, where possible, they will put you on AIDS medications later in your pregnancy to protect the baby. As of 2011, the World Health Organization recommends that if you don't need AIDS medications for your own health, you should still begin taking them as early as 14 weeks into the pregnancy to reduce the risk of HIV transmission to the baby.[9]

Scheduled Caesarian Section

In some cases, such as a woman with a high amount of HIV in her body, the risk of mother-to-child transmission of HIV may be lower if the child is delivered via a scheduled Caesarian section rather than by a natural vaginal delivery. However, Caesarian sections have their own risks for the mother and the child. If a woman is on AIDS medications and the amount of virus in her body is low, vaginal delivery may have no more risk of HIV transmission than Caesarian section[10] and is commonly chosen.

Intravenous (IV) AIDS Medications During Labor and Delivery

Where possible, every HIV positive woman should receive intravenous AIDS medications during delivery, once her water has broken. Where this is not possible, your doctor may give you oral AIDS medications to take when you go into labor.

AIDS Medications for the Child After Delivery

You can further reduce the risk that your baby will contract HIV by giving your baby oral AIDS medications after delivery. It's critical that you give the baby every dose of medication on schedule.

Š      If you are breastfeeding the child, you must give the child AIDS medications until at least one "week after all exposure to breast milk has ended."[11]

Š      If you stop breastfeeding the child before the child is six weeks old, or if you are feeding the child only infant formula, you must give the child AIDS medications until at least four to six weeks after birth.[12]

Feeding the Child Formula Instead of Breastfeeding

HIV can be transmitted to the baby through breast milk. Feeding your baby only infant formula can further reduce the risk your child will contract HIV. For infant formula to be considered, it must be safe for you and your child.[13] For example, you must have reliable access to clean water and infant formula. Your doctor may recommend that you feed the child infant formula instead of breastfeeding. If you follow all your doctor's instructions and feed the child only infant formula, you can reduce the risk that your child will contract HIV to as little as one chance in fifty.[14]

AIDS Medications During Breastfeeding

Feeding your child with infant formula may not be possible. For example, you may not have reliable access to clean water or may not be able to afford infant formula. When infant formula can't be used, your doctor will recommend that you breastfeed your baby. The doctor will also recommend that you take AIDS medications for at least as long as you are breastfeeding. This will reduce the risk that HIV will be transmitted to your baby through your breast milk. If you follow all your doctor's instructions and breastfeed the child, you can reduce the risk that your child will contract HIV to less than one chance in twenty.[15]

Don't Mix Breastfeeding and Feeding with Infant Formula

Either breastfeed your child or feed your child infant formula, but don't do both. Feeding the child both breast milk and infant formula increases the risk that the child will contract HIV, become ill, or die.[16]

AIDS Medications for the Mother After Delivery or After Breastfeeding Ends

Your doctor may tell you to stay on AIDS medications permanently to protect your own health. In a number of developed countries, many women who start taking AIDS medications stay on them. However, depending on treatment guidelines in your country, the doctor may have you continue taking AIDS medications for only a short period after delivery (if you are feeding the infant with formula) or after breastfeeding ends to reduce the risk that AIDS medications won't work against HIV in the future.[17]

Testing the Baby for HIV

All babies born to HIV positive mothers should be tested for HIV. Your doctor will tell you when and how your baby should be tested for HIV. Babies can't be tested for HIV using ordinary adult HIV tests until at least one year after delivery, but they can be tested using a special test that looks for HIV in their blood. If a baby tests HIV negative one year after delivery, the baby is considered HIV negative.

If Your Child is HIV Positive

If your child turns out to be HIV positive, do not despair. With appropriate treatment, HIV positive children may be able to live a healthy life. There are 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 doctor’s instructions exactly.

Important Things to Remember

Let’s close by reviewing some of the most important lessons from this video.

Š      If you think you are pregnant or want to become pregnant, see a doctor and get tested for HIV.

Š      If you are pregnant and HIV positive, there are many things you can do to reduce the risk of mother-to-child transmission of HIV. Talk to your doctor about what to do and follow the doctor’s instructions exactly.

