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I beg you...breastfeed the baby, things changed: infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission.
BMC Public Health. 2018 Jan 29; 18(1):188.BACKGROUND: For women living with HIV (WLWH) in low- and middle-income countries, World Health Organization (WHO) infant feeding guidelines now recommend exclusive breastfeeding until six months followed by mixed feeding until 24 months, alongside lifelong maternal antiretroviral therapy (ART). These recommendations represent the sixth major revision to WHO infant feeding guidelines since 1992. We explored how WLWH in rural Uganda make infant feeding decisions in light of evolving recommendations. METHODS: We conducted semi-structured interviews with 20 postpartum Ugandan WLWH accessing ART, who reported pregnancy < 2 years prior to recruitment. Interviews were conducted between February-August 2014 with babies born between March 2012-October 2013, over which time, the regional HIV treatment clinic recommended lifelong ART for all pregnant and breastfeeding women (Option B+). Content analysis was used to identify major themes. Infant feeding experiences was an emergent theme. NVivo 10 software was used to organize analyses. RESULTS: Among 20 women, median age was 33 years [IQR: 28-35], number of livebirths was 3 [IQR: 2-5], years on ART was 2.3 [IQR: 1.5-5.1], and 95% were virally suppressed. Data revealed that women valued opportunities to reduce postnatal transmission. However, women made infant feeding choices that differed from recommendations due to: (1) perception of conflicting recommendations regarding infant feeding; (2) fear of prolonged infant HIV exposure through breastfeeding; and (3) social and structural constraints shaping infant feeding decision-making. CONCLUSIONS: WLWH face layered challenges navigating evolving infant feeding recommendations. Further research is needed to examine guidance and decision-making on infant feeding choices to improve postpartum experiences and outcomes. Improved communication about changes to recommendations is needed for WLWH, their partners, community members, and healthcare providers.
Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: A systematic literature review.
Medicine. 2017 Oct; 96(40):e8055.BACKGROUND: To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. METHODS: Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). RESULTS: Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. CONCLUSION: Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.
Geneva, Switzerland, UNAIDS, 2016.  p.Efforts to reach fewer than 500 000 new HIV infections by 2020 are off track. This simple conclusion sits atop a complex and diverse global tapestry. Data from 146 countries show that some have achieved declines in new HIV infections among adults of 50% or more over the last 10 years, while many others have not made measurable progress, and yet others have experienced worrying increases in new HIV infections.
Guideline: Updates on HIV and infant feeding. The duration of breastfeeding and support from health services to improve feeding practices among mothers living with HIV.
Geneva, Switzerland, WHO, 2016.  p.The objective of this guideline is to improve the HIV-free survival of HIV-exposed infants by providing guidance on appropriate infant feeding practices and use of ARV drugs for mothers living with HIV and by updating WHO-related tools and training materials. The guideline is intended mainly for countries with high HIV prevalence and settings in which diarrhoea, pneumonia and undernutrition are common causes of infant and child mortality. However, it may also be relevant to settings with a low prevalence of HIV depending on the background rates and causes of infant and child mortality. This guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals, the global targets set in the comprehensive implementation plan on maternal, infant and young child nutrition, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) and the Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021. The target audience for this guideline includes: (1) national policy-makers in health ministries; (2) programme managers working in child health, essential drugs and health worker training; (3) health-care providers, researchers and clinicians providing services to pregnant women and mothers living with HIV at various levels of health care; and (4) development partners providing financial and/or technical support for child health programmes, including those in conflict and emergency settings. (Excerpt)
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: What’s new. Policy brief.
Geneva, Switzerland, WHO, 2015 Nov.  p. (Policy Brief)The 2015 guidelines includes 10 new recommendations to improve the quality and efficiency of services to people living with HIV. Implementation of the recommendations in these guidelines on universal eligibility for ART will mean that more people will start ART earlier. The updated guidelines present both new recommendations and previous WHO guidance. They include clinical recommendations (“the what” of using ARVs for treatment and prevention) and service delivery recommendations to support implementation (“the how” of providing ARVs), organized according to the continuum of HIV testing, prevention, treatment and care. For the first time the guideline includes “good practice statements” on interventions whose benefits substantially outweigh the potential harms.
