1. Overview of HIV and infant feeding After completing this session participants will be able to: explain the risk of mother-to-child transmission of HIV describe factors which influence mother-to-child transmission outline approaches that can prevent mother-to-child transmission through safer infant feeding practices state infant feeding recommendations for women who are HIV-positive and for women who are HIV-negative or do not know their status 17/1

2. Defining HIV and AIDS HIV Human immunodeficiency virus is the virus that causes AIDS AIDS Acquired immunodeficiency syndrome is the active pathological condition that follows the earlier, non-symptomatic state of being HIV-positive 17/2

3. Mother-to-child transmission of HIV Young children who get HIV are usually infected through their mother during pregnancy across the placenta at the time of labour and birth through blood and secretions through breastfeeding This is called mother-to-child transmission of HIV or MTCT 17/3

4. Estimated risk and timing of mother-to-child transmission of HIV in the absence of interventions Timing of MTCT of HIVTransmission Rate During pregnancy5-10% During labour and delivery10-15% During breastfeeding5-20% _______________________________________________________________________________________________________ Overall without breastfeeding15-25% Overall with breastfeeding to 6 months20-35% Overall with breastfeeding to 18–24 months30-45% 17/4

5. 100 mothers and babies 17/5

6. 1000 mothers and babies 17/5b

7. 100 mothers and babies 17/6 +++++ +++ ++++ +++++ ++ +

8. 1000 mothers and babies 17/6b

9. 100 mothers and babies 17/7 +++++ +++ ++++ +++++ ++ +

10. 1000 mothers and babies 17/7b

11. +++++ +++ ++++ +++++ ++ + 100 mothers and babies 17/8

12. 1000 mothers and babies 17/8b

13. 100 mothers and babies 17/9

14. 1000 mothers and babies 17/9b

15. 20 babies 17/10

16. 20 babies 17/11

17. 20 babies 17/12

18. Factors which affect mother-to-child transmission of HIV Recent infection with HIV Severity of disease Sexually transmitted infections Obstetric procedures Duration of breastfeeding Exclusive breastfeeding or mixed feeding Condition of the breasts Condition of the baby’s mouth 17/13

19. Policy of supporting breastfeeding “As a general principle, in all populations, irrespective of HIV infection rates, breastfeeding should continue to be protected, promoted and supported.” 17/14 HIV and Infant Feeding: a policy statement, developed collaboratively by UNAIDS, WHO and UNICEF, 1997.

20. Infant feeding recommendations for HIV-positive women When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended Otherwise, exclusive breastfeeding is recommended during the first months of life 17/15