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New lease for PMTCT

Returning the focus to an HIV prevention method that has been known to work for over a decade holds the key to not just eliminating paediatric AIDS, but putting South Africa on the road to achieving the Millennium Development Goals, reducing deaths among mothers and children, uplifting health systems and drawing men into HIV services.

The Prevention of Mother to Child transmission, or the prevention of vertical transmission as it is now known, has been given a new lease of life at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009) taking place in Cape Town this week.

A passionate Stephen Lewis, co-Director of AIDS-free world and former special advisor to the United Nations, fired the first salvo while speaking at the opening ceremony on Sunday when he turned his attention to the issue ‘€œcommonly known as PMTCT ‘€“ prevention of mother to child transmission.’€

‘€œThis should have been the easiest intervention of all, instead we’€™ve had a panorama of unnecessary death for both the mothers and their children. So-called PMTCT has been a colossal failure, subjected to twisted linguistics, lousy science, governmental chicanery, and astonishing delinquency on the part of the United Nations agencies. Only now is the political establishment coming to its senses. But it needs your help so that it never goes off the rails again,’€ said an emotional Lewis.

Lewis pointed out even now a dreadful double standard prevailed ‘€“ ‘€œIn the industrial world we used full HAART (antiretroviral therapy); in the developing world we still use, in the majority single dose nevirapine’€.

‘€œYou’€™re the scientists, you know what that means in terms of unnecessary infant infection and death,’€ he told the more than 5 000 delegates, mostly from outside of Africa.

Figures presented at IAS 2009 by the Elizabeth Glaser Pediatric AIDS Foundation’€™s Dr Christian Pitter showed that the vertical transmission rate (from the mother to child during birth) was over 30% when the mother’€™s CD4 count (measure of immune cells in her blood) was below 200.

This is compared to a transmission rate of just over 5% among mothers with CD4 counts of above 500. Those with a CD4 count of above 350 transmitted HIV in less than 10% of births.

By one year, over 25% of these HIV infected children are dead, with hospitals in South Africa recording rates closer to 40%.

 ‘€œThere is no doubt in my mind that if a women’€™s CD4 count is less than 350 that she needs to be put onto full antiretroviral therapy immediately,’€ said Dr Francois Venter of the Reproductive Health Research Unit in Johannesburg.

Lewis also accused the world of abandoning mothers. ‘€œIn 2007, only 12 percent of pregnant women living with HIV identified during antenatal care, were assessed for their eligibility to receive ARV treatment.   That’€™s an unconscionable neglect of women that smacks of vestigial misogyny,’€ Lewis said.

Nicholas Hellmann, Executive Vice President of the Elizabeth Glaser Pediatric AIDS Foundation said that too many women were slipping through the cracks and that the critical message of keeping the mother alive beyond the PMTCT programme had to reach everyone from politicians to the ante-natal clinics where women access services while pregnant.

Lewis also turned his outrage to the confusing messages being sent out around infant feeding and he called on the United Nations to mount a massive global education campaign to replace myths with facts.

Speaking at yesterday’€™s plenary session Dr Louise Kuhn of Columbia University in the United States showed that 84% of postnatal HIV transmission happened among mothers with CD4 counts of less than 350 while they were breastfeeding ‘€“ the transmission rate among this group is 12%.

If these mothers were to be placed on full antiretroviral therapy the transmission rate could be reduced to 1%.

Kuhn’€™s research also showed that by promoting formula feed, the transmission of HIV was virtually eliminated, however the mortality rate among the HIV exposed babies remained unchanged.

Both South Africa’€™s health minister Dr Aaron Motsoaledi and deputy president Kgalema Motlanthe have made strong commitments towards improving South Africa’€™s floundering PMTCT programme which is lagging behind much lesser resourced African countries.

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Anso Thom