In rich countries antiretroviral treatment in pregnancy has been highly successful in reducing transmission of HIV from mother to child. James McIntyre and Glenda Gray examine whether the success of that treatment—and other strategies, such as changing infant feeding practices—can be repeated in poor countries, which lack both money and infrastructure

HIV infection and AIDS threaten to reverse the gains made in child survival through the more widespread use of childhood vaccines and improved management of diarrhoeal and acute respiratory infections. Although the use of antiretroviral prophylaxis has dramatically reduced mother to child transmission of HIV in the world's rich countries, the effects of these interventions on infant and child survival in poor countries remain undocumented. Our knowledge of the mechanisms and timing of transmission, associated risk factors, and successful methods to reduce the risk have improved over the past decade. Indeed we know how to reduce mother to child transmission of HIV in even the worst affected regions. 1 2

The World Health Organization has promoted a three pronged approach to reducing mother to child transmission: the prevention of (a) new infections in parents to be, (b) unwanted pregnancies in HIV infected women, and (c) transmission from an HIV infected mother to her infant. The focus to date has been on strategies to prevent transmission to the infant; much is known about these strategies, but the challenge remains in their implementation.