Finally this is being addressed by aid agencies. This week in Barcelona a $50-million programme was announced to ensure that HIV positive mothers in eight countries — including three sites in South Africa — are given anti-retroviral drugs to ensure their survival after the births of their babies.
The MTCT-Plus programme, to be run by Columbia University in New York, will offer life-long care and treatment ‘ including anti-retroviral drugs where necessary ‘ to HIV positive mothers who have been through MTCT programme, their partners and infected children.
This means that mothers in the Medicins sans Frontieres programme in Khayelitsha and at programmes managed by Wits and Natal universities will for the first time be able to get the drugs and care to save themselves.
“By offering treatment to parents living with HIV/AIDS, this programme will help to ensure that thousands of children grow up nurtured and cared for by their families,” said Dr Helene Gayle of the Gates Foundation, one of the programme’s nine sponsors.
South African actuarial studies show that if anti-retroviral drugs are made available to parents in our country, this will halve the number of orphans by 2014 ‘ meaning that we will have one rather than two million orphans.
Columbia’s Professor Wafaa El-Sadr said the programme represented a “life-long commitment” to the families who enrolled as “there is no ethical way that we could stop treatment if it is needed”.
Uganda’s Beatrice Were of the International Organisation of Women living with HIV, said that until now she had been too afraid to test her eldest two children for HIV as she could not afford to treat them if they were HIV positive.
“I have lived with anxieties and worries, not knowing if my first two children are HIV positive or not,” said Were. “But I chose to live in denial, fearing that the truth would worsen my situation. Now I have hope I am prepared to test my children.”
There have been other exciting developments regarding MTCT coming out of Barcelona.
According to Dr Mary Glenn Fowler of the US Centres for Disease Control, a study from Thailand has shown that a combination of the drugs AZT and nevirapine for mothers and AZT for babies reduced the HIV transmission rate to 3,9%. Nevirapine alone, which is what is used in South Africa, cuts the transmission rate by up to 50%.
Fowler said that a short course of anti-AIDS drugs for mothers during pregnancy should also be considered as it reduced their viral loads and increase their CD4 counts (measure of immune-fighting white blood cells in the body), making it less likely that they would pass HIV to their babies. Mothers with a CD4 count of over 500 copies per millilitre of blood far less likely to transmit HIV to their babies than those with a CD4 count of under 500.
Meanwhile research presented yesterday (Thursday) by Dr Glenda Gray of Wits University’s Perinatal HIV Research Unit shows that giving nevirapine to babies only shortly after birth was as effective in blocking HIV transmission as giving the drug to both mothers and babies.This means it would be significantly cheaper and easier to give nevirapine to South African babies only, and it would also avoid the problem of possible drug resistance developing in mothers. This has been one of the concerns expressed by South Africa’s health ministry about the use of nevirapine only.
MTCT researchers continue to be concerned about the risk of HIV transmission via breastmilk. Fowler said that in a Kenyan study, 16% of babies born HIV negative were later infected via breastmilk a few months later.
But using formula feed in place of breastfeeding was more dangerous than HIV to babies living in places without clean running water. Thus, Professor James McIntyre, also of Wits University’s Perinatal HIV Research Unit, said companies needed to consider making ready-made long-life formula milk for women in such areas.