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World AIDS Day: India's battle against parent to child transmission of HIV/AIDS

On World AIDS Day, here's what you need to know about parent to child transmission of the HIV virus in India.

December 1st is World AIDS Day

Rajesh (name changed) sat nervously on the edge of his seat with his hands clasped tightly together. The 12-year-old avoided any form of eye contact and spoke in a hushed tone. He is one of the 925 children on Antiretroviral Therapy (ART) at the civic-run Lokmanya Tilak Municipal General Hospital (LTMGH) in Sion, Mumbai, after he was diagnosed with AIDS at the tender age of seven. It was only after his father died due to the disease in 2006, that his mother found out that she and two out of six of her children were also afflicted with it. Here are 11 interesting facts about HIV/AIDS you didn t know!

The National AIDS Control Organisation (NACO) estimated in one of its reports in 2012 that out of 27 million annual pregnancies in India, 34,675 occur in HIV-positive pregnant women. Without any form of medical intervention, there is a 20-45% risk of mother to child transmission of HIV, which is the primary route of transmission for HIV among children during pregnancy, delivery or the breastfeeding period. In order to address this issue, NACO launched the Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme in 2002, where doctors found that they were able to reduce the risk of transmission by 15% by administering a single-dose Nevirapine to pregnant mothers during delivery and to the newborn, within 48 to 72 hours of birth. To know more, you can read: prevention of transmission of HIV-virus to the child during pregnancy

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In 2013-14, these services covered nearly 10 million pregnant women in more than 15,000 Integrated Counselling and Testing Centres (ICTCs) across India out of which 12008 pregnant women were HIV positive. While the NACO claims that its PPTCT programme covers around 37% of the annual estimated pregnancies in the country, it was only in January, 2014, when a new and more effective form of treatment was introduced which consisted of three drugs in one single pill to be given to an expecting mother twice a day from the 14th week of her pregnancy till the breastfeeding stage.Under this new treatment, doctors say the risk of HIV/AIDS transmission from the parent to child can be reduced to 2%.

Doctors at LTMGH, which was declared as one of the seven Paediatric Centre of Excellence for HIV Care across India in December, 2011, were able to reduce the risk of parent to child transmission to 3% in the last one year itself. Requesting anonymity, a doctor at the hospital said, 'Since October 2014 -15, 98 babies who were exposed to the HIV virus were registered with us and were under investigation as their mothers are HIV-positive. We had started all of these expecting mothers with the new drug following which, we observed that out of these 98 babies, only three had tested positive for HIV.

Too little, too late?

Despite this positive step taken by NACO recently to reduce the risk of parent-to-child transmission of HIV/AIDS, Western countries like the USA, UK, and Australia among others, had widely introduced this new treatment more than a decade ago. In India, the government had rolled out the new PPTCT programme only in early 2014 after the pilot project was successful in Andhra Pradesh and Tamil Nadu, as per the NACO website.

Another hurdle faced by healthcare workers in India is the lack of awareness about parent to child transmission of the virus especially among the lower socio-economic groups. In many cases, by the time the parents are diagnosed with HIV or AIDS, it is too late as either one of their children is already suffering from the disease and needs to be started on the first line treatment of antiretroviral drugs. Dr Yeshwant Ghabhale, an Associate Professor at the paediatrics department of the civic-run hospital, says, Most of our patients undergoing treatment for HIV/AIDS have lost their parents to the disease as they weren t aware that they were suffering from it for several years on end. By the time they were diagnosed, it was too late due to which the child s grandparents or other relatives have to take up the responsibility of their upbringing. In many cases, they are unable to do so due to various reasons and then an NGO has to take over.

Ray of hope

In the case of Rajesh, he developed resistance to the drugs given in the first line treatment of ART because he was irregular in taking his daily medicines. His mother, who does odd jobs to earn a living, is uneducated and needs constant counselling sessions with doctors at the hospital to be able to take care of her son s health and well-being. Dr Mamatha M. Lala, Consultant - Pediatric HIV Telemedicine (UNICEF), LTMGH, says, Supportive treatment is just as important as ART because patients and their relatives first need to have a basic understanding of the disease. AIDS is a chronically manageable treatment provided the patients are regularly counselled about hygiene, nutrition and the possible side effects of the drugs which varies from patient to patient.'

'In some cases, patients undergoing antiretroviral therapy suffer from side effects like nausea, acidity, vomiting and in very rare cases, due to toxicity of the medicines, the bone marrow can get suppressed. However, the child will continue with the treatment despite the side effects if s/he is counselled. Without counselling, ART is not going to work,' adds Dr Lala.

In order to reach out to more children suffering from AIDS in rural parts of Maharashtra, Mamta V. Manglani , Professor & Head, Department of Pediatrics and Chief, Regional Pediatric ART Centre (RPAC), LTMGH,helped set up the telemedicine services in October, 2013 in association with the UNICEF, Maharashtra State AIDS Control Society (MSACS) and the National Rural Health Mission (NRHM). 'Through telemedicine, patients living in rural parts of Maharashtra are counselled by us via phone or video calls. This spares them from making a trip to Mumbai and we can keep track of their treatment and ensure that s/he is regularly taking medicines and responding to the treatment,' says Dr Lala.

You can also read:

  1. Here s everything you should know about testing for HIV
  2. Cuba becomes the 1st country to stop mother-to-child HIV & syphilis transmission

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