HIV Pearls

• Preventing unintended pregnancy in HIV+ women and preventing HIV infection among women are important to prevent mother-to-child transmission (MTCT). But how important are they?
  

• USAID is beginning an effort to prevent mother-to-child transmission of HIV by providing the antiretroviral drug Nevirapine to HIV+ women late in pregnancy, and to the infants in the early neonatal period. But it seems sensible to also try to prevent additional infant HIV infections by providing postpartum contraception to women who don’t want to conceive. Does that make sense?
  

Preventing unintended pregnancy in HIV+ women and preventing HIV infection among women are important to prevent mother-to-child transmission (MTCT). But how important are they?

Quite important in order to reach the UNGASS (United Nations General Assembly Special Session) goals to reduce the proportion of infants infected with HIV by 20% by 2005 and 50% by 2020. In fact it is fair to say the UNGASS goals cannot be met without these two other elements.

For example, in a recent analysis of 8 key African countries, experts from Johns Hopkins University and WHO conclude that short course ARV prophylaxis for HIV-infected pregnant women (and their infants) by itself would likely reduce MTCT an average of 4%. On the other hand, a comprehensive strategy that adds 1) a reduction in primary HIV infection by 5% and 2) a reduction in pregnancies among HIV-infected women by 10%, comes fairly close to the 2005 UNGASS goal in all 8 countries.

Reference: Sweat M et al. Linkages between family planning and HIV PMTCT programs: Opportunities and challenges. Presentation at Montreux, Switzerland. May 2004.

USAID is beginning an effort to prevent mother-to-child transmission of HIV by providing the antiretroviral drug Nevirapine to HIV+ women late in pregnancy, and to the infants in the early neonatal period. But it seems sensible to also try to prevent additional infant HIV infections by providing postpartum contraception to women who don’t want to conceive. Does that make sense?

Definitely. In fact WHO and various partners have outlined a comprehensive approach that includes 4 elements:

1. Primary prevention of HIV infection;

2. Preventing unintended pregnancies among HIV-infected women;

3. Preventing HIV transmission from HIV-infected women to their children; and

4. Providing care for HIV-infected mothers and their infants.

The concept of providing contraception for HIV+ women after they deliver falls squarely in element 2. It is also an example of good reproductive health care that should be offered to all women postpartum and thus in element 4 as well.

Reference: WHO. Strategic approaches to the prevention of HIV infection in infants. Report of a WHO meeting. Morges, Switzerland, 20-22 March 2002.

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