 

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

 

-------------------- STOP TRANSLATING HERE ------------------------------

Translators: Please leave text below this point as-is in English in the finished translation. If possible, please preserve footnotes in the finished translation as well.

WORD COUNT: 1574

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

This script was reviewed for accuracy and approved by Becky Kuhn, M.D. on June 16, 2012.

If footnotes are not present in a translated version of this document, refer to the original English script to find them.

© Copyright 2006-2012 Global Lifeworks. All rights reserved.

 

 

 

WORKS CITED

Limpongsanurak S. Efficacy and safety of caesarean delivery for prevention of mother-to-child transmission of HIV-1: RHL commentary (last revised: 15 December 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.

UNAIDS. "Countdown to Zero: Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive: 2011-2015." 2011.

United States Centers for Disease Control and Prevention. "Reducing HIV Transmission From Mother-to-Child: An Opt-Out Approach to HIV Screening." http://www.cdc.gov/hiv/topics/perinatal/resources/factsheets/opt-out.htm Accessed 4 December 2011.

United States Centers for Disease Control and Prevention. "STDs & Pregnancy - CDC Fact Sheet." http://www.cdc.gov/std/pregnancy/STDFact-Pregnancy.htm. Accessed 25 Nov 2011.

World Health Organization. "HIV and infant feeding: Revised Principles and Recommendations: RAPID Advice." November 2009.

World Health Organization. "Standards for Maternal and Neonatal Care: Prevention and management of sexually transmitted and reproductive tract infections." http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/prevention_mngt_stis.pdf. Accessed 25 Nov 2011.

World Health Organization. "Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Recommendations for a public health approach: 2010 version." 2010.

World Health Organization. "HIV and infant feeding: Revised Principles and Recommendations: RAPID Advice." November 2009.

 

FOR FURTHER READING

http://www.aidstruth.org/cohen-hivnet012.php

HIV TRANSMISSION: Allegations Raise Fears of Backlash Against AIDS Prevention Strategy

Science 24 December 2004

Vol. 306. no. 5705, pp. 2168 - 2169

by Jon Cohen

 

http://www.aidsnews.org/2004/12/nevirapine-ap.html

Nevirapine Misinformation: Will It Kill?

by John S. James

 

http://www3.niaid.nih.gov/news/newsreleases/2005/332005_nevirapine.pdf

Reports on nevirapine threaten public health

NATURE MEDICINE VOLUME 11 | NUMBER 3 | MARCH 2005

p. 245

 

UNAIDS, "Countdown to Zero: Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive: 2011-2015," 2011, p. 6.

 



[1] World Health Organization.,"Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants: Recommendations for a public health approach: 2010 version," 2010, p. 11.

[2] WHO, 2010, p. 11.

[3] WHO, 2010, p. 12.

[4] United States Centers for Disease Control and Prevention, "Reducing HIV Transmission From Mother-to-Child: An Opt-Out Approach to HIV Screening." http://www.cdc.gov/hiv/topics/perinatal/resources/factsheets/opt-out.htm Accessed 4 December 2011.

[5] United States Centers for Disease Control and Prevention, "STDs & Pregnancy - CDC Fact Sheet," http://www.cdc.gov/std/pregnancy/STDFact-Pregnancy.htm. Accessed 25 Nov 2011.

[6] World Health Organization, "Standards for Maternal and Neonatal Care: Prevention and management of sexually transmitted and reproductive tract infections," http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/prevention_mngt_stis.pdf, p.1. Accessed 25 Nov 2011.

[7] WHO, 2010, p. 19.

[8] WHO, 2010, p. 21.

[9] WHO, 2010, p. 3.

[10] S Limpongsanurak, "Efficacy and safety of caesarean delivery for prevention of mother-to-child transmission of HIV-1"

[11] WHO, 2010, p. 4.

[12] WHO, 2010, p. 4.

[13] WHO, 2010, p. 7.

[14] WHO, 2010, p. 12.

[15] WHO, 2010, p. 12.

[16] World Health Organization, "HIV and infant feeding: Revised Principles and Recommendations: RAPID Advice," November 2009, p. 15.

[17] WHO, 2010, p. 25.