Elsevier

The Lancet

Volume 359, Issue 9323, 15 June 2002, Pages 2097-2104
The Lancet

AIDS in Africa
HIV-1/AIDS and maternal and child health in Africa

https://doi.org/10.1016/S0140-6736(02)08909-2Get rights and content

Summary

Every day, 1900 children acquire HIV-1 infection from their mother in Africa. The 25–45% risk of mother-to-child transmission can be reduced in several ways: prevention of sexual transmission for women of child-bearing age, access to HIV-1 testing, reduction of unwanted pregnancies by education of HIV-1-infected women, and antiretroviral-based prevention. All antiretroviral regimens of proven efficacy can be used in a minimum package of care for HIV-1-infected pregnant women. At present, programmes in 13 countries reach less than 3% of HIV-1-infected African women. 35–59% of African children infected with HIV-1 die by their second birthday. Infectious complications are preventable by primary prophylaxis with co-trimoxazole. A rapid scaling-up and comprehensive continuum of care is needed for all members of affected families, including access to antiretroviral treatment and community-based responses to the increasing number of orphans. Prevention of mother-to-child transmission should become a universal standard of care in Africa, and research should continue to reduce the transmission risk to well below 5%.

Section snippets

HIV-1/AIDS in women

In Africa, 55% of HIV-1-positive adults are women, all of child-bearing age.2 Data from antenatal clinics show that in several parts of southern Africa, more than 30% of pregnant women are infected with HIV-1.9 The fastest growth has been in South Africa, where the prevalence of infection in adults increased from 1% in 1990, to 25% in 2000. In west Africa, the adult rate exceeds 5% in Burkina Faso, Cameroon, Côte d'Ivoire, Nigeria, and Togo. Incidence of HIV-1 infection in Uganda, especially in

Prevention of mother-to-child transmission of HIV-1 infection

Mother-to-child transmission of HIV-1 can occur during pregnancy, delivery, and post-partum through breastfeeding. In observational cohort studies, the cumulative rates of transmission are between 25% and 45% of all children born to HIV-1-infected mothers in Africa compared with 10–30% in more-developed countries. This difference is greatly but not totally accounted for by the risk of postnatal transmission in populations in which breastfeeding is common.30

The risk of intrauterine transmission

HIV-1/AIDS in children

More than 95% of HIV-1-infected children acquired their infection from their mother: 700 000 will have become infected in 2001 and 500 000 will have died from HIV-1/AIDS.9 In stark contrast with children everywhere else in the world, children in southern Africa have a shorter life expectancy than their grandparents.68 In Zimbabwe, 70% of deaths in children younger than 5 years are due to AIDS.9 Mortality is estimated at 26–45% by the first birthday and 35–59% at 2 years.69, 70, 71, 72 Few

Prevention of mother-to-child transmission in practice and integrated care for the family

Research findings already provide a strong rationale for implementation of prevention of mother-to-child transmission interventions in resource-poor countries, especially in Africa.4, 5, 6 WHO regularly reviews data and considers all antiretroviral regimens of validated efficacy as possible options in the minimum package of care that must be provided for HIV-1-positive women and their children, and not restricted to pilot projects or research settings.77 Drug(s) should be chosen according to

Orphanhood and HIV-1/AIDS

Historically, largescale orphaning has been a sporadic, short-term problem caused by war, famine, or disease. HIV-1/AIDS has transformed it into a long-term chronic problem that will worsen in coming decades.93 More than 15·6 million children have lost their mother or both parents to AIDS or related causes worldwide. The 12·1 million African children who had lost their mother or both parents to the epidemic by the end of 2001 is forecast to more than double during the next decade.9 9% of

Conclusions

Mother-to-child transmission is largely preventable with interventions that are readily accessible to resource-poor countries: prevention of sexual transmission of HIV-1 for women of childbearing age, especially very young women; access to HIV-1 testing and reduction of unwanted pregnancies by HIV-1-infected women informed of their serostatus; and antiretroviral-based prevention of motherto-child transmission. Prevention of mother-to-child transmission is the most cost-effective antiretroviral

Search strategy and selection criteria

We searched PubMed and Current Contents Life Sciences for English and French publications using the keywords HIV infections, female, prevention and control, all child, disease transmission and vertical, foster home care, and orphans; and obtained further information from abstracts of scientific meetings, the internet, and personal communications with scientists.

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