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HIV-positive Women in Africa Still Confused About Infant-feeding Choices

ADDIS ABABA, 9 December 2011 (PlusNews) – The latest guidelines on infant-feeding options for HIV-positive mothers in Africa have not been disseminated in many countries, leaving women dangerously confused about the best nutritional path to protect their children from contracting the virus, a new report shows.

The UN World Health Organization’s (WHO) 2010 guidelines recommend exclusive breastfeeding with an antiretroviral (ARV) treatment intervention for the first six months of a child’s life to reduce transmission, and continued breastfeeding – with complementary feeding – until the child is at least a year old. Alternatively – where it is acceptable, feasible, affordable, sustainable and safe – WHO recommends complete avoidance of all breastfeeding.

For HIV-positive mothers in most sub-Saharan African nations, exclusive breastfeeding is the most practical option. According to a large African study, Kesho Bora, giving HIV-positive mothers a combination of three ARVs during pregnancy, delivery and breastfeeding cuts HIV infections in infants by 43 percent by the age of 12 months and reduces transmissions during breastfeeding by 54 percent compared with WHO’s 2006 recommendations, where ARV drug regimens ended at delivery.

“The six months of exclusive breastfeeding is what is crucial for mothers to understand – that not doing it is what raises the child’s HIV risk; but we are finding that while many countries have officially adopted the WHO guidelines, they have not trickled down, and health centres, policy-makers and communities are still unclear on what advice to give mothers,” said Aditi Sharma, of the International Treatment Preparedness Coalition (ITPC), and coordinator of a report, The Long Walk: Ensuring comprehensive care for women and families to end vertical transmission.

Based on new research by community health workers from Cameroon, Cote d’Ivoire, Ethiopia and Nigeria, the report – launched at the 16th International Conference on AIDS and STIs in Africa (ICASA) in Addis Ababa, Ethiopia – found that prevention of mother-to-child transmission programmes were focused too narrowly on the provision of ARVs to HIV-positive pregnant women, rather than more comprehensive approaches that involved family planning, maternal healthcare and exclusive breastfeeding.

Confusion

“Nutritional counselling doesn’t exist in rural areas,” the report quoted one Cameroonian woman as saying. “Health personnel are not trained and women do not know how to care for their children.”

In Cote d’Ivoire, the report found that national guidelines did not meet the most recent WHO recommendations on infant feeding.

Although the Nigerian government had revised guidelines to comply with the WHO, consensus did not exist in support of the recommendations, and some clinicians and researchers continued to oppose breastfeeding because they believed it deliberately exposed babies to possible HIV infection. Several focus group participants indicated they assumed that replacement feeding was preferable to breastfeeding, and that it had been recommended by health practitioners.

“The guidance on infant-feeding options needs to urgently get into the curriculum and training of health workers and other people who support community healthcare, such as traditional birth attendants,” said Sharma, adding that efforts needed to be made to support mothers to exclusively breastfeed their children.

“It is not enough to issue guidelines – in places where women may complain of insufficient breast milk or inadequate nutrition, they need nutritional support to ensure they can continue to exclusively breastfeed,” she added.

Conference speakers said community health systems were crucial to the success of prevention of mother-to-child HIV transmission services, as community health workers and traditional birth attendants were often the first port of call for a confused mother. Community health systems can also be used to engage men – frequently absent from ante-natal visits – in their wives’ experiences.

Supporting partners

Beatrice Ochieng, author of a study on infant feeding choices in poor settings in the Kenyan capital, Nairobi, noted that just 23 percent of 357 women in the study discussed their chosen feeding option with their partners. “There is a need to support partner involvement through partner counselling and testing, during antenatal and postnatal care,” she said.

According to Ncumisa Vika, who works with the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) in South Africa, male involvement in reproductive health services, including PMTCT, remains low, creating challenges and barriers around disclosure of HIV-positive status to a partner, psychosocial support, adherence to treatment, and infant-feeding decisions. In 2010, in collaboration with community health organizations in South Africa’s Tshwane District, EGPAF was able to send invitation letters to the partners of all HIV-positive women who attended antenatal clinics, which boosted male participation in reproductive and family health matters.

Overall, ITPC’s Sharma said, there was a need for more comprehensive delivery prevention of mother-to-child services in Africa. “Countries must ensure that policy filters down to the women in all aspects of PMTCT – from HIV prevention for women to family planning, to the best ARV prophylaxis option to proper infant feeding to proper healthcare for the mother, child and family,” she said. “It is the only way we can achieve the 2015 targets of reducing vertical transmission by 90 percent.”

kr/mw

Theme (s): HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]

Provided by PLUS NEWS

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Aids-related Deaths ‘Down 21% From Peak’, says UNAids

Aids-related deaths are at the lowest level since their 2005 peak, down 21%, figures from UNAids suggest.

Globally, the number of new HIV infections in 2010 was 21% down on that peak, seen in 1997, according to UNAids 2011 report.

The organisation says both falls have been fuelled by a major expansion in access to treatment.

Its executive director, Michel Sidibe, said: “We are on the verge of a significant breakthrough.”

He added: “Even in a very difficult financial crisis, countries are delivering results in the Aids response.