Geneva, Switzerland, WHO, 2015 Sep.  p. (Guidelines)This early-release guideline makes available two key recommendations that were developed during the revision process in 2015. First, antiretroviral therapy (ART) should be initiated in everyone living with HIV at any CD4 cell count. Second, the use of daily oral pre-exposure prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches. The first of these recommendations is based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV compared with delayed treatment. The second recommendation is based on clinical trial results confirming the efficacy of the ARV drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide variety of settings and populations. The recommendations in this guideline will form part of the revised consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection to be published by WHO in 2016. The full update of the guidelines will consist of comprehensive clinical recommendations together with revised operational and service delivery guidance to support implementation.
Strength of recommendations in WHO guidelines using GRADE was associated with uptake in national policy.
Journal of Clinical Epidemiology. 2015;  p.Objectives: This study assesses the extent to which the strength of a recommendation in a World Health Organization (WHO) guideline affects uptake of the recommendation in national guidelines. Study Design and Setting: The uptake of recommendations included in HIV and TB guidelines issued by WHO from 2009 to 2013 was assessed across guidelines from 20 low- and middle-income countries in Africa and Southeast Asia. Associations between characteristics of recommendations (strength, quality of the evidence, type) and uptake were assessed using logistic regression. Results: Eight WHO guidelines consisting of 109 strong recommendations and 49 conditional ecommendations were included, and uptake assessed across 44 national guidelines (1,255 recommendations) from 20 countries. Uptake of WHO recommendations in national guidelines was 82% for strong recommendations and 61% for conditional recommendations. The odds of uptake comparing strong recommendations and conditional recommendations was 1.9 (95% confidence interval: 1.4, 2.7), after adjustment for quality of evidence. Higher levels of evidence quality were associated with greater uptake, independent of recommendation strength. Conclusion: Guideline developers should be confident that conditional recommendations are frequently adopted. The fact that strong recommendations are more frequently adopted than conditional recommendations underscores the importance of ensuring that such recommendations are justified.
Individualizing the WHO HIV and infant feeding guidelines: optimal breastfeeding duration to maximize infant HIV-free survival.
AIDS. 2014 Jul; 28 Suppl 3:S287-99.OBJECTIVES: To determine how infant feeding recommendations can maximize HIV-free survival (HFS) among HIV-exposed, uninfected African infants, balancing risks of breast milk-associated HIV infection with setting-specific risks of illness and death associated with replacement feeding. DESIGN: Validated mathematical model of HIV-exposed, uninfected infants, with published data from Africa. METHODS: We projected 24-month HFS using combinations of: maternal CD4, antiretroviral drug availability, and relative risk of mortality among replacement-fed compared to breastfed infants ('RR-RF', range 1.0-6.0). For each combination, we identified the 'optimal' breastfeeding duration (0-24 months) maximizing HFS. We compared HFS under an 'individualized' approach, based on the above parameters, to the WHO 'public health approach' (12 months breastfeeding for all HIV-infected women). RESULTS: Projected HFS was 65-93%. When the value of RR-RF is 1.0, replacement feeding from birth maximized HFS. At a commonly reported RR-RF value (2.0), optimal breastfeeding duration was 3-12 months, depending on maternal CD4 and antiretroviral drug availability. As the value of RR-RF increased, optimal breastfeeding duration increased. Compared to the public health approach, an individualized approach improved absolute HFS by less than 1% if RR-RF value was 2.0-4.0, by 3% if RR-RF value was 1.0 or 6.0, and by greater amounts if access to antiretroviral drugs was limited. CONCLUSION: Tailoring breastfeeding duration to maternal CD4, antiretroviral drug availability, and local replacement feeding safety can optimize HFS among HIV-exposed infants. An individualized approach leads to moderate gains in HFS, but only when mortality risks from replacement feeding are very low or very high, or antiretroviral drug availability is limited. The WHO public health approach is beneficial in most resource-limited settings.
Health outcomes and cost impact of the new WHO 2013 guidelines on prevention of mother-to-child transmission of HIV in Zambia.
