Nutrition and HIV/AIDS: A Training Manual - Linkages Project

Mother-to-child transmission (slide 5)HIV can be passed from a mother to her infant during pregnancy, during labor anddelivery, and through breastfeeding. This module focuses primarily on transmissionthrough breastmilk because breastfeeding is the basis of most infant nutrition in sub-Saharan Africa, regardless of the mothers’ HIV status. Prevention of mother-to-childtransmission (PMTCT) programming is the subject of the second portion of thissession.In the absence of PMTCT interventions, 24 percent-45 percent of HIV-infectedmothers will transmit HIV to their infants by all modes of transmission (Dabis et al2000). In the United States the risk is only 2 percent, in large part because of HIVcounseling, antiretrovirals (ARVs), elective Caesarian sections, and safe use of infantformula.Median duration of breastfeeding by region (slide 6)This section first analyzes the risks associated with MTCT, with an introduction tokey studies that provide the basis for recommended interventions. Next is anoverview of these recommended interventions, focusing on safe infant feedingguidelines in areas of high HIV prevalence. Finally, a case study of the NdolaDemonstration Project in Zambia illustrates some of the realities of PMTCT.Risks analysis and factors: Key research findingsThis section covers the risk of HIV transmission during pregnancy, labor and delivery,and breastfeeding.HIV transmission during pregnancy (slides 7, 8)There is a 5 percent-10 percent risk of transmission of HIV during pregnancy. A childis considered to have been infected in utero if the HIV-1 genome is detected within48 hours of delivery by a polymerase chain reaction test (DNA-PCR) or viral culture.(UNICEF/UNAIDS/WHO 1998a). Transmission during pregnancy occurs when theplacental protection of the fetus is compromised, allowing for viral transmission.The following factors are associated with transmission during pregnancy:188