“We have seen a massive scale up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere.”

‘End in sight?’

This latest analysis says the number of people living with HIV has reached a record 34 million.

Sub-Saharan Africa has seen the most dramatic improvement, with a 20% rise in people undergoing treatment between 2009 and 2010.

About half of those eligible for treatment are now receiving it.

UNAids estimates 700,000 deaths were averted last year because of better access to treatment.

That has also helped cut new HIV infections, as people undergoing care are less likely to infect others.

In 2010 there were an estimated 2.7m new HIV infections, down from 3.2m in 1997, and 1.8m people died from Aids-related illnesses, down from 2.2m in 2005.

The figures continue the downward trend reported in previous UNAids reports.

The UN agency said: “The number of new HIV infections is 30-50% lower now than it would have been in the absence of universal access to treatment for eligible people living with HIV.”

Some countries have seen particularly striking improvements.

In Namibia, treatment access has reached 90% and condom use rose to 75%, resulting in a 60% drop in new infections by 2010.

UNAids says the full preventive impact of treatment is likely to be seen in the next five years, as more countries improve treatment.

Its report added that even if the Aids epidemic was not over: “The end may be in sight if countries invest smartly.”

‘Promising moment’

The charity Medecins Sans Frontieres urged governments to keep up their funding.

MSF’s Tido von Schoen-Angerer, said: “Never, in more than a decade of treating people living with HIV/Aids, have we been at such a promising moment to really turn this epidemic around.

“Governments in some of the hardest hit countries want to act on the science, seize this moment and reverse the Aids epidemic. But this means nothing if there’s no money to make it happen.”

The International HIV/Aids Alliance said: “We welcome the ongoing commitment of UNAids to changing behaviours, changing social norms and changing laws, alongside efforts to improve access to HIV treatment.

“For bigger and better impact though, we must not be complacent. There is still much more to do.”

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UN Urges More Funds for Early HIV Treatment

The UN Programme on HIV/Aids (UNAids) has called for increased funding for the early treatment of people with HIV.

The head of the agency, Michael Sidibe, said a new study showed it could reduce the risk of HIV transmission by 96%.

He said the challenge was to expand access to drugs, and deal with social factors which stigmatise the disease.

On Thursday, a UN report said there had been a nearly 25% decline in new HIV infections and a reduction in Aids-related deaths during the past decade.

It was published ahead of the 30th anniversary on Sunday of the first official report on Aids by the US Centers for Disease Control and Prevention.

The General Assembly is to meet at UN headquarters to discuss the epidemic next week, with 20 world leaders and more than 100 ministers expected to attend.

An estimated 34 million people were living with HIV at the end of 2010 and nearly 30 million have died from Aids-related causes since 1981, the report said.

‘Shunned disease’

In the report published ahead of the anniversary, UNAids said the global rate of new HIV infections had declined by nearly 25% between 2001 and 2009.

In India, the rate of new HIV infections fell by more than 50% and in South Africa by more than 35%; both countries have the largest number of people living with HIV on their continents.

The report found that in the third decade of the epidemic, people were starting to adopt safer sexual behaviour, reflecting the impact of HIV prevention and awareness efforts. But there were still important gaps, it warned, with young men more likely to be informed about HIV prevention than young women.

There has also been significant progress in preventing new HIV infections among children as increasing numbers of mothers living with HIV have gained access to antiretroviral prophylaxis during pregnancy, delivery and breastfeeding.

About 6.6 million people in low- and middle-income countries were receiving antiretroviral drugs at the end of 2010, a nearly 22-fold increase since 2001.

“Thirty years ago this mystery disease was called a gay plague – it was a shunned disease, people were scared about each other,” Mr Sidibe said. “Now it’s a completely different world – we’ve been breaking the conspiracy of silence.”

However, the report found that at the end of last year nearly nine million people who needed treatment were not getting it, and that treatment access for children was lower than for adults.

And while the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7,000 per day.

The report also noted that there had been an increase in the rate of new HIV infections in Eastern Europe and in the Middle East and North Africa, and that HIV was the leading cause of death among women of reproductive age.

‘Game-changer’

UNAids also said that while funding for HIV treatments in low- and middle-income countries had risen 10-fold between 2001 and 2009, international resources had declined in 2010. Many states remain dependant on external financing.

“I am worried that international investments are falling at a time when the Aids response is delivering results for people,” Mr Sidibe said. “If we do not invest now, we will have to pay several times more in the future.”

He stressed the importance of a recent trial, which found that if a person living with HIV adhered to an effective antiretroviral regimen, the risk of transmitting the virus to their uninfected sexual partner could be reduced by 96%.

“Access to treatment will transform the Aids response in the next decade. We must invest in accelerating access and finding new treatment options.

“Antiretroviral therapy is a bigger game-changer than ever before – it not only stops people from dying, but also prevents transmission of HIV to women, men and children,” he added.

Mr Sidibe said the challenge was to expand access to drugs, and deal with social factors that in some countries continue to stigmatise the disease and make women particularly vulnerable.

To do this, UNAids believes an investment of at least $22bn is needed by 2015, $6bn more than is available today. It estimates such funds would stop 12m new HIV infections and 7.4m Aids-related deaths by 2020.

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