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  1. 51

    Global strategy for infant and young child feeding.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2003. vi, 30 p.

    The Executive Board of the World Health Organization, at its 101st session in January 1998, called for a revitalization of the global commitment to appropriate infant and young child nutrition, and in particular breastfeeding and complementary feeding. Subsequently, in close collaboration with the United Nations Children’s Fund, WHO organized a consultation (Geneva, 13–17 March 2000) to assess infant and young child feeding practices, review key interventions, and formulate a comprehensive strategy for the next decade. Following discussions at the Fifty-third World Health Assembly in May 2000 and the 107th session of the Executive Board in January 2001 of the outline and critical issues of the global strategy, the Fifty-fourth World Health Assembly (May 2001) reviewed progress and requested the Director-General to submit the strategy to the Executive Board at its 109th session and to the Fifty-fifth World Health Assembly, respectively in January and May 2002. During their discussion of the draft of the global strategy, members of the Executive Board commended the setting in motion of the consultative, science-based process that had led to its formulation as a guide for developing country-specific approaches to improving feeding practices. They also welcomed the strategy’s integrated and comprehensive approach. Several members made suggestions with regard to the exact wording of the draft strategy. These suggestions were taken carefully into account in preparing the strategy, as were comments from Member States following the Board’s 109th session and observations of other interested parties, including professional associations, nongovernmental organizations and the processed-food industry. Stressing the validity of a well-structured draft, the Executive Board recommended that the Health Assembly endorse the global strategy and that Member States implement it, as appropriate to national circumstances, in order to promote optimal feeding for all infants and young children. (excerpt)
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  2. 52
    Peer Reviewed

    China to offer free HIV testing and treatment.

    Koralage N

    BMJ. British Medical Journal. 2004 Apr 24; 328(7446):[2] p..

    The Chinese government is to offer free HIV tests and treatments to those who cannot afford to pay. The policy includes free antiretroviral drugs, testing, prevention of mother to child transmission, and schooling of orphans. Joel Rehnstrom, country coordinator of UNAIDS China, said he was “very encouraged by the commitment of central government in China to provide free testing and treatment.” He added, however, that there would no doubt be setbacks: “I believe it will be an enormous challenge to provide free testing and treatment across China. My sense is that every country in the world should probably have woken up earlier to HIV/AIDS. China is no exception.” UNAIDS (the Joint United Nations Programme on HIV/AIDS) has been involved with the scheme, including the development of guidelines for testing, voluntary counselling, and antiretroviral treatment. According to the state controlled Chinese media, the central government will fund the scheme in areas with a high prevalence of HIV—for example, Yunnan and Sichuan in the south west. Areas not covered by central government will be funded by local governments. (excerpt)
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  3. 53
    Peer Reviewed

    Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?

    Papathakis PC; Rollins NC

    Bulletin of the World Health Organization. 2004 Mar; 82(3):164-171.

    Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/ UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8–60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended a-linolenic acid per 450 ml mixture. It took 21–25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30–35 minutes for the fresh milk preparation. PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%. No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months. Commercial infant formula is the only replacement milk that meets all nutritional needs. Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed. If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and a-linolenic acids, and additional vitamins and minerals. (author's)
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  4. 54
    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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  5. 55

    Accelerating action against AIDS in Africa.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2003 Sep. 74 p. (UNAIDS/03.44E)

    This report provides a snapshot of the action being taken across the African continent in response to the challenge of AIDS. It highlights governments working with all their ministries to deliver a full-scale response. It demonstrates progress in closing the gaps in the provision of HIV prevention and treatment. It shows the value of partnership between government, communities and businesses. It showcases the determination of African women to throw off the disproportionate burden that AIDS represents for them. And it makes manifest the voice of hope, in the many successful responses by young people in fighting the epidemic. (author's)
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  6. 56

    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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  7. 57

    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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  8. 58
    Peer Reviewed

    HIV-positive mothers in Uganda resort to breastfeeding.

    Wendo C

    Lancet. 2003 Aug 16; 362(9383):542.

    An increasing number of mothers with HIV in Uganda are breastfeeding their babies after UNICEF stopped donating free infant formula. Doctors implementing the prevention of mother-to-child HIV transmission (PMTCT) project said on Aug 7 that most of the women could not afford infant formula. “They have a choice of whether to breastfeed or buy infant formula”, said Saul Onyango, national PMTCT coordinator. (excerpt)
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  9. 59

    WHO briefing notes for UNGASS on HIV / AIDS. Prevention of mother-to-child transmission of HIV infection: WHO's activities.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, [2001]. [5] p.

