What Women must Know About PTCT - SAfAIDS

9
What a Woman or Girl Must Know
About Parent-to-child Transmission
What is parent-to-child transmission of HIV (PTCT)?
Parent to child transmission of HIV is when an infected mother passes the virus
to her baby. This is sometimes referred to as vertical transmission. Because
transmission occurs directly from an infected mother to the baby, it is commonly
called mother-to-child transmission. However, the term parent-to-child is
preferrable as it recognises the role of fathers in parenting and the transmission
of infection.
How can parent-to-child transmission be prevented or reduced?
Prevent primary infection
The most effective way to prevent PTCT is for
you and your partner to prevent yourself from
getting infected with HIV. Ideally partners or
individuals should be tested for HIV before
planning a pregnancy. Go for Voluntary
Counselling and Testing (VCT) as you plan
to get pregnant. If you are HIV negative, you
will be counselled on how to stay negative.
If you are HIV positive, use a reliable family
planning method so that you only get
pregnant when you have planned to do so.

If you are pregnant and are HIV negative, you
need to be counselled on safer sex practices
because you can get infected with HIV while
you are pregnant.
Reduce the amount of virus in your
body during pregnancy
Having a high amount of virus in your body increases
the chances of the virus being passed on to the
baby. Therefore, when you are pregnant, it is very
important that you do not get a high viral load.
You may be given ARV medicines in order to reduce
the amount of virus in your body. It is possible that
you might be given the ARV medicines only during
pregnancy or during labour. In most cases you get
Nevirapine, which is also given to the baby just
after delivery. You can also be started on a full
course of ART. It is important for you to talk to
your doctor and understand which course you are
on. Be involved in deciding the care that you receive.
Antenatal Care
Care given to a pregnant woman
is called Antenatal Care (ANC).
The aim of this care is to make
sure that you and the baby stay
healthy throughout pregnancy,
at delivery and afterwards.
Therefore this care is very important
to both HIV negative and HIV
positive women. As you go for
ANC, you need to inform the
doctor or midwife that you are
HIV positive so that you can discuss
the care that you receive during
pregnancy and plan for a safer
method of delivery. VCT can be
part of antenatal care so you may
find out that you are HIV positive
when you are already pregnant.
It is possible that you get pregnant while you are
already on a course of ARV medicines. DO NOT
STOP TAKING YOUR ARV MEDICINES because you
have found out that you are pregnant. As you
attend ANC, you need to inform the doctor or
midwife that you are taking ARV medicines so
that they are careful of what medicines to give
you as they attend to you. You also need to
inform the doctor who has been looking after
you that you are now pregnant so that ARV
medicine doses may be adjusted since you may
have gained weight because of the pregnancy.

Make sure not
to get infected with
HIV while you are
pregnant!!! Use male
or female condoms
each time you
have sex...
As part of ANC, you shall receive some iron
tablets and vitamins to make sure that you
have enough blood. You may also get injections
that help prevent tetanus. If you are HIV positive,
you will receive medicines that help you not to
get infected with TB, malaria and pneumonia.
Ask your doctor about all these medicines. As
pregnancy progresses, the baby inside you
should be growing, and should gain weight.
If you have weight loss or are not gaining
weight when you are pregnant, you should go
and see your health care provider. A healthy
diet is very important during pregnancy.
What should I eat?
While you are still pregnant, it is very important
for you to discuss with the doctor or counsellor
how you will deliver.
As you give birth, efforts are made to reduce
the chances of the baby getting into contact
with fluids that have the virus.
At birth, usually the baby passes through the
birth canal, which is made up of the vagina and
part of the womb called the cervix. This passage
always has some fluids. If you are HIV positive,
these fluids contain HIV. If the baby gets in
contact with the fluids, he/she may get infected.
You need to eat a balanced diet. The following
are food groups that you need to know about:
1. Energy giving foods – carbohydrates like
bread, cereals – maize, rice, wheat, potatoes.
2. Body building foods– foods with proteins
– meat, milk, beans, ground nuts, eggs.
3. Oils – foods that give extra energy – peanut
butter, margarine, cooking oil.
4. Protective foods – with vitamins and
minerals mainly fruits and vegetables (even
wild fruits and indigenous vegetables).
Eating a balanced diet is having food from
each food-group everyday. This helps women
who are HIV positive or HIV negative, stay
healthy and strong.
Baby in
womb
Backbone
Birth
canal

Efforts are made to make sure that the fluids
have very little virus by having you take ARV
medicines (short course taken as soon as labour
starts or the long course of ART). There is blood
involved in childbirth. Blood has HIV, so you
want as little blood as possible to be in contact
with the baby. At times, the choice can be that
the baby does not pass through the birth canal
at all. This is when the baby is born by an
operation called a Caesarean Section.
The following are factors that may increase
risk of transmission during labor:
· Vaginal delivery
· A long time after waters are broken, but
baby has not been delivered
· Heavy bleeding during delivery
· A delivery where some instruments are
used to assist the baby to come out
ARV medicines may interfere with some of the
medicines that are used in labour. Therefore
you should let health care staff know that you
are taking ARV medicines.
It is very important that you let the maternity
staff know that you are HIV positive so that your
baby gets special care.
After delivery
Before you get pregnant and or while you are
still pregnant, you need to get information about
the choices that you have on feeding your baby.
Although breast milk is the best feed for a baby,
it may not be safe for you to breast feed if you
are HIV positive. You need to discuss with your
counsellor what is best for your lifestyle.
As much as possible, involve your partner and
or someone supportive, in these discussions.
If you are HIV positive, breast milk contains
HIV and it is possible for the baby to get
infected with HIV while breast -feeding.
Chances of the baby getting infected through
breast feeding increase if any or some of the
following situations are happening:
· If the mother has a high viral load
· If the breasts have sores, cracked nipples,
are swollen and painful, have a boil
· If the baby is exposed to the virus in breast
milk for a long time- long duration breast
feeding ie breast feeding for over six months.
· If the baby is getting both breast milk as
well as other feeds like cow’s milk, powder
milk and so on
· If the baby has oral thrush
Talk to your counsellor or health care provider
about the choices that you have. Safer breastfeeding
involves the following:
· Exclusive breast feeding – giving the baby
breast milk only and nothing else- not even
water till the baby is six months old.
· Good breast feeding technique – positioning
of the breast into the baby’s mouth so that
the baby grips not only the nipple but the
whole dark area around the nipple
· Early treatment of breast problems in the
mother and oral thrush in the baby
· Safer sex – use of male and/or female
condoms during the time that you are
breast feeding.