Over 90% of HIV infection in children is acquired by transmission from mothers to their babies. However, this does not mean that HIV is a death sentence for a mother or her child.
Mother-to-child transmission is the greatest source of HIV infection in young children. One in three pregnant women are HIV positive and it has been estimated that 50 000 HIV positive babies are born in South Africa each year. Most infected babies acquire HIV close to delivery or when they are breastfed.
However, modern drugs are very effective in preventing HIV transmission from mother to baby. Combined with good antenatal care, a healthy eating plan and gentle exercise, you and your baby can have a great future together.
How is HIV transmitted from a mother to her unborn baby?
Most HIV positive women give birth to an HIV negative baby
An HIV positive woman can transmit the virus to her baby during pregnancy, labour, delivery and through breastfeeding. Dr Vivian Black, maternal HIV expert at the Reproductive Health and HIV Research Unit in Johannesburg, says if the right procedures are followed, the chances of a baby becoming infected with HIV are actually very low. “Many people have the perception that an HIV positive mother will always give birth to an HIV positive child, but this is not the case, as the sperm and egg are not infected with HIV. The risk of transmitting the virus in utero is low, as there is no direct contact between the mother and baby and no blood actually passes from the placenta to the foetus unless the mother-to-be has a placental infection or is injured.”
Black adds that most HIV positive women give birth to an HIV negative baby, but a mother will only know her baby’s HIV status once he has been tested.
The risk of transmission of HIV from mother to child
Modern drugs have proven very effective in preventing HIV transmission during pregnancy, labour and delivery. “If no preventative drugs are taken and breastfeeding is excluded, the risk of transmission of HIV from mother to child is about 20%,” explains Black. “If the mother breastfeeds or mixes breastfeeding and formula feeding, the risk of transmission increases by about 10 to 15%.” Black says a complete course of anti-HIV medication, known as antiretrovirals (ARVs), starting from early pregnancy, and formula feeding, can reduce the risk of mother-to-child transmission to less than 2%.
Is it safe to take ARVs during pregnancy?
Thousands of women have taken ARVs during pregnancy without causing harm to their babies. The treatment has resulted in many babies, who might otherwise have been born infected, being born HIV negative.
Black says if a pregnant woman receives good antenatal care and takes the relevant steps to optimise her health, adverse affects on her pregnancy or her unborn baby are minimal, if any. The benefit of preventing HIV infection in the baby by using ARVs in pregnancy far outweighs the minimal risk of adverse effects on the pregnancy or the unborn child. “If a pregnant woman is not in optimal health and receives no antenatal or obstetrics care, there is a risk of her having a miscarriage, a stillbirth or her baby being born premature.”
Testing for HIV
Voluntary counselling and testing must be available to all pregnant women. The benefits of knowing your HIV status when you are pregnant will allow you to make informed choices about feeding your baby and treatment options for both of you. Finding out your status and going for counselling will also help you to accept your HIV status and help you to overcome any social issues you may have regarding this.
Black believes that every pregnant woman should include HIV in her antenatal screen tests. “Many women don’t test for HIV because they don’t believe they are at risk or don’t feel ill, but it is very important that they get tested. A woman can live with HIV for years and not even know it.”
Text by Xanet Van Vuuren, Photographs by Sally Chance Taken from the November 2009 edition Living and Loving
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