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  1. 1
    Peer Reviewed

    Time for new recommendations on cotrimoxazole prophylaxis for HIV-exposed infants in developing countries?

    Coutsoudis A; Coovadia HM; Kindra G

    Bulletin of the World Health Organization. 2010 Dec 1; 88(12):949-50.

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  2. 2
    Peer Reviewed

    Evidence behind the WHO guidelines: Hospital care for children: What are the risks of HIV transmission through breastfeeding?

    Bulteel N; Henderson P

    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)
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  3. 3

    Engaging faith-based organizations in HIV prevention. A training manual for programme managers.

    Toure A; Melek M; Jato M; Kane M; Kajungu R

    New York, New York, United Nations Population Fund [UNFPA], 2007. [53] 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)
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  4. 4

    The use of rapid syphilis tests.

    World Health Organization [WHO]. Special Programme for Research and Training in Tropical Diseases. Sexually Transmitted Diseases Diagnostics Initiative

    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)
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  5. 5

    HIV and infant feeding. A policy statement developed collaboratively by UNAIDS, UNICEF and WHO.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]; UNICEF; World Health Organization [WHO]

    [Geneva, Switzerland], UNAIDS, [2005]. [5] 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)
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  6. 6

    WHO - UNAIDS - UNICEF Technical Consultation on HIV and Infant Feeding: Implementation of Guidelines. Report of a meeting -- Geneva, 20-22 April 1998.

    World Health Organization [WHO]; Joint United Nations Programme on HIV / AIDS [UNAIDS]; UNICEF

    Geneva, Switzerland, UNAIDS, 1998. [38] 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)
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  7. 7

    Unite for children, unite against AIDS.

    Bolton S

    UN Chronicle. 2005 Dec; [2] 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)
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  8. 8

    A call to action. Children: the missing face of AIDS.

    UNICEF; Joint United Nations Programme on HIV / AIDS [UNAIDS]

    New York, New York, UNICEF, 2005. 25 p.

    The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
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  9. 9

    The Lancet's neonatal survival series [letter]

    Schmid G; Broutet N; de Bernis L; Hawkes S

    Lancet. 2005 May 28; 365(9474):1845.

    It is gratifying that The Lancet has called attention to the global problem of neonatal deaths by producing, and electronically distributing, its neonatal survival series. We are disappointed, however, that none of the articles in the series addressed the equally important subject of stillbirth despite The Lancet calling attention in electronic documents to the equal numbers of deaths due to stillbirth and in the neonatal period. A leading and almost totally preventable cause of fetal and neonatal death worldwide is congenital syphilis. A screening test in pregnancy can prevent death from syphilis at both times, but limiting discussion to the neonatal period fails to capture its significance. The number of infants dying annually from congenital syphilis is uncertain, but estimates are more than 500000. Adverse pregnancy outcomes occur in up to 80% of women with early syphilis, including stillbirth (40%), perinatal death (20%), and serious neonatal infection (20%). (excerpt)
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  10. 10

    Guidelines on infant feeding and HIV.

    World Health Organization [WHO]; UNICEF; Joint United Nations Programme on HIV / AIDS [UNAIDS]

    MCH News. 1998 Jul; (9):5, 9.

    This statement was released in Geneva on 1 May 1998: In a concerted effort to stop the mother-to-child transmission of HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its co-sponsors the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have developed a comprehensive set of guidelines that support the use of alternatives to breastfeeding for infants born to women infected with HIV, the virus that causes AIDS. The guidelines are intended to help governments devise national policies to reduce the risk of HIV transmission through breastfeeding and to assist health care managers in providing services and support to this end. The guidelines stress the importance of protecting, promoting and supporting breastfeeding as the best method of feeding for infants whose mothers are HIV-negative or who do not know their HIV status. But at the same time, they recognize the need to support alternatives to breastfeeding for mothers who test positive for the human immunodeficiency virus. (excerpt)
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  11. 11
    Peer Reviewed

    [New guidelines for preventing mother-to-child transmission of the human immunodeficiency virus] Nuevas orientaciones para prevenir la transmisión maternofilial del virus de la inmunodeficiencia humana.

    World Health Organization [WHO]

    Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2004; 16(4):289-294.

    During a meeting in Geneva, Switzerland, on 5 and 6 February 2004, a working group of experts from the World Health Organization (WHO) and other scientists, health officials, and community representatives from throughout the world revised the guidelines developed by WHO in 2000 on the use of antiretroviral agents. Special attention was paid to the role of such agents in the prevention of HIV transmission from mother to infant during pregnancy, labor, and breast-feeding. This paper summarizes the newly developed guidelines, which contain specific recommendations for low-resource settings. It is hoped that the information provided will help curb HIV transmission from mother to child in developing countries, where it accounts for the majority of cases of HIV infection in childhood. (author's)
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  12. 12

    Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.

