Preventing HIV infection among women of childbearing age;
Strengthening family and community support for women and theirpartners to prevent HIV infection and to access services forpreventing mother-to-child transmission;
Expanding access to voluntary and confidential counselling andtesting;
Improving antenatal care for pregnant women;
Expanding antiretroviral therapy for preventing mother-to-childtransmission of HIV;
Providing counselling and advice on appropriate feeding methodsfor infants of HIV-positive mothers; and
Improving the health, nutrition and well-being of parents andchildren living with HIV/AIDS.
Since April 1999, UNICEF has participated in a United Nationsinter-agency programme to prevent HIV infection in pregnant women,reduce transmission from HIV-infected mothers to their infants andprovide care and support for mothers and children living with HIV/AIDS.
By 2001, the UN inter-agency effort was supporting 2 national and79 site-specific programmes to prevent mother-to-child transmissionof HIV, operating in 16 countries. Between April 1999 and July 2001,these programmes reached over 300,000 new clients in antenatal carecentres, providing counselling to 220,000 women, HIV testing to138,000 women and treatment with antiretroviral drugs to over 4,500HIV-positive pregnant women.
In addition, in recent years UNICEF has provided support to thedevelopment of communication strategies as part of mother-to-childprevention programmes in Asia and Africa. This support has helpedthese programmes develop, review and strengthen communicationand community participation.
UNICEF also supports the design and implementation of simplemonitoring and evaluation systems to assess the effectiveness, safetyand acceptability of programmes to prevent mother-to-child transmis-sion. Most country programmes supported by UNICEF, such as inRwanda, have established routine monitoring systems for datacollection and are designing programme evaluations.
Preliminary results of the UN-supported programmes to preventmother-to-child transmission demonstrate that they are effective,reducing transmission of HIV by as much as 50 per cent. If morecountries expand such programmes, some 300,000 to 350,000infants can be protected from contracting HIV infection each year.
The FactsWithout preventive interventions, approximately 35 per cent of infantsborn to HIV-positive mothers contract the virus through mother-to-childtransmission.
In 2001, 800,000 children under the age of 15 contracted HIV,over 90 per cent of them through mother-to-child transmission.
Infants can become infected during pregnancy, childbirth orbreastfeeding. Some 15-20 per cent of infant infections occur inpregnancy, 50 per cent occur during labour and delivery, whilebreastfeeding accounts for a further 33 per cent of infant infections.
Sub-Saharan Africa is home to 90 per cent of the world’s HIV-infected children. Most of the 580,000 children under the age of 15 whodied of HIV/AIDS in 2001 were African.
For mothers living with HIV/AIDS, especially in developing countries,the decision on whether or not to breastfeed is a frightening dilemma.Infants not infected during pregnancy and childbirth, whose mothers areHIV positive, face a 10-15 per cent chance of acquiring HIV throughbreastfeeding, depending on how long they are breastfed. The use ofbreastmilk substitutes reduces this risk, but can expose them to otherdangerous health risks, including diarrhoea. Many mothers in developingcountries cannot afford breastmilk substitutes and lack access to cleanwater, which is essential for their safe preparation and use.
A mother living with HIV/AIDS therefore faces many grave difficul-ties: worries about her own health and survival; the risk of infecting herbaby through breastmilk; and the danger that her baby will develop otherhealth problems if she does not breastfeed.
The Response: Core principlesand strategiesThe United Nations General Assembly Special Session on HIV/AIDS inJune 2001 generated an unprecedented level of global leadership,awareness and support in response to the HIV/AIDS crisis. A Declarationof Commitment adopted at the Special Session specifies time-boundgoals and targets to measure progress and to ensure accountability.
Orphans and Other Children Affected by HIV/AIDSA UNICEF Fact Sheet Mother-to-Child Transmission of HIV
Note: This map does not reflect a position by UNICEF on the legal status of any
country or territory or the delineation of any frontiers.
