PARENTHOOD AND HIV: A JOINT STATEMENT FROM SPC, UNICEF, WHO, UNFPA,
UNAIDS AND PRHP.

HIV INFECTION AND PREGNANCY: THE PACIFIC CONTEXT

Over the last week, there have been a number of radio stories and
media releases about pregnancy and childbirth among HIV positive
women in Pacific Island countries.

SPC, UNICEF, WHO, UNFPA, UNAIDS and the Pacific Regional HIV Project
(PRHP) re-affirm that it is a woman's right to make informed choices
about pregnancy and childbirth (regardless of her HIV status), and
offer our warmest congratulations to the new and expecting parents.

However, we also believe that it is our responsibility to provide
some additional, up-to-date information about parenthood and HIV
to `aidstok' readers, and especially to people living with HIV/AIDS
(PLWHA) who may be considering having a baby.

A baby born to a HIV positive mother may become infected with HIV
during pregnancy, childbirth or breast feeding, with the maximum
risk associated with the actual delivery. Not all babies born to a
positive mother will become infected with HIV: without appropriate
care, the estimated risk of transmission to the baby is between 30%
and 45% (but the risk also depends on the mother's clinical stage of
HIV infection, her nutritional status and other factors).

Preventing transmission of HIV from an infected parent to her child
presents many and complex challenges – to the woman, her partner,
her family and her medical support team. These challenges must
always be met in a supportive and non-judgmental manner.

In the Pacific, unlike most developed countries, we are still at an
early stage in developing our capacity to deliver comprehensive
care, treatment and support for PLWHA. This includes strategies for
minimising the risk of mother-to-child transmission of HIV, and we
must address any pregnancy in the context of availability and access
to care, treatment and support, and prevention of mother-to-child
transmission (PMTCT) services.

Moreover, we must be mindful of the psycho-social and socio-economic
ramifications in our Pacific setting where one or both parents are
HIV positive. A family may be fortunate enough to be able to access
care, treatment and psycho-social and financial support before,
during and after pregnancy; however, in many countries and
communities, this is not the case.


APPROACHES TO PMTCT IN THE PACIFIC

While recognising the importance of care, treatment and support for
PLWHA and the central role of PLWHA in the fight against HIV/AIDS,
the Pacific Regional Strategy on HIV/AIDS places a primary emphasis
on the prevention of HIV infection, and this includes PMTCT.

We must also remember that many people infected with HIV do not know
that they are infected. It is therefore important that pregnant
women have access to voluntary, confidential HIV counselling and
testing (VCCT).

Since 2004, UNICEF and other agencies have supported countries to
examine and adopt the following "four-pronged" approach to PMTCT:

1) Prevention of HIV infection in women of reproductive age
2) Prevention of unintended pregnancy in HIV positive women
3) Prevention of mother-to-child transmission of HIV by:

a) providing antiretroviral therapy (ART) during pregnancy for HIV
positive mothers, and during the first week of life for the baby (or
adjustment and continuation of ART if the mother is already on
treatment)
b) implementing safer delivery practices
c) providing counselling and support on infant feeding methods (with
a artificial feeding where this is feasible, acceptable, safe,
sustainable and affordable, or exclusive breast feeding where it is
not) (Done correctly, these methods can reduce the transmission risk
to the baby to around 2%, but not to zero).

4) Provision of care, treatment and support to HIV-infected parents,
infants and families

Integral to these efforts is training for national teams (including
obstetricians and midwives) to provide care and counselling support
for PLWHA, and strengthening laboratory services to support
diagnosis and monitoring.

As countries develop their health systems to effectively deliver
comprehensive care, treatment and support for PLWHA, regional
support systems are able to assist countries to introduce ART and
comprehensive pregnancy care for HIV positive women. However, it
takes time to build health systems. We encourage clinical staff to
follow up with their delegates to the Global Fund CCM (or national
or regional UNICEF, WHO or PRHP offices) the current status of ART
and PMTCT in their country.

CONCLUSIONS

Managing a pregnancy where either or both parents are HIV positive
is neither simple nor straight-forward.

Regional development partners are moving as quickly as they can to
assist Pacific Island countries to strengthen VCCT services and to
put the necessary systems in place to manage HIV positive
pregnancies, but not all countries yet have all these facilities
available.

We emphasise the need for great care in planning and managing any
pregnancy where HIV may be a complicating factor, including
counselling prior to conception, early and comprehensive antenatal
care, appropriate antiretroviral therapy for mother and child, and a
careful and well-informed approach to infant feeding and care for
the family following delivery.

FOR FURTHER ADVICE OR INFORMATION:

SPC Public Health Programme (HIV/AIDS and STI Section) –
Dr Dennie Iniakwala (denniei@...; +687 262000).

SPC Public Health Programme (Adolescent Reproductive Health
Project) – Dr Rufina Latu (rufinal@...; +679 337 0733).

UNICEF Pacific –
Ms Judith Leveillée (jleveillee@...; +679 330 0439)

WHO Representative Office for the South Pacific –
Dr Seng Sopheap (sengs@...; +679 330 4600)

Joint United Nations Programme on HIV/AIDS (UNAIDS) –
Mr Stuart Watson (stwatson@...; +679 330 0439)

UNAIDS and Global Fund Project Technical Working Groups –
Dr Rob Condon (robc@...; +679 337 0733)

UNFPA –
Dr Seta Vatucawaqa (svatucawaqa@...; +679 330 8022)

Pacific Regional HIV Project (PRHP) –
Dr Tamara Kwarteng (tamara.kwarteng@...; +679 331 7945)

__________

Dr Rob Condon
Public Health Physician and Medical Epidemiologist
Pacific Island Countries Global Fund Project
and UNAIDS Technical Working Group
c/o Secretariat of the Pacific Community
PMB Suva, Fiji
E-mail: <robc@...>
________________________
Cross posted from aidstok
WEB : http://www.spc.org.nc/cgi-bin/lyris.pl?enter=aidstok