A note from Juuko Abdu…

Juuko, a student of medicine at Kampala International University, passionately advocates for HIV/AIDS education. He wants to share this with the WMF Family:

This is JUUKO ABDU Ugandan by nationality a new scholar of wells mountain foundation, chanced and privileged to continue with my bachelors in medicine and surgery in UGANDA,at Kampala international university.

Let me extend my special thanks to wells mountain staff, Directors, Donors and all well wishers for work well done, I promised to provide health education to the family members, their communities and the entire world as per the chance got to under take medicine.

I would ask all my fellow colleagues of wells mountain foundation to read hard and use the chance given to us because its our obligation as students and mostly us members of wells family who hope to go back to our communities and volunteer in types of worked per skills attained.
So our first TOPIC will be about HIV/AIDS, do you 80% deaths in AFRICA die of AIDS because of ignorance about it.

Did you know that a couple can have one person infected and the other not for a long time ?

Did you know that an infected mother can give birth to a HIV negative baby?

Did you know an infected couple can survive for more than 30 years?

So colleagues in Haiti, Ghana, Senegal, Peru am here.

I and my colleagues in Uganda we want to open eyes of many people out there and the entire world.

MOTHER TO CHILD TRANSMISSION OF HIV/AIDS (MTCT) OR VERTICAL HIV TRANSMISSION

Vertical transmission means that HIV passes directly from the infected mother into the fetus or infant.

Stigma
Stigma is particularly strong surrounding mother-to-child transmission. The very phrase “mother-to-child” itself may be stigmatizing as it puts all the responsibility of transmission on the mother and none on the father of the child. Stigma stops women coming forward to get themselves tested. It reduces their choices when it comes to health care and family life once they are diagnosed as HIV positive and has a negative effect on their quality of life. Equally troubling is the lack of sympathy or respect given to pregnant women with HIV especially in the developing nations where they are open to blame, ridicule and rejection. For example, in rural Uganda (Rakai) a man stated, “If a pregnant woman is sick and has premature baby who die before 3 months, then we know she is affected (infected with HIV) and turn away from her. This is our (HIV) test!”

Timing at HIV transmission
Worldwide, over the past two years, about 1.6 million HIV-infected children were born. Over 95% of these children were born in underdeveloped countries.

The exact time of HIV transmission to the fetus during pregnancy is unknown. It has been shown to occur as early as the fifteenth week of gestation, at or near the time of delivery and through breast-feeding.

Breast-feeding by mothers with HIV infection established before pregnancy increases the risk of vertical transmission by 14%. When a mother develops primary HIV infection while breast-feeding, the risk of transmission rises to 29%. In general, it is believed that 50% of HIV-positive babies are infected during the last two months of pregnancy and about 50% are infected during the birthing process or through the early months of breast-feeding (Miotti et al; 1999).

A working definition of the timing of maternal HIV transmission has been established to differentiate infants in utero (in the uterus) from those infected near the time of or during delivery (perinatally). In utero infection occurs in approximately 20% of HIV-infected infants. Children who are infected in utero have a more rapid progression to AIDS and generally become symptomatic during the first year of life. Those infected perinatally have no detectable HIV at birth but demonstrate HIV in the blood by 4 to 6 months of age. These children constitute the majority of HIV-infected infants and have a slower progression to AIDS, about 8% per year (Diaz et al; 1996).

Breast-feeding: Global summary
• Where no drugs or other methods of prevention are administered and the baby is breast-fed by its HIV-positive mother, the risk of infection is about 30 – 35%.
• Where no drugs are administered and the baby is not breast-fed by its HIV-positive mother, the risk of infection is about 20%.
• Where a one-month course of A2T (Zidovudine) is administered and he baby is not breast-fed, the risk of infection is about 10%.
• Where a one-month course of A2T (Zidovudine) is administered and the baby is breast-fed by its HIV-positive mother for up to six months, the risk of infection is about 18% at that age.
• Where two antiretroviral, 22T and STC (Lamivudine) are administered at the time of labour, and to mother and baby for one week following delivery, the risk of infection at six weeks of life, with the breast feeding, is around 11%. If the drugs are given from the 36th week of pregnancy, continued in labour, and given for a week after delivery, the risk of infection at six weeks of life, when the baby is breast-fed is about 9% (background Brief UNAIDS, 1999).