In the Declaration, governments determined that, together withpartners, they would:
Reduce the proportion of infants infected with HIV by 20 per cent by2005, and by 50 per cent by 2010, by:
Ensuring that 80 per cent of pregnant women accessing antenatalcare have information, counselling and other HIV-preventionservices available to them;
Increasing the availability of and providing access for HIV-infectedwomen and babies to effective treatment, especially antiretroviraltherapy, to reduce mother-to-child transmission of HIV; and
Effective interventions for HIV-infected women, including voluntaryand confidential counselling and testing, and, where appropriate,breastmilk substitutes and a continuum of care.
The United Nations partner agencies on HIV/AIDS have developed athree-pronged strategy to address mother-to-child transmission:
1. Preventing HIV infection in all people, particularly young women.This entails educating women and men about HIV/AIDS, providingaccess to condoms, strengthening the position of women in society andin their households and increasing men’s responsibility for stemming the
spread of HIV. Given the thousands of infants infected through mother-to-child transmission every year, a key element of prevention must be tomeet the needs of HIV-positive pregnant and lactating women.
2. Prevention of unintended pregnancy among HIV-positive women.
Strengthening reproductive health and family planning services so thatall women are enabled to avoid unintended pregnancy.
3. Specific interventions to reduce HIV transmission from HIV-
infected women to their infants. These interventions includeantiretroviral therapy, safe delivery practices, and counselling andsupport on infant-feeding methods. Increasing access to voluntary andconfidential counselling and testing is crucial, allowing women and theirpartners to learn whether they are infected with HIV.
Treatment with antiretroviral drugs. Such treatment can cut by halfthe rate of mother-to-child transmission during pregnancy, labour anddelivery. Treatment options include a one-month course of zidovudine(AZT) during the last weeks of pregnancy, or a single dose of nevirapinegiven to the mother at delivery, followed by a single dose to the infantwithin 72 hours of birth.
Safe delivery practices. These include avoiding such invasiveobstetrical procedures as episiotomy. Caesarean sections are effectivein reducing mother-to-child transmission, but are often not feasible indeveloping countries because of the high cost and risk of complications.
Zimbabwe (3)
Cambodia (1)
Myanmar (3)
Belarus Ukraine
India (11)Kenya (3)
Tanzania (5)
Malawi (1)
16 countries: 79 implementing sites, 2 national programmesSource: UNICEF, 2000.
Rwanda (1)
Burundi (1)
Zambia (6)
Botswana (25)
Honduras (8)
Côte d’Ivoire (6)
UN-sponsored programmes to prevent mother-to-child transmission of HIV, 2000
Uganda (5)
Countries withsite-specific programmes
National programmes
A family in Thailand. Thailand’s Government, together with UNICEF and NGOs,
has created the HIV/AIDS education initiative, aimed at the country’s 19 million
children aged 6 to 19 years old.
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Infant-feeding methods. All HIV-positive mothers should receivecounselling and support on infant-feeding methods. Replacement feedingshould be recommended only when it is acceptable, feasible, affordable,sustainable and safe. Otherwise, exclusive breastfeeding for six monthsis recommended.
UNICEF’s ResponseUNICEF’s work is guided by the Convention on the Rights of the Child,the world’s most widely embraced human rights treaty. Winning againstHIV/AIDS is a top priority for UNICEF because this disease is deprivingmillions of children of their rights to survive, to develop, to be protectedand to have a say in decisions that affect them.
Partnerships at all levels are key to UNICEF’s response. Thesepartnerships include support to pilot projects on mother-to-childtransmission. UNICEF is also working closely with national govern-ments, people living with HIV/AIDS, NGOs, civil society and faith-based organizations, in addition to UNAIDS and its co-sponsors.Further key alliances include support for the development of innovativecommunity-based programmes to provide care and support forchildren and families in need.
A robust response to HIV/AIDS is a top priority in UNICEF’s Medium-Term Strategic Plan for 2002-2005. Among a range of actions, the Plancommits UNICEF to:
Over 2.5 million children were at risk of HIV infectionthrough mother-to-child transmission in 2001
