Mother to Child Transmission possible

Phillipa Jaja

Ministry of Health and Child Care (MoHCC) Deputy PMTCT and Paediatric HIV Care and Treatment Coordinator, Dr Precious Andifasi recently revealed some startling news to the effect that close to 5000 babies got infected with HIV during pregnancy and breastfeeding in 2021 by their mothers.

In that same vein, 2 225 pregnant women also tested positive for syphilis. Untreated syphilis may lead to stillbirths.

 Zimbabwe has a generalised HIV epidemic and is among the 22 highest burden countries that account for over 90% of all pregnant women living with HIV worldwide. The Zimbabwe National Statistics Agency reported that 14.3% of pregnant women are HIV-positiveand at least 8.7% of their infants become infected with HIV.

World Health Organisation (WHO) says globally, an estimated 1.3 million women and girls living with HIV become pregnant each year. In the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, delivery or breastfeeding ranges from 15% to 45%.

The above mentioned statistics are nothing short of alarming. They paint a bleak future for the unborn child. Though they make it difficult to conceive the possibility of a zero mother to child transmission, it actually very much possible.

It is possible to stop perinatal transmission of HIV. Perinatal transmission is when pregnant mothers transmit HIV to their baby any time during pregnancy, childbirth, or breastfeeding. It is equally possible to treat syphilis through linking individuals’ diagnoses and treatments given the persistent link between HIV and active syphilis.

Former Minister of Health and Child Care, and Public Health Practitioner Dr Henry Madzorera reiterated that perinatal transmission of HIV can indeed be wholly prevented.

“When we say perinatal transmission we are talking about the transmission of HIV from mother to baby during pregnancy, during delivery, and finally during the period of breastfeeding. In this day and age, there is no reason absolutely whatsoever, why any baby should get HIV infection from his or her mother. We have all the tools necessary to prevent mother to child transmission.

He outlined the steps a mother should take to make it possible.

“The backbone of this program of mother to child transmission prevention is the testing of the mother for HIV in the first place. Mothers should be tested before they get pregnant, that is while they are preparing to get pregnant, then while they’re pregnant, and finally a couple of months before delivery. We know that a mother can get HIV at any time during that continuous period before, during, and after conception. The second intervention to prevention of mother to child transmission of HIV is actually giving antiretroviral therapy to all mothers who are discovered to be positive for HIV,” he said.

Dr Madzorera said complete and full treatment for HIV prevented mother to child transmission adding that it was important to note that if a mother contracted HIV during pregnancy, anytime during pregnancy, the viral load of the mother would be very high initially, and transmission rates of HIV to the baby would consequently be very high.

“So we encourage that mothers be tested at least twice during pregnancy to ensure that we have the desirable outcome.”

Regarding breastfeeding mothers, Madzorera said;

“A mother who is breastfeeding, and is on antiretroviral therapy, will not be able to transmit HIV to the baby through breastfeeding, as long as we keep the viral load undetectable. And that is extremely important.

“That is why we want to make sure that every HIV positive mother is put on a full course of antiretroviral therapy during pregnancy and after delivery. This treatment that we start during pregnancy is lifelong treatment,”

Madzorera said once on treatment, the mother should not stop antiretrovirals for any reason whatsoever, noting that it was administered for the good of both the unborn baby and the mother.

“So the therapy should not be stopped at all. That is the current thinking and we thank the Ministry of Health and Child Care for keeping accurate records about HIV infection during pregnancy and lactation.”

In the Zimbabwean context, it has been noted that a number of factors have contributed to mother to child transmission. Denial which leads to mothers’ unwillingness to get HIV treatment during the pregnancy and breastfeeding period, stigma, economic dependence on partners who might be infected and late antennal bookings are all to blame.

However, all that can be changed if society adopts a positive mind-set regarding this matter leading to constructive behaviour change critical in preventing perinatal transmission, as Dr Madzorera noted

“Issues of stigma and denial should now be a thing of the past. We should work with both mother and father to ensure that we bring an end to mother to child transmission of HIV. Let’s not leave the father outside. Let’s target fathers in our messaging.”

 Evidence to support the notion of an end to HIV transmission from mothers to babies is available. This is further reason why it is important raise awareness around it and promote it in this country. For example, in 2022, Oman was validated by WHO as the first country in the Eastern Mediterranean Region to have successfully eliminated mother-to-child transmission of HIV and syphilis. In 2021, Botswana, became the first high-burden country to be certified for achieving an important milestone on the path to eliminating mother-to-child transmission of HIV by the World Health Organization (WHO).

As pointed out by Dr Madzorera, prevention is always better than cure.

“So, let us ensure that all our mothers get tested for HIV before, during, and after delivery so that we can bring HIV transmission from mother to baby right down to zero. No baby in this day and age should be born with HIV infection because God has generously given us the ability to prevent mother to child transmission of HIV.”

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