Long-awaited goal of ensuring every child is born HIV-free
SHOBHA SHUKLA - CNS
Goal to eliminate parent to child transmission of HIV must be achieved as soon as possible
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Science has gifted us tools and evidence-based approaches to ensure that there is minimal risk of transmission of HIV virus from HIV-positive parents to the child during pregnancy, delivery and breastfeeding. Despite these tools existing since almost two decades now to ensure every child is born HIV-free to positive parents, we have failed to implement them fully. As per UNAIDS, despite substantial progress made in the last two decades to ensure that every child born to positive parents is HIV-free, 150,000 such children were born in 2020. This is nearly eight times more than the desired "goal of achieving less than 20,000 children born with HIV worldwide by 2020". More worrying is that the pace of the decline has slowed in recent years.
Dr Glory Alexander, who has been devotedly working for providing medical care to people living with HIV, for more than three decades, spoke with CNS (Citizen News Service) spoke around the 24th International AIDS Conference (AIDS 2022). Besides, being one of the organisers of this world's largest AIDS conference taking place in Montreal, she is also the founder of ASHA Foundation (Action, Service, and Hope for AIDS Foundation) in Bengaluru, India, and elected as national Vice President of AIDS Society of India.
According to the latest report of NACO (National AIDS Control Organization of India), in 2020-21 a little more than half (56% or 11,744) of the estimated HIV positive pregnant women (20,900) received care through HIV counselling and testing services in government and private healthcare facilities. Of those diagnosed HIV positive, 10,937 pregnant women were initiated on or were already on lifelong antiretroviral therapy and 85% infants born to HIV-positive mothers were put on antiretroviral prophylaxis. The report further says that 'To achieve the target of elimination of Mother-to-child transmission of HIV, there is a need of significant improvement since overall coverage of Prevention of Mother to Child Transmission (PPTCT) cascade service is low at National level as well as inter-State level.'
Dr Alexander said that, "In India women constitute about 44% of those infected with HIV. Women who come from HIV key affected populations such as sex workers, are more likely to be reached by HIV services periodically and receive care. But 90% of the women living with HIV in India are housewives who mostly get infected through their husbands. When they get pregnant, HIV infection could get transmitted to their children. It is very important to target these women, more so as they do not perceive themselves to be at risk of HIV infection as they are likely to have single partners and may not be indulging in risky sexual behaviours. Moreover, Indian women are perceived as caregivers but themselves have poor health-seeking behaviour. So they rarely come by themselves to get tested, even though it is very important to diagnose these women early on."
However, women are likely to reach out to a health facility during pregnancy. "That is a good time to do their HIV test and put them on treatment, if diagnosed HIV positive. The treatment also prevents the risk of transmission to the child during the mother's pregnancy. Treatment for prevention of mother to child transmission brings down the risk of transmission from about 40% in the breastfeeding population to less than 5%. If a woman is already on antiretroviral therapy and she becomes pregnant the risk of transmission is less than 1%," shared Dr Alexander.
"Women are more prone to co-morbidities like cardiovascular and cerebrovascular diseases. They also respond in a different manner to antiretroviral therapy as we have to worry about their bone health and there is an increased risk of cancer of the cervix in women who are HIV positive. Thus women and children are very important cogs in the wheel for the management of HIV infection and need to be diagnosed and treated early on", she added.
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