InterPress News Service (IPS); Monday, 8 September 1997.
Yvette Collymore

Although scientists have reported progress in the treatment of AIDS in the United States and other wealthy nations, the expensive regimen eludes the rest of the world, delegates at a major medical conference heard here.

Young children contract the human immunodeficiency virus (HIV) or the related acquired immune deficiency syndrome (AIDS) mainly from their mothers. A mother may pass the infection on to the foetus late in pregnancy, or during labour, delivery, or breastfeeding.

The problem is especially worrisome in developing nations, where populations lack the means for even the most basic health care. HIV/AIDS, like many other diseases, thrives on poverty and roughly 90 percent of those infected with the virus live in the poorer countries of the South.

"It is in these countries that mother-to-infant transmission remains an area of darkness, and issues surrounding it are likely to suffer neglect for some time to come," according to Jaya Shreedhar, a physician and AIDS expert from Tamil Nadu, India.

Shreedhar spoke at a four-day international conference on pediatric AIDS and mother-to-child transmission, sponsored by the American Society for Microbiology and the Office on AIDS Research at the National Institute of Health (NIH), which ended Saturday. Researchers and public health workers analysed the obstacles in preventing the transmission of HIV from mothers to their babies.

The good news is, researchers show progress in slowing maternal- infant transmission of the disease. The bad news: most of the women infected with HIV/AIDS around the world can never afford the drug regimen touted in the North.

The regimen was the focus of clinical trials made public in 1994 by the New England Journal of Medicine, the pre-eminent U.S. medical publication. At a time when transmission of HIV from mother to child was identified as the leading cause of pediatric infections, tests showed that AZT, a drug used to slow replication of the virus, could effectively reduce the rate of transmission. The same year, the U.S. Public Health Service approved recommendations for use of the drug - also known as Zidovudine - among pregnant women in the country.

AIDS experts now attribute the decline in mother-child transmission in the United States to a combination of factors, including the use of AZT. The regimen involves 6-26 weeks of the drug therapy, beginning early in the pregnancy. The treatment is also given intravenously during delivery, and the newborns themselves receive the treatment for six weeks, but the average cost of the entire regimen is a hefty 1,000 dollars - far greater than health care costs per head in developing countries.

The regimen "costs 80 times the per person annual health budget for many developing nations," notes Dr Helene Gayle of the U.S. National Centre for HIV, STD, and TB Prevention in Atlanta.

For this reason, Southern health care experts are far from impressed with the news from the scientific world.

"These (drug) interventions look like they work, but they cost money," says Kenyan paediatrician, Ruth Nduati. "As long as health care is seen as a commodity that you buy, the intervention will be out of reach."

More than 3.1 million people contracted HIV infections last year, nearly half of them women, according the joint United Nations Programme on HIV/AIDS (UNAIDS). Today, an estimated 22.6 million people are living with HIV or AIDS, including 9.2 million women and 830,000 children.

"Despite the exciting news of effectiveness of AZT in reducing perinatal transmission, public health authorities throughout the world agree that the complex, highly intensive, lengthy regimen of zidovudine...is simply not feasible for use in most developing countries," says Gayle.

At the same time, she and others note that fewer than 500 U.S. infants are born every year with HIV, compared with a daily rate worldwide of 1,000 infants.

In seeking ways to reduce mother-to-infant transmission, scientists have been researching the role of breastfeeding. As Nduati, points out, the chances of transmiting the virus through breast milk are great in the South. "Some women in developing countries breastfeed for up to 24 months," she says.

But when children lack access to safe alternatives to their mothers' milk, many contend that the risk of acquiring HIV through breastfeeding is lower than the risk of dying because of contaminated food. They argue that safe bottle feeds depend on the availability of clean water for commercial formula, and money to buy the powdered milk.

"As a general policy, breastfeeding continues to be promoted," says Dr Joseph Saba of UNAIDS. Saba is coordinating a clinical trial on the prevention of mother-to-child transmission. The three-year experiment, which began in Jan. 1996, focusses on infected pregnant women from South Africa, Tanzania, and Uganda.

Saba and others look to a time when an AIDS vaccine would provide a cheap and effective way to fight the virus. But given the reluctance of phamaceutical companies to sink money into research that may either prove unsuccesful, what with the variety of HIV strains, or bring in little profit, that time remains distant.

For now, prevention through the use of condoms is regarded as the best defence against AIDS. Until recently condoms used by men was the only contraceptive available for protection against sexually transmitted diseases, including HIV. But health specialists say the new, female condom, now sold by the public sectors of up to 10 developing countries for less than a dollar, gives women more control and offers them a better chance of negotiating safer sex with their partners. (END/IPS/yjc/mk/97)

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