n Southern African Journal of HIV Medicine - Preventing mother-to-child transmission of HIV : African solutions for an African crisis : prevention




The issue of mother-to-child transmission (MTCT) of HIV has become increasingly politicised in South Africa, with accusations and counter-accusations from all sides. Clinicians and activists, unable to comprehend the government's decisions not to provide inexpensive treatment to prevent MTCT, accuse it of child murder, while the President and Minister of Health claim concern about the safety of the drugs and make sweeping statements about mothers being killed. Amid all the political noise, scientific findings seem to be forgotten. The South African President has called for a 'search for specific and targeted responses to the specifically African incidence of HIV-AIDS', but it appears that some of the evidence already collected by African scientists and their collaborators, with the participation of African women and children, has been ignored. HIV seroprevalence in pregnant women in South Africa averages 23%, rising to 33% in the worst-hit provinces. Some South African studies' have reported MTCT rates of over 35% in the absence of any intervention and where breast-feeding is practised. With a conservative estimate of 800 000 births per year in South Africa, this suggests 70000 infants are affected annually. The head of the Medical Research Council, Professor Malegapuru Makgoba, wrote in a recent Science editorial that the decision not to use antiretrovirals for the prevention of MTCT 'poses serious moral and ethical dilemmas in a nation where maternal-fetal transmission of HIV accounts annually for 10% of the total HIV disease burden'. The need for an effective and affordable strategy to reduce MTCT of HIV is a matter of urgency.


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