Prevention of Mother-to-Child HIV Transmission Internationally1

Data from the Joint United Nations Programme on HIV/AIDS (UNAIDS) indicate that in 2003, 34–46 million people were living with HIV infection, and three fourths of these cases were in sub-Saharan Africa. Approximately 2.1–2.9 million children were living with HIV/AIDS. HIV transmission in sub-Saharan Africa is predominately heterosexual, and by the end of 2002, women represented 58% of HIV cases. UNAIDS estimates that in many African countries <1% of pregnant women receive needed antiretroviral prophylaxis to prevent mother-to-child HIV transmission (PMTCT). This has a substantial impact on the death rate in children, with previous gains reversed for children <5 years of age in several countries. Without intervention, the risk of mother-to-child HIV transmission is 30%–35%. With antenatal HIV testing, combination antiretroviral drugs, and safer infant feeding, the risk can be reduced to 1%–2%. Simplified short-course interventions can reduce PMTCT transmission to 15%20%. Interventions for PMTCT should also be provided in the broader context of prevention, including primary prevention of HIV, preventing unintended pregnancies, and care and support to HIV-infected women and their families.