    Rutenberg N; Baek C; Kalibala S; Rosen J

    New York, New York, UNICEF, 2003. 47 p. (HIV / AIDS Working Paper)

    This overview report presents key findings from an evaluation of UN- supported pilot PMTCT projects in eleven countries, including: Botswana, Burundi, Cote d'Ivoire, Honduras, India, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Key findings discuss: feasibility and coverage; factors contributing to programme coverage; programme challenges; scaling-up; the special case of low prevalence countries; and recommendations. Recommendations include: To increase coverage and improve infant feeding counseling: supplement clinic staff with lay counselors; introduce rapid HIV tests so women can receive same day counseling, HIV testing, and test results; improve the quality of HIV and infant feeding counseling by providing job aids and active supervision; offer support to PMTCT providers including material support and peer psychosocial support; partner with community groups to offer community education and outreach; and expand the vision of PMTCT to encompass an active role for fathers and male partners. To strengthen postnatal support and follow up of HIV- infected women and their infant to assist them with infant feeding, getting care for themselves and their families, and to evaluate the program: establish national infant feeding guidelines; establish postnatal follow-up protocols; forge partnerships between the PMTCT program and NGO care and support groups; Enhance referral links between PMTCT programs and HIV care; New measurement tools and systems should be developed. To scale up PMTCT programs the findings suggest: expand to new sites but enlarge the scope of activities within existing sites to reach more women; and provide a comprehensive package of HIV prevention and care. The pilot experience has shown that introducing PMTCT programs into antenatal care in a wide variety of settings is feasible and acceptable to a significant proportion of antenatal care clients who have a demand for HIV information, counseling, and testing. As they go to scale, PMTCT programs have much to learn from the pilot phase, during which they successfully reached hundreds of thousands of clients. (author's)
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  13. 13

    Saving mothers, saving families: the MTCT-Plus Initiative. Case study.

    Rabkin M; El-Sadr WM

    Geneva, Switzerland, World Health Organization [WHO], 2003. 13 p. (Perspectives and Practice in Antiretroviral Treatment)

    The primary objective of the MTCT-Plus Initiative is to provide lifelong care and treatment for HIV/AIDS to families in resource-limited settings. In addition to reducing mortality and morbidity, the Initiative hopes to further reduce the mother-to-child-transmission of HIV; to promote voluntary counselling and testing and other preventive strategies; to strengthen local health care capacity; to decrease stigma among, enhance support for and empower people living with HIV/AIDS; and to develop a model for HIV care in resource-limited settings that can be generalized. An international review committee selected the initial sites after a request for applications was widely distributed in early 2002. Of the 47 eligible applicants – all of whom had ongoing programmes to prevent the mother-to-child-transmission of HIV, HIV prevalence of at least 5% and the ability to enroll at least 250 people per year – the committee selected 12 demonstration sites. An additional 13 sites were given planning grants. (excerpt)
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  14. 14

    Coverage of selected health services for HIV / AIDS prevention and care in less developed countries in 2001.

    Stover J; Schwärtlander B

    Geneva, Switzerland, World Health Organization [WHO], 2002 Nov. v, 38 p.

    The Declaration of Commitment on HIV/AIDS adopted by the United Nations General Assembly Special Session on HIV/AIDS in June 2001 commits Member States and the global community to taking strong and immediate action to address the HIV/AIDS crisis. It calls for achieving a number of specific goals, including reducing HIV prevalence among young men and women, expanding care and support and protecting human rights. The Millennium Development Goals adopted at the Millennium Summit in September 2000 call for expanded efforts to halt and reverse the spread of HIV/AIDS by 2015. Other important documents, such as the Abuja Declaration and Framework for Action on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases adopted at the African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases in 2001, declare regional and national commitments to confront the epidemic. Progress towards achieving these goals requires significantly expanding HIV/AIDS programmes to foster a supportive environment, to prevent new infections, to care for those already infected and to mitigate the social and economic consequences of the epidemic. One measure of progress is the percentage of people living in low- and middle income countries who have access to key prevention and care services. This report presents the results of an assessment of the coverage of several key health services in 2001. It is intended to serve as a baseline against which future progress can be measured. This report includes about 70 countries, including most low- and middle income countries with more than 10 000 people living with HIV/AIDS in 2001. The information presented here relies on service statistics and on expert assessment and is therefore much less precise than estimates based on population-based surveys. The results should be interpreted with caution but are useful in indicating the starting point in efforts to achieve future goals. (excerpt)
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  15. 15

    The Glion Call to Action on Family Planning and HIV / AIDS in Women and Children, 3-5 May 2004.