PloS One. 2014; 9(3):e90991.BACKGROUND: Countries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either 'Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)' or 'Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)', while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia. METHODS: A decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of =350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined. RESULTS: Our analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with 'ARVs during pregnancy and breastfeeding' and further reduced by 15% with 'Lifelong ART'. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners. CONCLUSION: The shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment.
Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
Country adaptation of the 2010 World Health Organization recommendations for the prevention of mother-to-child transmission of HIV.
Bulletin of the World Health Organization. 2012 Dec 1; 90(12):921-31.The World Health Organization (WHO) revised its global recommendations on treating pregnant women infected with the human immunodeficiency virus (HIV) with antiretrovirals and preventing mother-to-child transmission (PMTCT) of HIV. Initial draft recommendations issued in November 2009 were followed by a full revised guideline in July 2010. The 2010 recommendations on PMTCT have important implications in terms of planning, human capacity and resources. Ministries of health therefore had to adapt their national guidelines to reflect the 2010 PMTCT recommendations, and the Elizabeth Glaser Pediatric AIDS Foundation tracked the adaptation process in the 14 countries where it provides technical support. In doing so it sought to understand common issues, challenges, and the decisions reached and to properly target its technical assistance.In 2010, countries revised their national guidelines in accordance with WHO's most recent PMTCT recommendations faster than in 2006; all 14 countries included in this analysis formally conducted the revision within 15 months of the 2010 PMTCT recommendations' release. Governments used various processes and fora to make decisions throughout the adaptation process; they considered factors such as feasibility, health delivery infrastructure, compatibility with 2006 WHO guidelines, equity and cost. Challenges arose; in some cases the new recommendations were implemented before being formally adapted into national guidelines and no direct guidance was available in various technical areas. As future PMTCT guidelines are developed, WHO, implementing partners and other stakeholders can use the information in this paper to plan their support to ministries of health.
Time for new recommendations on cotrimoxazole prophylaxis for HIV-exposed infants in developing countries?
Bulletin of the World Health Organization. 2010 Dec 1; 88(12):949-50.Add to my documents.
The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review.
PloS One. 2013; 8(3):e56550.BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed.
How evidence based are public health policies for prevention of mother to child transmission of HIV?
BMJ. 2013; 346:f3763.Add to my documents.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach.
Geneva, Switzerland, WHO, 2013.  p.The 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection provide new guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the care of people living with HIV and the use of antiretroviral (ARV) drugs for treating and preventing HIV infection.
Preventing HIV and unintended pregnancies: Strategic framework 2011-2015. In support of the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive. 2nd ed.
[New York, New York], United Nations Population Fund [UNFPA], 2012.  p.We are at a turning point for delivering on the promise to end child and maternal mortality and improve health -- marked by bold new commitments. This strategic framework supports one such commitment, the 'Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive'. It offers guidance for preventing HIV infections and unintended pregnancies -- both essential strategies for improving maternal and child health, and eliminating new paediatric HIV infections. This framework should be used in conjunction with other related guidance that together address all four prongs of eliminating mother-to-child transmission of HIV. This document focuses on strengthening rights-based polices and programming within health services and the community.
The reach and limits of the US President's Emergency Plan for Aids Relief (PEPFAR) funding of Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Nigeria.
African Journal of Reproductive Health. 2012 Mar; 16(1):23-34.WHO advocates the use of comprehensive 4-pronged strategy for PMTCT of HIV. It includes HIV prevention, preventing unintended pregnancies in HIV positive women and follows up treatment and support as well as therapeutic interventions around delivery. This study examines PEPFAR's funding of Nigerian PMTCT, via an analysis of the funded activities of 396 agencies PEPFAR funds to do PMTCT. PEPFAR Sub-partners selected for this study were included because they were funded to do therapeutic intervention around delivery, but significant gaps were identified regarding the other 3 prongs advocated by WHO. Up to 70% were not funded to do any primary prevention. PEPFAR's own reporting does not allow assessment of Sub-partner involvement in preventing unintended pregnancies. Regarding follow up treatment and care, some Sub-partners were not funded at all. PEPFAR is not supporting a comprehensive approach to PMTCT in the way it funds PMTCT in Nigeria.
