Mother to Child or Vertical Transmission
Lyn's Comment: Babies can be infected with HIV while their mother is still pregnant, during birth, or during breastfeeding. Fortunately, it is possible to minimise this mode of transmission.
Treatment of mothers and newborns with ART, and choice of baby feeding method are the most important methods for preventing transmission. Much has been written over the years of the dilemma facing HIV positive mothers when they need to make decisions about feeding their babies. On the one hand, there is a risk of transmitting HIV through breast milk. On the other hand, alternative methods of feeding are not always AFASS - Acceptable, Feasible, Affordable, Sustainable and Safe.
Guidelines for HIV-positive mothers in resource limited countries
For HIV positive women in low- and middle-income countries, it is not always possible to use replacement feeding safely. There might be problems with access to clean water, sanitation and health services that can increase the risks of disease and even death of the baby. Suitable replacement feeding might also not be affordable. As most HIV positive women in poorer communities cannot safely formula feed their infants, breastfeeding is the only realistic option available.
The latest (2010) guidelines from WHO (the World Health Organisation), is that both mothers and their babies should take antiretroviral drugs throughout the breastfeeding period.
Mothers should exclusively breastfeed their babies for 6 months and after that introduce other foods while continuing to breastfeed up to the age of two. Exclusive breastfeeding means that, except for medicine and vitamins, a baby should receive nothing else to eat and drink – not even water. Breast milk provides all the fluids and nutrients required.
When antiretroviral drugs are taken through the pregnancy and breastfeeding stage, the HIV infection rate drops to as low as 2 percent. It is extremely important that mother and baby take their medicine as prescribed for the whole time the baby breastfeeds (and that the baby continues taking the medicine for one week after stopping breastfeeding).
Where ARV treatment for mother and baby are not possible the 2006 WHO guidelines should be followed (Breastfeed exclusively for six months and rapid weaning thereafter. Mixing breastfeeding with other feeds should be avoided).
Terminology Alert: This mode of transmission is often called "Mother to Child Transmission". (From this the acronym used for "Preventing Mother to Child Transmission" is PMTCT). This terminology has sadly lead to blaming of HIV + mothers, and also to fathers not accepting that they also have a role to play in preventing HIV transmission to their unborn child. Some people speak of "Parent to Child" transmission - this has caused some confusion and questions about the possibility of the baby of a HIV negative mother being infected through a positive father. It might therefore be better to speak of "Vertical Transmission".