    Glion Call to Action on Family Planning and HIV / AIDS in Women and Children (2004)

    New York, New York, UNFPA, 2004. 6 p.

    In order to achieve internationally agreed development goals, it is vital that the linkages between reproductive health and HIV/AIDS prevention and care be addressed. To date, the benefits of the linkages have not been fully realized. United Nations agencies have initiated consultations with a wide range of stakeholders to identify opportunities for strengthening potential synergies between reproductive health and HIV/AIDS efforts. This Glion Call to Action reflects the consensus of one such consultation, which focused on the linkage between family planning (a key component of reproductive health) and prevention of mother-to-child HIV transmission (PMTCT) (a key component of HIV/AIDS programmes). The focus of the Glion Call to Action on preventing HIV among women and children is fully consistent with the parallel need for increased commitment to the health and wellbeing of women themselves. Therefore, the Glion Call to Action rests on the consensus achieved at the International Conference on Population and Development (ICPD) in Cairo and acknowledges the rights of women to decide freely on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence, and the need to improve access to services so that couples and individuals can decide freely the number, spacing and timing of their children. In order to ensure that these rights are respected, policies, programmes and interventions must promote gender equality, and give priority to the poor and underserved populations. (excerpt)
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  16. 16

    Prevention of mother-to-child transmission of HIV infection generic training package.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2004. 2 p.

    Of the 40 million people living with HIV/AIDS worldwide at the end of 2003, 2.5 million are children under 15 years of age. In 2003 alone, 700,000 children were newly infected with HIV. Most of these infections result from mother-to-child transmission during pregnancy, labour and delivery or through breastfeeding. By integrating a comprehensive prevention of mother-to-child transmission (PMTCT) programme, through prevention and treatment interventions, as an essential part of maternal, child and newborn health programmes, the PMTCT programme can significantly reduce the number of HIV-infected infants and promote better health for children, mothers and their families. Human capacity building at all levels of the health system is one of the big challenges of setting up HIV/AIDS initiative. The rapidly growing HIV/AIDS pandemic requires global and in-country collaborative efforts to maximise the use of existing human resources and develop strengthened human capacity. Globally, up to 100,000 people need to be trained for the "3 by 5" initiative to reach the target. Meeting that training goal will require strong collaboration among communities, nations, and international organisations. This generic PMTCT training package is designed to provide a template for the development of a national training plan and an appropriate national PMTCT curriculum, based on a rapid adaptation process. For countries that already have begun PMTCT training and have draft materials, this generic training package can be used to update and strengthen the national curriculum and training plan. This training package is an evidence-based course on PMTCT and is targeted to resource-constrained settings. (excerpt)
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  17. 17

    The Glion Call to Action on family planning and HIV / AIDS in women and children.

    Global AIDSLink. 2004 Aug-Sep; (87):9.

    The linkages between reproductive health and HIV/AIDS prevention and care must be strengthened in order to achieve internationally agreed development goals. United Nations agencies have initiated a series of consultations to identify ways to build and reinforce these linkages. The Glion Call to Action reflects the consensus of the first consultation in May 2004, which focused on the linkage between family planning and prevention of mother-to-child HIV transmission. The call is set within the context of the objectives and actions agreed at the 1994 Cairo International Conference on Population and Development (ICPD). (excerpt)
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  18. 18

    Waking the giant: making the case for mainstreaming.

    Osborne K

    Global AIDSLink. 2004 Aug-Sep; (87):16-17.

    The importance of addressing HIV/AIDS from a stronger sexual and reproductive health and rights perspective has over the past few months been gaining increased global momentum and recognition. Earlier this year, the All Party Parliamentary Group on Population, Development and Reproductive Health in the UK commenced their hearings into the very question of integration: its successes, failures and contextual realities. The Glion Call to Action (see page 8)— released in June — specifically addressed the integration aspects involved in PMTCT programs and policies. And in May, UNFPA hosted a series of technical meetings that aimed to explore some of the broader technicalities of integration. This advocacy document was launched in July at the Bangkok XV International AIDS Conference. Clearly, the question of when, where and how to integrate HIV/AIDS with reproductive health has been plaguing programmers and policy makers, donors and service providers. Answering these questions with meaningful action is not only long overdue but — in the age of increased awareness, and treatment access increasingly becoming a reality — it is unarguably the most unexplored terrain of our international response. For it is only with the concerted effort and coordinated involvement of the sexual and reproductive health community that the lofty Millennium Development Goals; the UN General Assembly's Special Session on HIV/AIDS Commitments; the '3 by 5' targets; and even new modalities of reducing HIV/AIDS-related stigma, will be achieved. The mainstreaming of HIV/AIDS is perhaps not only an untapped avenue, but it also has the potential to awake the full potential of a by-and-large under used resource. Getting there, however, would involve a change in mind-set of all the role players involved. A 'business as usual' approach that does not move beyond rhetoric will have damning consequences. The exceptionality of HIV/AIDS as a largely sexually transmitted infection requires an exceptional response — especially from sexual and reproductive health providers. (excerpt)
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  19. 19

