Prevention of MTCT

Current interventions aimed at reducing MTCT target the peripartum period but their application in populations where breast feeding is the norm presents considerable problem Effective interventions used include reduction of maternal viral load through ARV therapy the avoidance of exposure to contaminated maternal secretions through delivery by caesarean section and avoidance of breast feeding Washing the birth canal with antiseptic to reduce exposure to contaminated section also has some effect Several questions and challenges remain For example choice availability affordability duration and long term safety of ARV agents to be used during pregnancy and early neonatal life and the issue of transmission in situations where alternatives to breast feeding are not available The challenge is to find the most cost effective and feasible intervention to achieve zero percent transmission of HIV from an infected mother to her child

Pregnant women face many difficult decisions including decisions around HIV testing treatment options and infant feeding A womans male partners extended family greater community and health care setting all influence her decision and ability to take advantage of MTCT prevention In developing countries there is lack of access to medications in general and ARV drugs in particular In addition there is very little access to good health care for women both before and after birth limited HIV counseling and testing and high stigma and discrimination against HIV positive women In the developed world it is recommended that HIV positive mothers do not breast feed as formula feeding is safe well accept and readily available Formula feeding requires clean water for mixing formula or sanitation and cannot afford formula and therefore cannot avoid breast feeding

HIV is a preventable disease MTCT is best prevented by effective accessible and sustainable HIV prevention diagnosis and treatment programs for women men and their children Structural interventions are also needed that increase access to HIV treatment treatments clean water and formula Education and empowerment for all women in every country are as essential as access to good medical care and nutrition for women and their children whether they are HIV positive or HIV negative With the Sub Saharan African socioeconomic setting exclusive breast feeding of the baby born to HIVpositive mother is inevitable lest the baby dies within the first days after birth Replacement feeding is unacceptable unaffordable unsustainable unsafe and not feasible in most of these countries So the big question remains how can nutritionists and other health workers make breast feeding safer for every baby born to HIV positive mother and improve upon complementary feeding for such children Thus there is greater need for urgent research on how to improve the local foods to make them nutritionally balanced and safer for complementary feeding and replacement feeding of such children