South Africa has had a prevention of mother-to-child HIV transmission (PMTCT) programme since 2003, yet it is only reaching an estimated one-sixth of pregnant, HIV positive women.


This means that thousands of babies are being infected each year as at least one in three pregnant women nationally was HIV positive by 2005 and around a third of HIV positive mothers transmit HIV to their babies.


‘€œSouth Africa is one of only nine countries in the world where the child mortality rate is increasing instead of decreasing, mainly as a result of HIV-related deaths,’€ revealed Professor Nigel Rollins, head of the Centre for Maternal and child health at the University of KwaZulu-Natal.


‘€œIn KwaZulu-Natal alone, 20 000 to 30 000 children are being infected with HIV each year and half of them will need antiretroviral drugs by the age of 12 months.


‘€œThere is no way that the health system will be able to meet the treatment and care demand for these children if this infection rate continues,’€ Rollins told a session convened by the United Nations children’€™s organisation, Unicef.


The health system is already failing to treat HIV positive children. By last year, only 21 000 children were getting ARVs out of an estimated 123 000 children who needed the medicine, according to Farai Dube from Enhancing Children’€™s HIV Outcomes.


Over six out of 10 children under the age of five who died in Durban last year showed clinical signs of HIV infection, yet ‘€œthe vast majority’€ did not have access to PMTCT or ARV treatment, according to Dr Kimesh Naidoo of King Edward Hospital.


The new National HIV/AIDS Strategic Plan aims to reduce the rate of mother to child transmission to 5% by 2011.


To do so, government needed to prioritise pregnant women with a low CD4 count (measure of immunity in the blood) who were most likely to transmit HIV to their babies, said Rollins.


These women should be treated with at least two antiretroviral drugs to reduce their infectiousness and ensure that they were well enough to look after to look their babies, he added.


At present, the PMTCT programme gives one dose of nevirapine to women when they are in labour and to their babies within 72 hours of birth.


‘€œWe will never cut the transmission rate to 5% with one dose of nevirapine. In the US and Europe, mother-to-child transmission has been reduced to around 2% with the use of two to three antiretroviral drugs,’€ said Dr Francois Venter, head of the SA HIV Clinicians’€™ Society.


‘€œIf we fix PMTCT, we don’€™t have to expand child HIV treatment.’€

A wide range of conference delegates pleaded for government to change the way that PMTCT was being implemented to reach more women. Among the proposals put forward were that:


  • PMTCT should be integrated into antenatal clinics and run by midwives and nurses instead of being a stand-alone programme run mainly by lay counsellors.
  • All antenatal clinics and hospitals should stock nevirapine.
  • Clinic staff should be involved in developing locally appropriate messages to encourage women to have HIV tests.