Some 37,500 Indians are born with HIV infection every year. This amounts to one in every 700 born each day. By comparison, the United States adds only 93 HIV-positive children a year to its population.
According to the Joint United Nations Programme on HIV/AIDS (Unaids), only 2% of an estimated 1.3 lakh HIV-infected pregnant women in India received anti-retroviral drugs in 2005, condemning a lot more children to be born with HIV.
Alarmed at the growth in the number of both HIV-positive women and children, the National AIDS Control Organization (Naco) is now looking to boost its prevention of parent-to-child transmission programme.
“We plan to double the number of centres that offer targeted interventions for pregnant women,” says an official with Naco, up to 5,000 from about 2,500. “We expect to offer this programme even at primary health centres in rural India.”
The programme gets about Rs100 crore, which is almost 10% of the total budget for HIV prevention and control programmes run by Naco. The organization’s targeted intervention entails counselling pregnant women, recommending they test for HIV, providing post-test counselling if the woman tests positive, and providing both mother and child with doses of nevirapine at birth.
In Mumbai, the project has already been scaled to all government hospitals. Nevirapine is an anti-retroviral medicine that brings down the risk of HIV transmission from mother to child.
“We now have 46 centres located at all government hospitals and nursing homes,” said Dr Uma Tendolkar, additional project director, Mumbai District AIDS Control Society. The society has branded the service as Paalvi (‘new foliage’ in Marathi), and is now generating awareness about the programme. According to Tendolkar, the efforts are paying off. Last year, 1.19 lakh women came to these centres.
An HIV-positive woman can pass the virus on to her baby during the pregnancy, childbirth, or even after birth through breast-milk. The risk of mother-to-child transmission is around 15-30% before or at birth, but it can rise to up to 30-45% with prolonged breast-feeding.
The risk can be halved by giving a short course of anti-retroviral drugs to the mother and the child around the time of delivery, in conjunction with replacement feeding.
Seema, a counsellor at a non-governmental organization (NGO) involved in creating awareness on HIV/AIDS, got similar treatment. Seema (her surname has been kept confidential) is HIV positive, and says her child benefited from an intervention programme that specifically targets pregnant women. Having discovered her HIV status when she registered for ante-natal care, Seema took a four-month course of nevirapine. Her child, who was also administered the drug at birth, remains HIV-free.
The benefits of such targeted treatment are well documented. In many high-income countries, treating pregnant women has resulted in a steep drop in disease-transmission rates to about 2%, according to Unaids.
The reduction has been brought about through efficient identification of HIV-infected pregnant women, enrolling them in specific programmes, ensuring access to effective anti-retroviral regimens, and supporting them in providing safe infant feeding.
At the Lokmanya Tilak Memorial Hospital in Mumbai, for instance, the Paalvi centre has about 40 women coming in for counselling and testing every day. “In the last one year, 106 HIV-infected women registered at the hospital, and all of them were provided counselling and intervention,” said Nitin Alhad, project coordinator with World Vision, an NGO. It partners with the hospital to offer counselling services at the Paalvi centre.
The impact of these interventions can only be determined 18 months after the birth of a child. Since follow-up is poor in many cases, there is little data to determine how many children have benefited from these programmes.
Going by the response to Paalvi, Tendolkar believes that a significant number of children may have benefited from the programme. Naco estimates that 70,000 HIV infections among infants would have been averted by 2008 because of the targeted intervention programme for pregnant women.
“We hope that in about a year or two, 50% of women who do seek medical help at the time of delivery will be covered under the programme. But we do not think it will be possible for the programme to cover the entire population of pregnant women in the near future,” a Naco official said.