    Prevention of HIV in infants and young children. Review of evidence and WHO's activities.

    World Health Organization [WHO]. Department of HIV / AIDS

    Geneva, Switzerland, WHO, 2002. [6] p. (WHO/HIV/2002.08)

    HIV among children is a growing problem, particularly in the countries hardest hit by the AIDS epidemic. The overwhelming majority of infected children acquire the infection through mother-to-child transmission. Prevention of HIV infection in infants and young children is now a high priority and has been the rallying point for enhanced prevention efforts. While HIV infection among infants is a problem all over the world, it is most acute in sub-Saharan Africa, where almost 90% of all HIV infected children live. HIV/AIDS is wiping out years of progress in improving child survival. It is already responsible for substantially increasing the mortality rates of children under 5 years of age, which could double in some countries by the year 2010 due to the impact of AIDS. (excerpt)
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  20. 20

    Review of field experiences: integration of family planning and PMTCT services.

    Rutenberg N; Baek C

    New York, New York, Population Council, 2004 Apr. 40 p.

    Preventing unintended pregnancy among HIV-positive women through family planning services is one of the four cornerstones of a comprehensive program for prevention of mother-to-child HIV transmission (PMTCT). Reducing unintended pregnancies among HIV-positive women through family planning reduces the number of children potentially orphaned when parents die of AIDS-related illnesses. It also reduces HIV-positive women's vulnerability to morbidity and mortality related to pregnancy and lactation. In addition, family planning for both HIV-positive and -negative women safeguards their health by enabling them to space births. The global public health community––NGOs, governments, and international donors–– has mobilized to design and provide essential PMTCT services: voluntary counseling and testing (VCT), infant feeding counseling, outreach to communities and families, and a short course of antiretroviral therapy. In most cases, the implementation approach has been to incorporate PMTCT into services that already reach pregnant women and women of childbearing age: antenatal care, obstetrical care, and maternal/child health. Yet the complexity of introducing PMTCT into the real world—that is, existing health services in resource-poor settings—soon became clear. Population Council and its research partners have been addressing several key questions about PMTCT services and how well they function in field settings. This report reviews field experiences with the integration of family planning and PMTCT services. It is hoped that this review will provide evidence and information for developing effective strategies for appropriately promoting family planning within PMTCT programs. (excerpt)
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  21. 21

    Violence against women and HIV / AIDS: setting the research agenda. Meeting report, Geneva, 23-25 October 2000.

    World Health Organization [WHO]. Department of Gender and Women’s Health

    Geneva, Switzerland, WHO, Department of Gender and Women's Health, 2001. 62 p.

    The meeting brought together researchers, activists and policy makers working in the area of violence against women and HIV/AIDS in low and middle-income countries to: 1. Discuss current research activities in the area of violence against women and HIV/AIDS; 2. Identify key research questions (epidemiological, social/behavioural, clinical and intervention related) related to the connections between domestic and sexual violence against women and HIV/AIDS in different regions and among different age and population groups; 3. Identify opportunities to integrate issues of violence into ongoing HIV/AIDS research activity, and vice-versa; 4. Discuss methodological, ethical and safety issues associated with conducting research in relevant areas of violence against women and HIV/AIDS, including provision of post-exposure prophylaxis (PEP) to rape survivors; 5. Make recommendations/proposals for a research agenda to address violence against women and HIV/AIDS. (excerpt)
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  22. 22
    Peer Reviewed

    Nevirapine to prevent mother-to-child transmission of HIV-1 among women of unknown serostatus.

    Stringer JS; Rouse DJ; Sinkala M; Marseille EA; Vermund SH

    Lancet. 2003 Nov 29; 362(9398):1850-1853.

