New hope for children of HIV-infected mothers

Twenty seven-year-old Shakhlo (not her real name) was not happy to find out that she was pregnant. She couldn't face having a baby. "What fate can a child of an HIV-infected woman face?!" she asked herself. The young woman had an abortion during the first month of pregnancy. "This happened two years ago in Khujand [capital of the northern Sogd province, some 350 km to the north of the capital, Dushanbe]," Rano Alieva, deputy head of the health ministry's maternal and child health department, told IRIN. But the introduction of new treatment regimes for such mothers means that people like Shakhlo now have alternatives. "The woman had a termination because she thought there was no hope. At that time the country's medical institutions couldn't help an HIV-infected mother to deliver a baby. Now we could have saved the child of that woman." HIV can be transmitted from an infected mother to her child during pregnancy, labour and delivery, or through breastfeeding. In the absence of breastfeeding, most infections occur during labour and delivery. Reported transmission rates ranged from 13 to 32 percent in industrialised countries and from 25 to 48 percent in developing countries. Some reports suggest that breastfeeding can increase the risk of transmission by up to 15 percent. According to the estimates of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Tajikistan is now at an early stage of HIV/AIDS epidemic. But statistics show that the infection is on the rise in the impoverished Central Asian country. In March 2004, there were 170 officially registered HIV/AIDS cases. By 1 November 2004, according to Azam Mirzoev, director of the National AIDS Centre, that figure had increased to 305, including 61 women. However, statistics on the number of HIV-infected women who are pregnant, or have already delivered children, were neither available at the Ministry of Health nor at the AIDS centre. "The majority of HIV-infected women in the country are injecting drug users, commercial sex workers and prisoners, most do not want to be pregnant," Sobir Kurbanov, head of UNICEF's public health programme in the former Soviet republic, told IRIN. According to the World Health Organization (WHO), mother to child transmission (MTCT) is the most significant source of HIV infection in children below the age of 15 years. Since the beginning of the pandemic, an estimated 5.1 million children worldwide have been infected, almost all through MTCT. In 2000, more than 600,000 children became infected, of whom 90 percent were in Africa. Khairiniso Zurkholova, head of neonatology at the Tajik Scientific Research Institute of Obstetrics, Gynaecology and Paediatrics, believes that the risk group has to include wives of labour migrants who go back and forth to Russia. The estimates for migrant workers in the country vary between 600,000 and over a million. There have been some reported cases when wives of migrant workers from remote areas were diagnosed with syphilis, gonorrhoea and other sexually transmitted diseases (STDs). Some local health workers say that migrant workers often contract HIV/AIDS in Russia and infect their wives back in their home country. Now there is a growing realisation in Tajikistan that such women need assistance during their pregnancies and medical intervention to prevent the syndrome spreading to the unborn child. "Medical institutions in the country should be ready to render assistance to pregnant HIV-infected women regardless of whether they interrupt pregnancy or deliver a child," Alieva of the mother and child health department said. In an effort to tackle the issue, a project on the prevention of MTCT was launched in 2002 with the support of the UN Children's Fund (UNICEF). Three health specialists from Dushanbe underwent training in Ukraine. Guidelines have been developed for medical workers on the prevention of MTCT. "Currently, we have purchased medicines for anti-retroviral [drugs that inhibit the replication of the virus] therapy, this will dramatically reduce the MTCT rate," Kurbanov said. A number of maternity hospitals, where medical personnel are able to deliver a child from an HIV-infected women, have been identified in Dushanbe, Sogd province and the southern Khatlon province. At these facilities, HIV-positive expectant mothers can undergo complete examination and diagnostics and also receive courses in anti-retroviral (ARV) drugs. ARV drugs have the potential to dramatically improve the health and extend the lives of some people with HIV/AIDS. Yet the high cost and demanding clinical requirements of these drugs put them out of reach of the vast majority of people with HIV. This problem is especially acute in poor countries like Tajikistan, where public resources are extremely scarce. Her colleague Zurkholova said how important they were. "The experience of working in the provinces has shown that medical staff [on the ground] frequently lack information on HIV transmission. Up to now many continue to think that AIDS is transmitted only via sex. It is necessary for us to train medical personnel to deliver children without harm to the health of the mother, child or personnel," she pointed out. "In any case, women should not panic having learnt about the diagnosis. Medical personnel should explain to them that prevention of the transfer of the disease to the child is possible with the help of anti-retroviral therapy," she added. In wealthy nations, interventions such as ARV drugs, safe alternatives to breast milk, and elective caesarean section mean that only 2 to 5 percent of HIV-positive mothers infect their babies, according to the US-based Bill and Melinda Gates Foundation.