    This document presents the efforts of WHO in preventing mother-to-child transmission (MTCT) of HIV infection. It reports that the WHO and its partners have put forward a framework for action to prevent MTCT, and will be issuing a strategy paper based on an extensive review of the evidence and the development of consensus on country needs.
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  10. 60

    HIV / AIDS in the Caribbean: issues and options.

    Marquez PV; Sierra VH; Gayle J; Crown R; Griffin C

    Washington, D.C., World Bank, 2001. xvii, 75 p. (World Bank Country Study)

    This report provides an overview of the challenges and opportunities in addressing the problem of HIV/AIDS in the Caribbean. It presents a snapshot of the HIV/AIDS epidemic in the region, offers examples of ways in which Caribbean countries and regional bodies such as the Caribbean Community have responded to the epidemic, discusses alternative actions for addressing the crisis, highlights a range of strategies for donor coordination and cooperation in the region, and identifies the potential role of the World Bank in addressing the HIV/AIDS epidemic in the Caribbean.
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  11. 61

    Early breastfeeding cessation as an option for reducing postnatal transmission of HIV in Africa: issues, risks, and challenges.

    Piwoz EG; Huffman SL; Lusk D; Zehner ER; O'Gara C

    Washington, D.C., Academy for Educational Development [AED], 2001 Aug. 40 p.

    This document examines the recent WHO recommendations for modifying breastfeeding to reduce postnatal transmission of HIV in Africa. Specifically, it reviews the three-stage strategy for "modified breastfeeding" for HIV- positive mothers that involves exclusive breastfeeding followed by an early transition to exclusive replacement feeding. Organized into six chapters, this document also describes a step-by-step process for making the transition from exclusive breastfeeding to exclusive replacement feeding. However, many of the behaviors discussed in this review represent a major change in traditional infant care practices in Africa, and their feasibility and impact on child survival have yet to be determined. It is recommended, therefore, that these guidelines be subjected to additional research and testing before being implemented.
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  12. 62

    Cooperative project helps to prevent AIDS spread in Henan province.

    China Population Today. 2001 Dec; 18(6):13.

    To prevent more children from falling victims to AIDS, a project will soon be implemented by UN International Children's Emergency Fund in collaboration with the Ministry of Health of China and Henan Provincial Health Division, in Shihe District of Xinyang City and Shangcai County of Zhumadian City, Henan Province. The project is focused on intervention of AIDS transmission from mother to baby. Mother-to-baby is one of the major channels for AIDS transmission. In the early 1990s, driven by profits, some organizations and individuals began to engage in illegal and tainted collection and trade in blood and blood products, which gave rise to the rapid proliferation of AIDS among blood donors. According to the Ministry of Health, since 1995, local health departments have conducted seven special surveys and identified Wenlou Village of Shangcai County as the village worst struck by AIDS. This project will provide counseling among target groups about HIV antibiotic tests, provide drug therapy to women tested positive to HIV during antenatal, childbirth and postnatal periods, and follow up with babies born to women tested positive to HIV. Breast-feeding is not recommended for such women. (full text)
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  13. 63

    HIV and infant feeding.

    Progress in Reproductive Health Research. 2000; (55):8.

    Evidence has grown that HIV can be transmitted through breast milk. Based on WHO and UNAIDS estimates, a child has 20% risk of infection when breast-fed by an HIV-positive mother. In this respect, UNAIDS, WHO, and UNICEF issued a joint policy statement on HIV and infant feeding, which states that breast-feeding should be upheld irrespective of HIV infection rates. The three agencies issued guidelines on HIV and infant feeding in 1998, calling for promotion of breast-feeding among mothers who are HIV-negative or of unknown HIV status. In October 2000, a WHO Technical Consultation was organized by the Programme on behalf of the UNAIDS/UNICEF/UNFPA/WHO Interagency Task Team on the Prevention of Mother-to-Child Transmission of HIV, concluding that 1998 guidelines should remain valid. For HIV-positive women who choose to breast-feed, exclusive breast-feeding is recommended for the first months of life and should be discontinued when an alternative form of feeding becomes feasible. The consultation also concluded that the benefit of decreasing mother-to-child HIV transmission with antiretroviral drug regimens greatly outweighs concerns related to development of drug resistance.
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  14. 64

    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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  15. 65

    A changing emphasis for feeding choices for HIV seropositive mothers in East, Central and Southern Africa.

    Pillay K

    SOCIETES D'AFRIQUE ET SIDA. 1997 Jul-Oct; (17-18):12-4.

