msnbc.com
updated 11/29/2007 10:16:42 PM ET 2007-11-30T03:16:42

In the impoverished mountain kingdom of Lesotho, nearly one in four adults is HIV positive, according to a 2006 report from UNAIDS. Completely surrounded by South Africa, this little-known country of 2 million people has one of the highest HIV infection rates in the world.

Out of an estimated 800,000 children under the age of 15 in Lesotho at the end of 2005, about 20,000 were living with HIV. Most were infected by their mothers; the virus spread to them during pregnancy or birth or through breast-feeding.

Preventing transmission of HIV from mothers to their children and getting treatment for infected mothers is critical in the fight against AIDS.

In a special msnbc.com multimedia presentation, three HIV-positive mothers in Lesotho share their concerns about passing the virus to their babies, their fears of dying from the disease and their hopes for the future. Read on to learn more about mother-to-child-transmission of HIV.

Q. How common is the spread of HIV from an infected mother to her child in Lesotho, compared to other parts of the world?
A.
Mother-to-child transmission can occur during pregnancy, labor, delivery or breast-feeding. One in four pregnant women is HIV-positive in Lesotho, among the highest known infection rates in the world, according to a report by the U.N. children’s agency UNICEF. One in 10 children in Lesotho are born HIV positive; half will die by their second birthday.Globally, only one in 10 children infected with HIV gets treatment.

With adequate treatment, mother-to-child-transmission is almost entirely preventable. But in Sub-Saharan Africa, the lack of access to lifesaving anti-HIV drugs means an estimated one in three children born to an infected mother will contract the virus. Breast-feeding by a mother with chronic HIV infection can increase the odds of transmission from 10 percent to 14 percent. In countries such as Lesotho, up to a half of all HIV infections in children are transmitted through breast-feeding. The longer the baby breast-feeds, the greater the risk. However, HIV-positive mothers in poor countries often can't afford other feeding options for their infants.

Q. How can mother-to-child transmission be prevented?
A. An expectant mother can pass HIV during the second and third trimesters of pregnancy. If a pregnant woman is given antiretrovirals during pregnancy and labor, and her baby gets a dose of medication immediately after birth, the chances of her spreading HIV to the infant can be reduced to below 2 percent.

Mother-to-child transmission prevention programs are growing in Sub-Saharan countries, but on average just nine percent of HIV-positive pregnant women have access to the medicines needed to prevent them from passing the virus to their unborn babies.

In Lesotho, mother-to-child prevention programs are now available in 18 hospitals, but despite these gains only an estimated 20 percent of HIV-positive mothers have access to the drugs.

Q. Why aren’t more pregnant women being given the medications?
A.
A weak health system and a critical shortage of medical personnel prevent women from getting access to treatment. Even where anti-HIV drugs are available, many don't take them because they don’t understand the instructions or live too far from a medical facility. Others are afraid to seek treatment because their husbands or families might discover their HIV status and abandon them.

Some progress is being made due to lower drug prices, faster diagnosis of infected mothers and the expansion of mother-to-child prevention programs in a number of countries in eastern and southern Africa. With the support of UNICEF, the government of Lesotho has increased the number of clinics and hospitals offering help for expectant mothers. In these clinics, pregnant women are tested for HIV, given counseling and provided lifesaving antiretroviral drug regimen, if needed.

Q. How can I help?
A.
A number of programs are focused on helping prevent mother-to-child transmission or providing pediatric services for HIV-positive children around the world, including:


UNICEF
The William J. Clinton Foundation
Elizabeth Glaser Pediatric AIDS Foundation

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