- It is mandatory for all pregnant women to be tested for HIV: Expert
- Treatment is most effective when started early during a pregnancy: Expert
- HIV infected woman can transmit the virus to her foetus: Expert
New Delhi: According to UNAIDS – the joint United Nations Programme on HIV/AIDS, in India preventing mother-to-child transmission of Human Immunodeficiency Virus (HIV) remains one of the foremost challenges in public health. It says that without any interventions there is a 15-30 per cent risk of HIV transmission from mother to child during pregnancy, and delivery and breastfeeding increases the risk of transmission by 10-15 per cent. Mother-to-child transmission which is also known as ‘vertical transmission’ contributes significantly to the incidences of HIV among children, as per UNAIDS. According to the India HIV Estimates 2019 Report of the National AIDS Control Organisation (NACO) of the Ministry of Health and Family Welfare (MoHFW), there were 79,000 children living with HIV in India in 2019 accounting for 3.4 per cent of the total people (over 23 lakh) living with HIV in the same year.
How Can Mother-To-Child Transmission Be Prevented?
A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk) and thus the chances of transmission of HIV to a child is very low if the mother is on Anti Retroviral Therapy (ART), says UNAIDS. According to the national guidelines on preventing parent-to-child transmission of NACO, pregnant women who are detected to be HIV infected during pregnancy should start taking lifelong ART with a combination of antivirals (triple-drug regimen) regardless of the clinical stage of her infection. However, it is important to obtain a sample of blood for CD4 cell count which assesses immunity level and for baseline tests before initiating ART. The initiation of ART should not be delayed for want of CD4 test results, says NACO.
Dr Sravanthi Gadhiraju, Consultant Gynaecologist, Obstetrician and Laparoscopic Surgeon, Yashoda Hospitals in Hyderabad highlighted that it is mandatory for every pregnant woman to take an HIV test. She explained,
As soon as a woman is found to be pregnant, we make an antenatal profile for her. It is a must to include information about her HIV status and viral load in the profile. If she is found positive, she is immediately put on ART. However, if the result is negative, we conduct the test again after three months considering that she might be in the window period during the first test because HIV antibodies are not detectable soon after exposure. If she is found negative this time also, we test her again in the third trimester and then during labour. This is a protocol that all hospitals need to follow. She needs to be linked with ART at whatever stage of pregnancy she is found to be positive. The risk of transmission does become higher when she is found positive during labour but because of the regular screening, this chance decreases. Also, it is important to remember the treatment is best in the early stages but it is still very helpful in all other stages including labour. The baby of an HIV positive mother needs to be tested soon after the birth and put on treatment if positive.
Dr Gadhiraju added that the HIV viral load test and the CD4 cell count that indicates her immunity level and HIV positive patients are required to do every 2-3 months for the HIV positive pregnant women. It is because the results of these tests will help change the treatment as required, she said.
According to the latest estimates by NACO, in 2019, there were an estimated 20,520 pregnant women who would require ART to prevent mother-to-child transmission of HIV across India with Maharashtra accounting for the highest 14.7 per cent of these women.
Dr Gadhiraju, who has done over 10,000 HIV positive deliveries said that because of the early diagnosis and treatment, the rate of transmission of the virus from mother to child has come down significantly in the last ten years. While it was about 33 per cent ten years ago, now it is about 8 per cent, across the globe, including India, she said.
During the course of my years of works, I have seen the incidences of HIV positive mothers coming down which really gives hope. I have worked in both government and private set-up. The government hospital I used to work with had an ART centre also. While, there is still a long fight ahead, but I can see that people are becoming more and more aware, she added.
Dr Bhagya Lakshmi, Consultant Obstetrics and Gynaecologist, Yashoda Hospitals, Hyderabad said that many children who would have been infected and subjected to a life of misery have been saved by their mother’s decision to go for screening and adhere to treatment plans. She said that women who were already known HIV positive and get pregnant, are recommended to continue with their ART regimen.
