Community care gives hope to infants vulnerable to HIV infection
Sally Ko says prevention of transmission from infected mothers is vital
According to UNAids, last year, some 240,000 children worldwide acquired HIV. That is one new infection every two minutes. In many developing countries, HIV is still one of the major causes of death among children under five. The vast majority of these children contract the virus from their mother during pregnancy, delivery or breastfeeding.
Without treatment, about a third of children living with HIV die by their first birthday and half by their second. Their deaths could be prevented.
Yet, last year, only 42 per cent of infants born to mothers living with HIV in low- and middle-income countries received proper testing. Though the number of new child HIV infections globally has dropped from 580,000 in 2001 to 240,000 last year, efforts must be redoubled to reach the global plan's target of a 90 per cent reduction by 2015. Prevention of mother-to-child transmission is one of the increasingly low-cost approaches that could reduce the risk of transmission.
The approach combines prevention and treatment for both mother and child, with improving reproductive health, antenatal, delivery and post-natal, and infant and child health in a continuum of care.
We focus on community-based prevention of mother-to-child transmission that aims to achieve zero new HIV infections among children within our development programmes and guarantee all pregnant women living with HIV in our project areas access to services in a stigma-free environment. Such community-based schemes include various models to empower a community to ensure the well-being of mothers and their children.
Because HIV affects the whole family, it is useful to offer primary health-care counselling to everyone in the household. Community health workers or volunteers are trained to provide counselling for households with specific needs at specific times, which has proven more effective than random counselling.
This not only helps link the affected members to live-saving care, but also encourages fathers or partners to address any issues that could affect the well-being of the mother and child. Stigma against women with HIV is both widespread and severe in regions with a high incidence of the disease, and it is not uncommon for women to be abandoned by their husband when they are diagnosed as HIV positive. We also engage, equip and mobilise community leaders, especially faith leaders who are often among the most influential in any community, to respond to core issues such as HIV and Aids, maternal and child health, and gender equity.
Their beliefs and values can inspire entire communities to care for one another. But without proper information and insight, their misunderstandings can also inadvertently promote stigma and discrimination.
Psycho-social peer support has also been shown to help prevent mother-to-child transmission. In support groups, HIV-positive mothers can help educate others in similar situations in a safe environment where women can discuss challenging issues. According to a UNAids study, women who participate in this kind of programme are more likely to disclose their HIV status, get tested during pregnancy and receive antiretroviral drugs for themselves and their children.
We also work closely with government health services and other clinical service providers to ensure integration with the community. Partnerships are key to achieving zero infections, which is also critical to the achievement of the Millennium Development Goals which aim to reduce child mortality and improve maternal health, combat HIV/Aids, malaria and other diseases.
