HIV In Pregnancy: An Overview

In some countries, HIV infections have become one of the most common medical complications during pregnancy. More than 90% of HIV infections in children are caused by mother-to-child transmission. This amounts to 1,000 children becoming infected with HIV every day1.

Africa has been the centre of the mother-to-child HIV transmission epidemic. A rapid rise in infection rates has also been seen across South East Asia. Sources suggest that the rate of transmission of HIV from mother to child can be as high as 30% in the absence of treatment2, and can occur during three different stages of pregnancy:

  1. Within the uterus (Very low chance. This is affected by mother’s overall health)
  2. During labor and delivery (15%-30% chance2)
  3. Post partum through breastfeeding. (5%-20% chance2)

Most HIV transmissions are believed to occur during labour or breast feeding. HIV testing during pregnancy should be balanced with the possible risks of discrimination and violence, as HIV-positive women are often seen as being irresponsible for becoming pregnant. Oftentimes, HIV-positive pregnant women are rejected by family & friends, receive poorer treatment in healthcare settings, and are deprived of other rights. The World Health Organization also cites fear of discrimination as the main reason why people are reluctant to be tested, to disclose HIV status, or to take antiretroviral drugs3. Post-test counseling for patients with HIV-positive results is often essential, as is educating all women on future mother-to-child risk reduction.

Comprehensive care of HIV-positive pregnant women is of the utmost importance. The standard of care to reduce the risk of HIV transmission from mother-to-child has become antiretroviral drugs paired with caesarean section (where available). These have been shown to help reduce the risk of mother-to-child transmission. It is estimated that 13%-38% of all pregnant women in South Africa are HIV positive1. In the most severely affected countries, HIV is wiping out families, destroying communities and threatening socio-economic progress. In most cases, the obstetric management of HIV-positive pregnant women is very similar to that of uninfected women. The ongoing social support & education of treatment options for HIV-positive pregnant women has been seen as the integral part in reducing HIV transmission.

Sources:

1.UNAids HIV In Pregnancy/UNAids AIDS Epidemic Update 2009

2. De Cock et al. Prevention of mother-to-child HIV transmission in resource-poor countries. JAMA 283(9) Mar 2000

3. Wolfe et al. The Impact of Universal Acceess to Antiretroviral Therapy on HIV Stigma in Botswana.2008.

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