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Mothers and Infants
On this page, you will find:
- Microbicides for primary prevention
- Microbicides for prevention of unwanted pregnancies
- Microbicides during childbirth and breastfeeding
According to UNAIDS, 39.5 million people are living with HIV, of whom 2.3 million are children under 15 (Dec. 2006). Preventing perinatal transmisison is by far the most common source of HIV infection in children, particularly in those regions hardest hit by the epidemic. Other sexually transmitted diseases (STIs) can affect infant health as well.
A child can contract HIV from its mother at three stages. The virus can be transmitted in utero during pregnancy. More commonly, it is transmitted during labour and delivery, when the infant is likely to be exposed to its mother's blood. Breastfeeding presents another risk to the newborn, as HIV can be passed through breast milk.
The United Nations agencies recommend a three-pronged strategy to prevent transmission of HIV to infants.
- Primary prevention of HIV among parents-to-be.
- Prevention of unwanted pregnancy among HIV+ women
- Prevention of HIV transmission from HIV+ women to their infants during delivery and breastfeeding.
The range of interventions that fall under this strategy can greatly reduce the risk of preventing perinatal transmisison. These include reducing the vulnerability of girls and young women, voluntary counselling and testing for women and their partners, provision of anti-retroviral drug regimens around the time of childbirth, and support for bottle-feeding or safer breast-feeding practices. Strategies for implementing these interventions are being developed and improved.
Microbicides could contribute to a comprehensive strategy of preventing perinatal transmisison in each of the three areas identified in the UN strategy: primary prevention, prevention of unwanted pregnancy, and prevention of transmission during childbirth and breastfeeding.
Microbicides for Primary Prevention
For many women today, prevention strategies like abstinence, mutual monogamy, and condoms are unrealistic. Too often, women's social or economic status means they have little or no control over the timing or circumstances in which sexual relations take place. Women often fear their partner's reaction to requests to use a condom.
As a "woman-controlled" method, microbicides would give women a tool they could use even without the cooperation of their partner. With more prevention options available, more women would be able to protect themselves, and fewer women would become infected with HIV.
Microbicides for Prevention of Unwanted Pregnancies
Several microbicides under investigation could be "dual protection" methods, meaning that they would prevent both sexually transmitted infections AND unwanted pregnancy. Because they are women-controlled, it is likely that more women could use microbicides than are currently able to use male condoms, including HIV positive women who choose to avoid pregnancy. Family planning experience has shown that the more methods that are available to women and couples, the more likely they are to find a method that they can use consistently and comfortably. More methods universally translate into fewer unwanted pregnancies. Contraceptive microbicides would offer an additional option for HIV positive women to avoid unwanted pregnancy.
Microbicides During Childbirth and Breastfeeding
Once microbicides currently under development are proven safe and effective in preventing the sexual transmission of HIV, it is likely that some could be reformulated as "washes" to help reduce the presence of HIV and/or other pathogens in the vagina immediately before delivery. This type of microbicide could help prevent the transmission of HIV and other STIs from mother to infant during child birth either as an adjunct to antiretroviral regimens or on its own.
Though most existing microbicides are topical products, some preliminary studies have been performed on a microbicide that could be used to treat breast milk. Such a substance could inactivate almost all the HIV virus present in expressed breast milk without damaging the crucial proteins, fats and antibodies. If programs that teach women how to express and treat their breast milk were widely accepted and implemented, then babies could still receive all the nutritional benefits of breast milk without the risk of contracting HIV.
Microbicides can make a contribution to our ability to prevent mother to child transmission of HIV globally. As a "public health good," however, microbicides are largely dependent on public-sector funding in order to make meaningful progress in research and development.
