Prevention of mother-to-child transmission of HIV and saving mothers' lives
Programmes to prevent mother-to-child transmission of HIV (PMTCT) which focus only on short-term treatment strategies to protect infants perinatally run the risk of mothers dying young, drug resistance to future treatment in mothers who survive and get treatment, and an increase in the number of AIDS orphans and children with AIDS. Although the use of short-course treatments reduces perinatal infection, the proportion of infants in the pan-African Petra study who became infected within 18 months of birth through breastfeeding grew steadily to 18–20% regardless of regimen used. Use of highly active antiretroviral therapy by pregnant and breastfeeding women would prevent all these problems. Finally, in the past year or so, strategies to save the lives of HIV-positive mothers in Africa, and therefore better support the lives of their babies, through antiretroviral treatment have been under consideration. [1,2]
Alcorn K. MTCT programmes short-sighted if no long-term drugs for mums. At: 〈www.aidsmap.com/news/newsdisplay2.asp?newsld=1428〉, 5 April 2002.
Beckerman KP. Mothers, orphans and prevention of paediatric AIDS. At: 〈www.thelancet.com/search/search.isa〉, 26 September 2002.
Canadian doctors endorse universal HIV-testing for pregnant women
The Canadian Medical Association endorsed routine HIV testing of pregnant women in 2002 and passed a resolution calling on provincial governments and health authorities to adopt a universal HIV screening policy for pregnant women, with an opt-out provision for those who do not want to be tested. The aim is that HIV testing of pregnant women will become as routine as tests for hepatitis, syphilis and gonorrhoea. At present, Canada does not have national or provincial guidelines for testing pregnant women, and the few HIV tests that are carried out are done at the discretion of the physician. It is estimated that 2–4% of babies in Canada are born with HIV. [1]
MDs call for HIV testing of all pregnant women. CDC HIV/STD/TB Prevention News Update. On: 〈[email protected]〉, 22 August 2002.
Standard treatment regimens effective enough for preventing MTCT
A multi-country study has revealed that for pregnant women already taking highly active antiretroviral therapy, short-course intrapartum nevirapine treatment does not further reduce mother-to-child-transmission of HIV. In a controlled trial, 1,270 HIV-positive pregnant women taking antiretroviral therapy were given a 200mg nevirapine tablet or a placebo during labour, with their newborn infants receiving a 2 mg/kg oral dose two or three days after birth. Perinatal infection rates were virtually identical (±1.5%) for both arms. [1]
Greer M. HIV/AIDS vertical transmission: short-course nevirapine doesn't improve standard preventive therapy. At: 〈[email protected]〉, 2 September 2002.
Campaign to stop manufacture of nonoxynol–9 condoms and lubricants
Research has shown that nonoxynol-9 (N-9) can increase the risk of HIV infection if used frequently and with anal sex. [1] The use of N-9 in lubricants and on condoms is no longer recommended, especially for anal sex. Even a low dose of N-9 can cause major short-term disruption and shedding of the cells lining the rectum. Efforts are underway to get manufacturers to agree to discontinue condoms and lubricants containing N-9. The “Call to Discontinue Nonoxynol 9 for Rectal Use” campaign, launched by the Global Campaign for Microbicides, has been endorsed by many organisations and scientists. Not all companies have agreed to date, however, and continuing public health education is needed, including among condom producers in developing countries. [2] New US Food and Drug Administration draft regulations will require manufacturers to add new warning labels to all over-the-counter vaginal contraceptives containing N-9. These will state that N-9 contraceptives do not protect against HIV or other STDs and that frequent use of such products can increase vaginal irritation and possibly increase HIV risk. [3]
Van Damme L, Ramjee G, Alary M, et al. Effectiveness of COL-1492, a nonoxynol 9 vaginal gel, on HIV-1 transmission in female sex workers, a randomised controlled trial. Lancet 2002;360(9338):971–77.
N–9 update. Global Campaign for Microbicides, 1 April 2003.
At: 〈http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/03-902.htm〉.
Integrated strategy has reduced HIV prevalence in Uganda
Uganda's success in reducing HIV prevalence rates during the 1990s is due to an integrated, three-pronged behaviour change strategy. The components include delay in first sex among young people, reduction in the number of sexual partners, and condom use among those who are sexually active. HIV prevalence studies revealed that condom use among unmarried women and men has risen significantly. The proportion of unmarried women, though not of men, who said they had had sex with more than one partner in the past year had also declined. Fewer adolescents, particularly young women, reported ever having had sex than in previous years. Among those who were sexually active however, there was no return to abstinence. The Ugandan government's programme has been comprehensive and has proven the benefits of promoting multiple risk reduction strategies. [1]
Wind R. Increased abstinence, fidelity and condom use drive HIV/AIDS declines in Uganda. AGI Update, 24 October 2002.
Male community-based distributors can increase condom distribution
Worldwide, an estimated six to nine billion male condoms are used annually. Experts estimate that in order to provide adequate protection against STDs and HIV/AIDS, 24 billion male condoms should be used annually. As the drive to promote condom use to increase dual protection, community-based distributors (CBDs) have an important role to play. However, most CBDs are women, which probably explains why many programmes distribute more oral contraceptives than condoms. The most successful CBD agents are peers of their target populations. A review of operations research and other studies in 13 countries has shown that adding more men to CBD programmes in order to reach men and distribute more condoms is effective and acceptable. Male CBDs target men more, and also distribute more condoms that women. Including more male distributors in CBD requires only minor adjustments to programme operations, and should be considered a form of best practice. [1]
Using men as community-based distributors of condoms. Population Council Frontiers in Reproductive Health, Program Brief No. 2, January 2002.
Figure 1 Shenzhen, China, 1993