    Since the first descriptions that HIV-1 can be transmitted from mother to infant by breast-feeding, infant feeding practices in HIV-1 seropositive mothers had to be re-evaluated. In developed countries, public health policies recommend artificial feeding. A workshop sponsored by the South African Department of Health and the World Bank in collaboration with the Department of Pediatrics & Child Health, University of Natal and the Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa was held in Durban, South Africa (May 20-21, 1996) to address the question on breast-feeding infants with seropositive mothers. The presentations of the program included the epidemiology of mother to infant transmission of HIV with special emphasis on breast-feeding, the biological aspects of HIV transmission through breastmilk, a review of international studies on breast-feeding and mother to infant transmission of HIV and an exploration of the potential impact of breast-feeding on interventions against mother to child transmission of HIV by antiretrovirals. Thus, a shift in emphasis on the question of feeding choices for HIV seropositive women in developing and intermediate income countries has occurred. However, this statement has yet to be converted into policy.
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  16. 66

    Breastfeeding and complementary feeding. Summary.

    United Nations. Administrative Committee on Coordination. Sub-Committee on Nutrition. Working Group on Breastfeeding and Complementary Feeding

    SCN NEWS. 1999 Jul; (18):7.

    Eight issues were discussed by this Working group and recommendations included in the following. All implementing agencies should adopt a rights-based approach to all of their infant feeding programs; and an intersectoral rights-based approach to child survival growth and development should be adopted by all implementing bodies. Regarding maternity legislation, it was requested that the Sub-Committee on Nutrition (SCN) Secretariat use its good offices to approach the new Director General of International Labor Organization and express concern over the process towards the re-negotiation of the Maternity Protection Convention. The Benefits of Breastfeeding Model (BOB) for assessing the economic value of breastfeeding should be used more widely to advocate for the introduction and strengthening of breastfeeding policies and programs. The Breastfeeding Counseling training course and its complementary feeding component needs to be more widely implemented, particularly in countries affected by the HIV epidemic to counter the tendency to abandon breastfeeding protection, promotion and support. In the context of mother-to-child transmission (MTCT) of HIV, global implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly resolutions needs to be accelerated and strengthened. UN Children's Fund should prepare a briefing note explaining the continued relevance of the Code in the context of prevention of MTCT of HIV, explaining particularly the provisions concerning free and low cost supplies. It was recommended that additional research is needed on the relative safety of exclusive breastfeeding, on the effects of the alternative feeding options proposed in connection with MTCT of HIV on children's health and family well-being, and specifically on how mothers cope in practice using various feeding options. In all preventive MTCT initiatives, infant feeding practices and their effects on children's health need to be more closely monitored. (full text)
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  17. 67

    The development and evaluation of an intervention to inform and counsel Zimbabwean women about HIV transmission through breastfeeding. A study by the ZVITAMBO Project, Johns Hopkins University School of Hygiene and Public Health, the Support for Analysis and Research in Africa (SARA) Project and the LINKAGES Project at the Academy for Educational Development.

    Academy for Educational Development [AED]. Breastfeeding, LAM, Complementary Feeding, and Maternal Nutrition Program [LINKAGES]

    Washington, D.C., AED, LINKAGES, [2000]. [2] p.

    In 1998, the policy recommendations of UN organizations regarding breast-feeding shifted, following reports of evidence that HIV can be transmitted from infected mothers to their babies during breast-feeding. From a recommendation in the early 1990s that all babies in developing countries should be breast-fed, the UN recommends that HIV-positive women be fully informed about various feeding options and supported in their individual decisions about how to feed their babies. With a view of this recommendation, the Zimbabwe Vitamin A for Mothers and Babies Project (ZVITAMBO) was developed. This Project is a large clinical trial being conducted in Harare to assess the impact of a large dose of vitamin A provided to mothers and/or newborn babies on infant mortality, new HIV infections among postnatal women, and HIV transmission through breast-feeding. It also explores ways to fully inform pregnant and early postnatal women about the risks and benefit of breast-feeding, mixed feeding, and replacement feeding for infant health and mother-to-child transmission of HIV. Results from the qualitative and quantitative studies conducted by ZVITAMBO will provide guidance to the government of Zimbabwe and other agencies about how best to counsel women about infant feeding in the context of high HIV prevalence.
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  18. 68

    The milk of human kindness. How to make a simple morality tale out of a complex public health issue.

    Yamey G

    BMJ. British Medical Journal. 2001 Jan 6; 322(7277):57-8.

