21:40 09.11.2008 | All news from "AIDS/HIV"

Uganda: Less Pregnancies Key to the PMTCT Policy

WE strongly commend the President's recent call for increasing HIV prevention programmes, specifically with regard to the emphasis placed on programmes that prevent mother-to-child transmission (PMTCT).

It is, indeed, true that reducing MTCT can reduce the number of children living with HIV in Uganda.

To achieve this reduction, in addition to his spirited call for providing pregnant women with HIV testing and access to treatment, we would recommend simultaneously strengthening family planning provision for women living with HIV who do not wish to become pregnant.

In 2002, the World Health Organisation recommended the following comprehensive approach for PMTCT programmes:

  • Primary prevention of HIV infection.
  • Preventing unintended pregnancies among HIV-infected women.
  • Preventing HIV transmission from HIV-infected women to their children; and
  • Providing care for HIV-infected mothers and their infants.

Most programmes focus almost solely on element three - preventing HIV transmission from HIV-infected women to their children by giving antiretroviral drugs, usually nevirapine, during labour and to their infants after delivery. Programmes are increasingly focusing on element Four - providing care for HIV-infected mothers and their infants - through PMTCT+ programmes.

Less attention is given to elements of primary prevention and preventing of unintended pregnancies. More attention is deserved because prevention of unintended pregnancies in HIV-infected women reduces the number of children who may become orphans and those born with HIV who will need care and treatment throughout their lives.

The global community's frequent recommendations to strengthen linkages between reproductive health and HIV/AIDS services are a positive development and we strongly support their implementation.

However, the challenge is for policy-makers, donors and implementers to think about preventing unintended pregnancies in HIV-positive women as central to HIV prevention efforts and not simply a sexual and reproductive health "add on" to HIV programmes in their countries.

If donors demand that HIV programmes include prevention of unintended pregnancies among HIV-poistive women, this will prevent more HIV-positive births.

The President's Emergency Plan For AIDS Relief (PEPFAR)- supported PMTCT programmes have prevented an estimated 194,000 infant infections over the past five years. In contrast, we estimate that current levels of contraceptive use in PEPFAR countries may be preventing over 220,000 HIV-positive births per year.

In Uganda, for example, an estimated 7,573 unintended HIV+ births are averted every year from current levels of contraceptive use. This number could rise if access to family planning was increased for women with unmet need.

A recent analysis shows that were Uganda to focus on preventing HIV+ births through contraception rather than PMTCT services, the potential cost-savings could be over $2m (sh3.3b).

By increasing voluntary contraceptive use among HIV-positive women who do not want to get pregnant, the Government can have a major impact on reducing the number of children born with HIV and the number of AIDS orphans.

We hope the Government and its partners will prioritise this approach to strengthen Uganda's PMTCT and HIV prevention programmes.

The writer is the country director of Family Health International



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