Evidence behind the WHO guidelines: Hospital care for children: What are the risks of HIV transmission through breastfeeding?
Journal of Tropical Pediatrics. 2007 Oct; 53(5):298-302.The World Health Organization (WHO) has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. This review addresses the question: What are the risks of HIV transmission through breastfeeding? The WHO Pocketbook of Hospital Care for Children estimates the additional risk of mother-to-child transmission (MTCT) of HIV through breastfeeding without interventions to be 5-20%. This risk varies depending on duration and method of breastfeeding, and also because of differences in population characteristics, such as maternal and CD4+ cell counts and RNA viral load. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2007.  p.The influence behind faith-based organizations is not difficult to discern. In many developing countries, FBOs not only provide spiritual guidance to their followers; they are often the primary providers for a variety of local health and social services. Situated within communities and building on relationships of trust, these organizations have the ability to influence the attitudes and behaviours of their fellow community members. Moreover, they are in close and regular contact with all age groups in society and their word is respected. In fact, in some traditional communities, religious leaders are often more influential than local government officials or secular community leaders. Many of the case studies researched for the UNFPA publication Culture Matters showed that the involvement of faith-based organizations in UNFPA-supported projects enhanced negotiations with governments and civil society on culturally sensitive issues. Gradually, these experiences are being shared across countries andacross regions, which has facilitated interfaith dialogue on the most effective approaches to prevent the spread of HIV. Such dialogue has also helped convince various faith-based organizations that joining together as a united front is the most effective way to fight the spread of HIV and lessen the impact of AIDS. This manual is a capacity-building tool to help policy makers and programmers identify, design and follow up on HIV prevention programmes undertaken by FBOs. The manual can also be used by development practitioners partnering with FBOs to increase their understanding of the role of FBOs in HIV prevention, and to design plans for partnering with FBOs to halt the spread of the virus. (excerpt)
Research Triangle Park, North Carolina, Family Health International [FHI], Interagency Youth Working Group, 2007 Mar. 4 p. (YouthLens on Reproductive Health and HIV / AIDS No. 21)Young people, especially those who are sexually active, need access to a variety of reproductive health (RH) and HIV services, including contraception, HIV counseling and testing, testing and treatment for other sexually transmitted infections (STIs), pre- and postnatal care, and postabortion care. Frequently youth seek services only when there is an acute illness or problem - such as a symptomatic STI or pregnancy - and do not typically seek preventive services, such as contraception to avoid pregnancy. Also, health facilities serving youth sometimes offer one primary service or have separate units providing different types of services. In either situation, to provide comprehensive care, a provider may need to refer clients between contraceptive and HIV/STI services. As a result, although many young people are at risk of both pregnancy and HIV/STIs, they may receive only one service while related sexual health needs are not addressed. An integrated approach can make a variety of services available during the same hours, at the same facility, or from the same provider. While such integration seems appealing, more analysis was needed to address whether this was feasible, what needs were unmet, and what kinds of models might work best. (excerpt)
Geneva, Switzerland, WHO, Special Programme for Research and Training in Tropical Diseases [TDR], 2006. 25 p. (TDR/SDI/06.1.)Syphilis is a curable infection caused by a bacterium called Treponema pallidum. This infection is sexually transmitted, and can also be passed on from a mother to her fetus during pregnancy. As a cause of genital ulcer disease, syphilis has been associated with an increased risk of HIV transmission and acquisition. Most persons with syphilis tend to be unaware of their infection and they can transmit the infection to their sexual contacts or, in the case of a pregnant woman, to her unborn child. If left untreated, syphilis can cause serious consequences such as stillbirth, prematurity and neonatal deaths. Adverse outcomes of pregnancy are preventable if the infection is detected and treated before mid-second trimester. Early detection and treatment is also critical in preventing severe long term complications in the patient and onward transmission to sexual partners. Congenital syphilis kills more than one million babies a year worldwide but is preventable if infected mothers are identified and treated appropriately as early as possible. (excerpt)
[Geneva, Switzerland], UNAIDS, .  p.The number of infants born with HIV infection is growing every day. The AIDS pandemic represents a tragic setback in the progress made on child welfare and survival. Given the vital importance of breast milk and breast-feeding for child health, the increasing prevalence of HIV infection around the world, and the evidence of a risk of HIV transmission through breast-feeding, it is now crucial that policies be developed on HIV infection and infant feeding. The following statement provides policy-makers with a number of key elements for the formulation of such policies. (excerpt)
WHO - UNAIDS - UNICEF Technical Consultation on HIV and Infant Feeding: Implementation of Guidelines. Report of a meeting -- Geneva, 20-22 April 1998.