An HIV positive pregnant mother must also be tested for other STIs (Sexually Transmitted Diseases) and treated accordingly, apart from providing them with nutritional and psychological support. The mode of delivery is planned according to the viral load in the mother and appropriate safety precautions are taken during the delivery. Early infant diagnosis is essential to identify the HIV status of infants and to start a treatment programme, as peak mortality occurs between 6 weeks to 4 months of age for children who have acquired HIV infection. The baby has to adhere to the immunization schedule, Dr Bhagya Lakshmi said.
In 2016, the World Health Organisation (WHO) released guidelines recommending that mothers living with HIV who are on treatment and are being fully supported to adhere to it should exclusively breastfeed their infants for the first six months of life, then introduce appropriate complementary foods while continuing to breastfeed for at least 12 months and up to 24 months or longer (similar to the general population).
While talking to NDTV about preventing mother-to-child transmission of HIV, Surender Kaur, HIV survivor and a social activist working with HIV positive working women in Haryana’s Rohtak said,
Family planning is one of the most important measures for preventing mother-to-child transmission. Also, HIV positive women are at greater risk of dying from pregnancy-related complications than women who are not living with HIV. Women living with HIV must be supported to plan when they do and do not have children and it can help reduce the number of children being born with HIV. So, we raise awareness about family planning among the communities. We also work with sex workers and drugs addicts on measures to prevent HIV infection.
Ms Kaur who has helped in the safe delivery of over 250 children, so far, said that most of the women she had worked with got to know about their HIV status during pregnancy.
I am with them at every step of their treatment and ante-natal check-ups and care. This continues when the baby comes and till the baby becomes 18 months old. I make sure that both mother and the baby are receiving the treatment, their medicines, viral load tests, CD4 cell counts are on time as planned by their doctors. It is important that the viral load remains undetectable in the mother’s blood when she is breastfeeding. We encourage HIV positive women to practice exclusive breastfeeding during the first six months and also connect them with the Anagwadi centres and Integrated Counselling and Testing Centre of the government to help them get nutritional and medicinal support. It is all free of cost. We just have to make sure that they go to these centres and take the needed support.
Impact Of COVID-19 On Health Services And Support To HIV Positive Pregnant Women And Children
According to Dr Gadhiraju, during the initial days of the pandemic, there was disruption of services for some days because of the complete lockdown as pregnant women were unable to visit the ART centres and even their doctors. She said,
At that time, there was a threat of the reversal of the progress made over decades in the fight against HIV, when it comes to pregnant women and children. It is because people living with HIV require uninterrupted access to life-saving treatment, ART, had it not been for the community health workers like ASHAs (accredited social health activists) and ART workers, we would have lost a lot of the progress made. They used to go door-to-door to provide medicines to the women in need. To ensure uninterrupted access to the medicines, ART centres started giving 3 months’ supply of medicines to HIV positive pregnant women. Earlier, medicines were given only for one month. It is important to note here that at all government hospitals and health care centres, HIV treatment and all HIV related tests are completely free. ART centres continued to operate during the lockdown.
She added that once the complete lockdown was lifted, pregnant women started going to the ART centres for their medicines and checkups. She stressed that new pregnancies during the pandemic were undergoing HIV tests as the protocol during the antenatal (before delivery) period.
Ms Kaur, who has been working on the ground for years, said that the pandemic did slow down her work during the first month but after that, she continued to monitor ART, test regimen of HIV positive pregnant women and their children as usual.
About World AIDS Day
In a bid to show support for people living with HIV and to commemorate those who have died from AIDS-related illness, December 1 is marked as World AIDS Day. Founded in 1988, World AIDS Day was the first-ever global health day. Each year, organizations and individuals across the world bring attention to the HIV epidemic with a particular theme to increase HIV awareness and knowledge and speak out against HIV stigma. According to the WHO, the theme for the 2021 observance is “End inequalities. End AIDS” which aims to lay a special focus on reaching the people left behind and highlighting the growing inequalities in access to essential HIV services.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, that is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.