    Each year, about 2 million babies are born to HIV-1- infected women. Despite widespread knowledge of proven methods to prevent mother-to-child transmission (MTCT) of the virus, most infants at risk of contracting the infection from their mothers receive no prophylactic intervention. This inaction leads to the infection and ultimate death of about 800 000 children per year. It has been known since 1994 that MTCT is largely preventable, and interventions appropriate for use in the developing world have been available since 1999. Singledose intrapartum and neonatal nevirapine—the simplest and perhaps most effective of the short-course antiretroviral regimens studied—has been available free of charge from the manufacturer since 2000. Nevertheless, few women have access to MTCT-prevention services. In the more than 3 years since its inception, the donation programme has shipped only 189 000 courses of the drug, a tiny fraction (<5%) of the estimate worldwide need. Why this feasible10 and cost-effective intervention has failed to reach so many of the women and infants who need it is a difficult question with no simple answers. Whatever the reasons, we believe that the continued low level of coverage of MTCT-prevention services is no longer acceptable from either a public health or a humanitarian perspective. We argue for a goal-directed approach to scaling-up of such services, in which we first acknowledge that the guiding objective should be to save babies from HIV-1 infection. To meet this objective, it will be necessary in many settings to dissociate the complex business of expanding HIV-1 testing services from the simpler matter of providing nevirapine prophylaxis. (author's)
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  23. 23

    HIV and infant feeding. A UNICEF fact sheet.


    New York, New York, UNICEF, 2002. [2] p. (UNICEF Fact Sheet)

    Approximately one third of infants born to HIV-infected mothers will contract the virus. Without preventive interventions, transmission of the virus occurs during a mother’s pregnancy or during childbirth or breastfeeding. Without interventions, about 15 to 30 per cent of children become infected during pregnancy or delivery; about 10 to 20 per cent contract the virus through breastmilk if breastfed for two years. An estimated 800,000 children under the age of 15 contracted HIV in 2001, about 90 per cent of them through mother-to-child transmission (MTCT). The risks of HIV infection have to be compared with the risks of illness and death faced by infants who are not breastfed. Breastfeeding provides protection from death due to diarrhoea and respiratory and other infections, particularly in the first months of life. During the first two months, a child receiving replacement feeding is nearly six times more likely to die from these infectious diseases, compared to a breastfed child. Breastfeeding also provides complete nutrition, immune factors and the stimulation necessary for good development, and it contributes to birth spacing. (excerpt)
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  24. 24

    Mother-to-child transmission of HIV. A UNICEF fact sheet.


    New York, New York, UNICEF, 2002. [2] p. (UNICEF Fact Sheet)

    Without preventive interventions, approximately 35 per cent of infants born to HIV-positive mothers contract the virus through mother-to-child transmission. In 2001, 800,000 children under the age of 15 contracted HIV, over 90 per cent of them through mother-to-child transmission. Infants can become infected during pregnancy, childbirth or breastfeeding. Some 15-20 per cent of infant infections occur in pregnancy, 50 per cent occur during labour and delivery, while breastfeeding accounts for a further 33 per cent of infant infections. Sub-Saharan Africa is home to 90 per cent of the world’s HIV infected children. Most of the 580,000 children under the age of 15 who died of HIV/AIDS in 2001 were African. For mothers living with HIV/AIDS, especially in developing countries, the decision on whether or not to breastfeed is a frightening dilemma. Infants not infected during pregnancy and childbirth, whose mothers are HIV positive, face a 10-15 per cent chance of acquiring HIV through breastfeeding, depending on how long they are breastfed. The use of breastmilk substitutes reduces this risk, but can expose them to other dangerous health risks, including diarrhoea. Many mothers in developing countries cannot afford breastmilk substitutes and lack access to clean water, which is essential for their safe preparation and use. A mother living with HIV/AIDS therefore faces many grave difficulties: worries about her own health and survival; the risk of infecting her baby through breastmilk; and the danger that her baby will develop other health problems if she does not breastfeed. (excerpt)
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  25. 25

    Building technical knowledge -- thematic priorities. Mother-to-child transmission.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    [Unpublished] [2000]. [4] p.

    The transmission of HIV from mother-to-child represents a major cause of illness and death among young children, particularly in developing countries with a high prevalence of HIV infection. In addition, AIDS threatens to reverse many years of steady progress in child survival that has been achieved through measures such as the promotion of breast-feeding, immunization and oral rehydration. In response to this situation, three of UNAIDS cosponsors: UN Children's Fund, WHO and UN Population Fund have been involved in developing interventions to prevent mother to child transmission of HIV and constituted an Inter-Agency Task Team. A strategic option paper, guidelines on infant feeding and guidelines on voluntary HIV testing for pregnant women in high HIV prevalence countries are included in the document section of this paper. Also mentioned are the implementing strategies for preventing mother-to-child transmission of HIV, which Country Program Advisers and cosponsor field staff should be aware of.
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