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Brazil pushes to end mother-to-child HIV transmission

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RIO DE JANEIRO, Nov 30, 2005, 2005 (IPS/GIN via COMTEX) -- Brazil is pushing ahead with its widely praised anti-AIDS program by setting a goal to reduce transmission of HIV from mother to child to less than 1 percent within three years.

At present the proportion of infants infected by their mothers is estimated at 3.7 percent. Transmission from mother to child during pregnancy or birth accounts for 88 percent of HIV/AIDS cases in children up to 13 years of age, according to data from the Brazilian Health Ministry's National Program for Sexually Transmitted Diseases and AIDS (STD/AIDS).

From 1983 until last June, 10,077 cases of mother-to-baby transmission were recorded in Brazil. But this form of contagion is preventable if the HIV-positive expectant mother takes antiretroviral medications, gives birth by C-section and avoids breastfeeding.

Reducing mother-to-baby transmission to almost zero in this country "is possible, with a little extra effort," said Sister Maria Thereza Alves da Silva, who heads Casa Vida ("House of Life"), a shelter for children abandoned by seropositive mothers in Sao Paulo. She said that Brazil's AIDS program, which provides antiretroviral treatment to all patients free of charge, is considered exemplary around the world.

Casa Verde was founded in 1991, and has already taken in about 150 girls and boys, 14 of whom have died, the Roman Catholic nun told IPS. "Many babies are simply left behind at the maternity ward by poor and misinformed women," she said. Some are the children of drug users, and their fathers are in jail. "Here they receive health care, education and affection," she added.

Many of the children escape contagion even if the initial tests show them to be HIV-positive. Some are adopted, usually by foreigners. Most have no contact with their parents, many of whom are already dead.

Casa Vida is divided into House 1, which receives the children up to 12, and House 2 where the older children live. "One baby who arrived with a prognosis of only two months of life is now 9 years old and is in third grade," Sister Maria Thereza said with a smile.

The number of infections in children under five has fallen steadily since 1998, when there were 943 known cases. By 2004 that total had dropped to 703 cases, and in the first six months of this year only 221 cases were reported, said Health Minister Jose Saraiva Felipe, presenting this year's Epidemiological Bulletin on AIDS and STDs Wednesday, on the eve of World AIDS Day (Dec. 1).

These results are due to the prevention and control program launched by the government in the mid-1990s, but there is still much to be done if the goal of reducing mother-to-child transmission to "almost zero" over the next three years is to be achieved, he acknowledged.

The annual statistical bulletin states that 371,827 cases of HIV/AIDS were registered in Brazil between 1980 and June 2005. There are fewer new cases among young adults and intravenous drug users, but there has been an increase in infections in women of all ages and in men over the age of 40.

Several aspects of care need to be strengthened, but the key factor for reducing maternal transmission is "early access" by pregnant women to AIDS tests to diagnose the disease in time for them to receive the necessary treatment, said Debora Fontenelle, a doctor at the Pedro Ernesto university hospital in Rio de Janeiro.

The Brazilian Interdisciplinary AIDS Association (ABIA) recently complained that AIDS tests carried out at the specialized centers in Rio de Janeiro take an extremely long time, and that results are sometimes delayed by up to six months, by which time the baby is born. Many women do not even bother to pick up the results, says ABIA.

If the expectant mother is unaware of her HIV-positive status, the precautions needed before and during labor are not taken, making it much more difficult to avoid transmission to the baby. It's even less useful to receive an HIV-positive result after childbirth, when the baby has already been breast-fed, said Fontenelle.

Even so, she said she knew of a case in which a baby was breast-fed for months yet was not infected, "either by luck or because the mother had a low viral load due to being recently infected."

The STD/AIDS program has announced it will distribute 50,000 kits for rapid diagnosis of pregnant women in the poorest states of northeastern Brazil, as part of a campaign supported by the United Nations Children's Fund (UNICEF) which also seeks to prevent AIDS in adolescents

It is currently estimated that 70 percent of pregnant women in this country of 184 million undergo an AIDS test. But access to the tests, and to information about HIV/AIDS, is more limited in poor, remote regions.

The problem in Roraima, a state in the extreme north of Brazil, is not so much the availability of tests nor the delays in receiving results, which arrive in "20 or 30 days," but that many women are afraid of the diagnosis and refuse to be tested, Sumaia dos Santos Dias told IPS. Dos Santos Dias is responsible for the local STD/AIDS program's preventive actions and medication, and is herself HIV-positive.

"There are still prejudices, and people fear discrimination in small towns and villages where everybody knows everybody else," explained Dos Santos Dias, who is also an activist in the NGO Association for the Struggle for Life (Associa o de Luta pela Vida). "Our job is to convince pregnant women to have the test done, but we can't force them."

Copyright (c) 2005 IPS-Inter Press Service. All Rights Reserved.

(C) 2005 Inter Press Service. All Rights Reserved

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