    On December 5, 2000, the Wall Street Journal ran a lead news story and an accompanying editorial claiming that donations from baby food manufacturers would stop the mother-to-child transmission of HIV. The article contended that the UN Children's Fund's (UNICEF) feud against the formula industry was to be blamed for allowing AIDS to spread, especially in sub-Saharan Africa, and for killing millions of children. In 6 days, the American dailies had taken a highly contentious health issue and turned it into a battle between the corporations and the international health agency. Despite assaults from the media, as well as from several UN officials, UNICEF remains firm in its stance against accepting donations. Carole Bellamy, executive director of UNICEF, explained that a rush to promote formula feeding could lead to the spread of other infectious diseases. Bellamy notes that if formula is to be used, it needs to be done in a targeted manner. Moreover, Bellamy argued that the paper failed to acknowledge that UNICEF is leading the way in addressing mother-to-child transmission. WHO officials also expressed frustration at the paper for implying that formula donations were the easy answer to the difficult HIV/AIDS crisis. However, the Wall Street Journal rejected the powerful criticisms it has received from the international community and has made no apologies for the story and the hard-hitting editorial.
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  19. 69

    Mother-to-child transmission intervention.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]. Intercountry Team for Eastern and Southern Africa

    SAfAIDS NEWS. 1998 Sep; 6(3):13.

    HIV is contributing substantially to rising child mortality, especially in Africa, Asia, and Latin America. In view of such, the Joint UN Programme on HIV/AIDS (UNAIDS) introduces the mother-to-child package designed to help HIV-positive mothers increase their chances of having a healthy child. This public health initiative aims to offer voluntary and confidential HIV counseling and testing to pregnant women and provides antiretroviral drugs, better birth care, and safe infant feeding methods to HIV-infected women. The UNAIDS Secretariat together with its collaborating cosponsor agencies, the UN International Children's Emergency Fund and the WHO, assists countries to deliver the package within the broader context of HIV prevention measures that help girls and women stay uninfected, and better access to care for infected women and their families. However, with the high cost of delivery, this initiative calls for action by an array of partners including governments, health care managers, and communities.
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  20. 70

    Zidovudine to prevent mother-to-infant HIV transmission in developing countries: any questions? [editorial]

    Van der Stuyft P; Boelaert M; Temmerman M

    Tropical Medicine and International Health. 1998 Sep; 3(9):689-90.

    The 12th World AIDS Conference in Geneva, Switzerland, held last June 28 to July 3, 1998, pursued the noble aim of bridging the HIV control/AIDS care gap between the developing and developed world. The collaboration of three organizations, namely, the Joint UN Program on AIDS/HIV, the UN Children's Fund, and the WHO, took an initiative to reduce mother-to-child perinatal HIV transmission in developing countries. It will seek support to provide a short zidovudine regimen to 30,000 HIV-infected pregnant women living in 30 project areas in 11 pilot countries. The cost of drugs under the proposed short regimen seems promising, some US$50 per treatment course. However, for the short zidovudine regimen to be effective, at least one antenatal visit is needed before 34-36 weeks of gestation. At that moment pregnant women should have access to voluntary and nonstigmatizing HIV testing. In less developed countries unjust distribution of global health services is prominent. Thus, several ethical problems concerning equity, sustainability, development, and women's and patients' rights remained to be considered in developing countries.
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  21. 71

    Effect of zidovudine on perinatal HIV-1 transmission and maternal viral load [letter]

    Golden B; Cooper E; Cundall D; Moy R

    Lancet. 1999 Jul 10; 354(9173):158-9.

    The International Child Health Group of the Royal College of Pediatrics and Child Health is displeased with the UNAIDS, UNICEF, and WHO policy statement endorsing the artificial feeding of infants. The statement holds that with nutritionally adequate breast milk substitutes safely prepared and fed to the infants of mothers with HIV infection, the infants are at less risk of morbidity and mortality than if they were breast-fed. This global policy has more potential to harm than help, for women in extremely poor and unsuitable settings may wrongly decide to adopt bottlefeeding. The better strategy is to promote exclusive breast-feeding for 4-6 months. Efforts should also be made to reduce the vertical transmission of HIV by increasing the use of short-course zidovudine wherever feasible. Further efforts should be made to address the factors which contribute to HIV infection and prevent social and economic development.
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  22. 72
    Peer Reviewed

    AIDS therapy. Controversial trial offers hopeful result.

    Marshall E

    SCIENCE. 1998 Feb 27; 279(5355):1299.