Geneva, Switzerland, UNAIDS, 1998.  p.The Guidelines and Guide recognise that: HIV infection can be transmitted through breastfeeding. Appropriate alternatives to breastfeeding should be available and affordable in adequate amounts for women whom testing has shown to be HIV-positive. Breastfeeding is the ideal way to feed the majority of infants. Efforts to protect, promote and support breastfeeding by women who are HIV-negative or of unknown HIV status need to be strengthened; HIV-positive mothers should be enabled to make fully informed decisions about the best way to feed their infants in their particular circumstances. Whatever they decide, they should receive educational, psychosocial and material support to carry out their decision as safely as possible, including access to adequate alternatives to breastfeeding if they so choose; To make fully informed decisions about infant feeding, as well as about other aspects of HIV, mother-to-child transmission (MTCT) and reproductive life, women need to know and accept their HIV status. There is thus an urgent need to increase access to voluntary and confidential counselling and HIV testing (VCT), and to promote its use by women and when possible their partners, before making alternatives to breastfeeding available; An essential priority is primary prevention of HIV infection. Education for all adults of reproductive age, particularly for pregnant and lactating women and their sexual partners, and for young people, needs to be strengthened; Women who are HIV positive need to understand the particular importance of avoiding infection during pregnancy and lactation. (excerpt)
UN Chronicle. 2005 Dec;  p..The new campaign of the United Nations Children's Fund (UNICEF), "Unite for Children, Unite against AIDS", hopes to focus global attention on the devastating impact that the HIV/AIDS pandemic has had on children. Ann Veneman, UNICEF Executive Director, in launching the campaign at UN Headquarters in New York on 25 October 2005, described what AIDS means to the youngest generation. "It is a disease that has redefined their childhoods, causing them to grow up too fast, or sadly not at all." In the worst-affected countries, where life expectancy has plummeted from the mid-60s to the early-30s, turning 18 no longer means reaching adulthood, but rather middle-age. A global campaign designed to strengthen the commitment to the fight against AIDS is crucial, explained Ms. Veneman, because "the scale of this problem is staggering, but the world has been largely unresponsive". "Unite for Children, Unite against AIDS" aims to prevent mother-to-child transmission, provide paediatric treatment, prevent infection among adolescents and young people, and protect and support children affected by HIV/AIDS. It also provides a platform for urgent and sustained programmes, advocacy and fund-raising to limit the impact of the disease on children and help halt its spread. (excerpt)
Adapted for use in former Soviet countries, WHO/US government PMTCT protocols are introduced in three Russian cities.
Connections. 2005 Aug-Sep;  p..HIV/AIDS is called a women's disease in African countries because almost 60 percent of the people infected with the virus are women. This comparison may soon also be relevant for Russia where the relative share of women among people with HIV is rising steadily. In some regions it is already in excess of 40 percent. Russian experts attribute this situation to the development of the commercial sex trade, as well as to a rising rate of transmission through sexual contact with drug users. The gravest situation is the escalating incidence of HIV/AIDS among women of childbearing age, especially those between 15 and 30. More and more cases of the disease are being reported in this group. Many of them are diagnosed during pregnancy, which translates to a corresponding increase the number of HIV-infected children in Russia. At the start of 2005, approximately 10,000 such children had been registered, whereas in 1996 there were only 18 of them. While it is practically impossible to prevent the spread of HIV/AIDS among adults, mother-to-child transmission of the virus can be controlled. The question, "How?" is complex and multifaceted. It was discussed in detail by participants in a series of workshops sponsored by UNICEF and AIHA in three Russian cities-- Magnitogorsk, Orenburg, and Chelyabinsk--between May and August this year. (excerpt)