Sunday Times (Johannesburg) - June 11, 2007
Claire Keeton

Only about eight percent of infants are being protected from HIV - because access to anti-Aids drugs remains a problem.

South Africa's programme to prevent mothers passing HIV onto their babies was failing hopelessly, doctors and scientists agreed yesterday at the 3rd South African Aids conference.

Despite effective drugs to block transmission during birth and after delivery, as well as knowledge on how to reduce HIV infection during infant feeding, South Africa is one of nine countries in the world where infant and child mortality is rising as a result of HIV.

In KwaZulu-Natal, for example, child deaths have trebled over the last 15 years.

Dr Glenda Gray from the Wits University Perinatal HIV Research Unit, slammed access to prevention-of-mother-to-child-transmission programmes as "abysmal".

The programmes only reach about 17 percent of HIV-positive mothers even though roughly 90percent of pregnant women attend antenatal clinics.

Gray said: "About 300000 children get HIV every year because of breast feeding."

Dr Nigel Rollins of the Maternal and Child Health at the University of KwaZulu-Natal, said: "Eliminating HIV in infants and young children is one of South Africa's realisable goals in the next few years."

The reasons South Africa's programmes have failed include low coverage, weak drug regimens, not getting antiretroviral drugs to the mothers and infants in time and drugs out of stock.

Low rates of testing of mothers and infants, poor monitoring and weak administrative systems also contribute.

Rollins said that studies had shown that the survival of mothers was critical to the survival of children.

He urged "as a priority" that HIV-positive mothers with low immunity (CD4 counts of less than 200) be put on antiretroviral treatment. "After the mother dies, the young child is four times more likely to die. You cannot divorce child and maternal health."

Mothers with a low immunity were about twice as likely to infect their children, and women who "reported themselves as uninfected" when they were HIV positive were also much more likely to pass on HIV, studies have shown.

Rollins said that antenatal clinics should offer HIV testing to pregnant women as well as offer support on the best infant feeding choices. He said it was important to develop district-based health care and clinics, and give health care staff support.

One study found at 18 months that more breast-fed infants on a single antiretroviral drugs were HIV infected but more formula-fed infants had died.

Gray said research into how to minimise the dangers of infant feeding, such as putting the mother or child, or both, on antiretroviral drugs, is necessary.

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