    A US-funded, placebo-controlled clinical trial in Thailand has found that a brief, relatively inexpensive course of the antiretroviral drug AZT given during the final weeks of pregnancy can reduce the transmission of HIV from mothers to their newborn infants. Plans are now being developed to make the therapy available to thousands of HIV-infected women in the developing world. Main findings of the Thai study were released on February 18, 1998. Researchers conducted the trial to assess whether the provision of AZT orally to pregnant HIV-infected women for 4 weeks before going into labor would reduce the amount of HIV they passed onto their children. AZT was already known to be effective in reducing HIV transmission when given in a more complex and expensive regimen, but the short regimen costs only one-tenth that of standard treatment. In order to obtain clear results, half of the women received AZT and the other half a sugar tablet placebo. Preliminary data indicate that the level of HIV transmission fell from 18.6% in the placebo group to 9.2% in the AZT test group. The short-course AZT regimen therefore proved to be well tolerated and effective in women who did not breast-feed. Despite critics' complaints that the placebo-controlled nature of the trial was both unethical and unnecessary, evaluation of the therapy against a placebo enhanced the statistical power of the study, yielded rapid results, gave health officials confidence to recommend the broad use of the therapy, and fostered the recommendation that other placebo-controlled trials be changed.
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  23. 73

    Report on the global HIV / AIDS epidemic.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    [Geneva, Switzerland], UNAIDS, 1998 Jun. 75 p.

    Estimates by the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization indicate that, by the beginning of 1998, 30.6 million people were infected with HIV and 11.7 million HIV-related deaths had occurred. During 1997, 5.8 million new HIV infections were reported and 2.3 million people died of AIDS. Also in 1997, almost 600,000 children were infected with HIV, primarily through their mothers before or during birth or through breast feeding. At present, there are 8.2 million AIDS orphans. 89% of people with HIV live in sub-Saharan Africa and the developing countries of Asia, which together account for less than 10% of the global gross national product. It will be a long time before the benefits conferred by combination antiretroviral therapy will be experienced in developing countries. Well-designed, carefully targeted prevention campaigns have been able to arrest or reverse HIV trends, however. The most effective campaigns work simultaneously on many levels, each initiative reinforcing the others. This UNAIDS report presents global estimates of the HIV/AIDS epidemic by the end of 1997 and summarizes current knowledge on AIDS orphans, the evolution of the AIDS epidemic in each world region, prevention efforts, injecting drug use and HIV, preventing sexual transmission of HIV among youth, HIV testing, HIV and mortality, treatment regimens, vertical transmission, and HIV/AIDS estimation techniques and indicators.
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  24. 74

    Glaxo's AZT announcement welcomed, but detail is yet to follow. mother-to-child transmission.

    Worthington H

    AIDS ANALYSIS AFRICA. 1998 Apr; 8(2):2.

    Following recently completed trials of AZT in Thailand among pregnant women which showed that a short course of AZT can significantly reduce the mother-to-child transmission of HIV, Glaxo Wellcome recently announced that it will supply the antiretroviral drug AZT at a preferential price for pregnant women infected with HIV in developing countries. Since the size of the HIV/AIDS epidemic and the quantity of AZT needed cannot be predicted, Glaxo Wellcome has stated that it is unfeasible to implement a mass donation program of the drug. The preferential public sector pricing was instead arrived at after 3 years of discussions and collaboration with UNAIDS, governments, and nongovernmental organizations (NGOs). Glaxo and UNAIDS both agree that the pricing will be a price reduction and not a subsidy, but additional details remain unclear. Eligible countries will be defined according to World Health Organization guidelines, with UNICEF likely to play a key role in the AZT's distribution.
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  25. 75

    Prevention of congenital syphilis: an outline for prevention and control.

    World Health Organization [WHO]. Global Programme on AIDS. Programme of Sexually Transmitted Diseases

    [Unpublished], 1993. Background paper for Informal Technical Working Group Meeting on STD Activities in GPA, Geneva, Switzerland, February 15-17, 1993. 28 p.

    Although preventable, congenital syphilis remains a major health problem worldwide. In many developing countries, maternal syphilis is a common cause of fetal loss, stillbirth, prenatal mortality, and congenital abnormalities. The most important contributing factor for congenital syphilis is poor prenatal care. If pregnant women are serologically screened and maternal syphilis is adequately treated, the risk to the infant becomes minimal. Most developing countries provide antenatal care, but the opportunity to address the issue of syphilis and its consequences in pregnancy has been poorly seized. Guidelines are presented on the prevention and control of syphilis in pregnancy with the goal of preventing congenital syphilis. The epidemiology and natural history of syphilis, whether preventing congenital syphilis is cost-effective, the objectives of controlling syphilis in a pregnancy program, strategies, situation analysis, intervention and support, monitoring and evaluation, and program management are discussed.
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