Rate of transmission
The worldwide rate of HIV transmission from mother, without drug therapy, to child varies geographically. In Africa, maternal transmission is as high as 50%, producing about 1600 infected babies a day.
In Europe and United States, without he use of antiretroviral drugs the overall rate is 25% to 30% producing less than 500 infected babies a year. The U.S Public Health Service and 16 other National Health Organizations recommended that HIV testing be offered to all women at risk prior to or at the time of pregnancy. Through year 2002, only six states, Arkansas, Connecticut, Florida, Michigan, New York and Tennessee require health care providers to HIV-test every pregnant woman as early as possible in her pregnancy unless she refuses. The rate of vertical HIV retransmission in New York State has decreased dramatically from 25% to 3.5% since the implementation of its 1996 law requiring:
(a) HIV counseling and offer of an HIV test to all pregnant women, and
(b) Infant HIV testing and maternal notification. Because of this law, over 99% of HIV-infected NewYork women and their children have been linked to counseling and medical care.

New born: HIV positive
Because newborns who test HIV positive may not be HIV-infected, infected mothers in developed nations are advised not to breast-feed their children. The reason a new born can test positive and not be infected is because the mother’s HIV antibodies can enter the fetus during pregnancy (gestation). Because of the presence of maternal HIV antibody, the new born may appear to be infected but is not. The HIV antibody will be lost with time and the child will revert to seronegativity (No HIV antibody in the serum). Mothers in underdeveloped nations have been advised to breast-feed because of the lack of available health care and nutrition. On average, an estimated 350,000 new borns worldwide become HIV-infected through breast-feeding each year between 1997 and the beginning of 2003.

Perinatal Transmission
Many factors that influence perinatal HIV transmission are not known; but, influencing factors do exist because one mother gave birth to an HIV-infected child followed by an infected child who was followed by an infected child (Dickson, 1988)!

There are multiple factors involved in HIV transmission risk, including maternal immunity and viral load, placental conditions, route of delivery, duration of membrane rupture, and fetal factors (birth order, gestational age). This knowledge has led to trials of various interventions, such as drug therapy to reduce viral load (the number of HIV RNA strands present in the mother’s blood at the time of birth) and cesarean section to reduce HIV exposure during delivery.

Viral RNA load Associated with Perinatal HIV transmission – Although the close association between stage of HIV infection in a pregnant woman and likelihood of perinatal transmission has been established, there are no precise numerical criteria for pregnancies at high and low risk of transmission.

Breast-feeding, drug therapy( treatment ) and HIV transmission
Without question, one of the most significant accomplishments of the HIV/AIDS era has been the dramatic reduction in transmission of HIV between mother and child. In America, from 1992 until the present time, perinatal transmission has declined over 80% and its now possible using combination anti-HIV drug therapy, to achieve transmission rates as low as 1% – 2%, compared to 25% – 30% two decades ago.

In 1999, two studies that were perhaps the first, demonstrated the relationship of viral load and mother-to-child breast-feeding HIV transmission. The higher the maternal viral load the greater the chance for HIV transmission via breast-feeding (Katzenstein et al; 1999, Plaegaer et al; 1999).

Nucleoside Reverse Transcriptase Inhibitor Monotherapy that appears to Reduce HIV Transmission During Pregnancy (Zidovudine, Lamivudine)
In 1999, researchers at Makerere University in Kampala, Uganda and Johns Hopkins University in Baltimore gave HIV-infected women a single dose of nevirapine (a non-nucleoside and another dose to their infants within 3 days of birth. The infection rate dropped from 25% to 13%. At a cost of $4, the nevirapine regimen is some 70 times cheaper than A2T given during the last month of pregnancy.

REMAINS JUUKO ABDU ( UGANDA )
juuko.abdu [at ] yahoo.com

THANKS WELLS MOUNTAIN FOR THIS CHANCE