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Monday, June 29, 1998 Published at 11:29 GMT 12:29 UK


Health

UN Aids programme targets mothers

Breastfeeding accounts for half of child HIV cases in poor countries


The BBC's Claire Doole reports on the Geneva Aids conference
The United Nations has launched a new programme to reduce the transmission of HIV from women to children.

The programme, launched at a major Aids conference in Geneva, will be targeted at 30,000 women in 11 countries: Botswana, Burkina Faso, Cambodia, Honduras, Cote d'Ivoire, Rwanda, Tanzania, Thailand, Uganda, Zambia and Zimbabwe.

The countries were chosen because of their high incidence of HIV transmission to children and because they have local health systems which can offer information and advice programmes to women.

The programme includes offering treatment with the drug AZT, which has been shown to reduce HIV transmission in developed countries. It will also promote alternatives to breastfeeding, which is thought to be the route of infection for a third of children.

The risk of transmission through breast milk is one of the most controversial topics to be addressed by the UNAIDS conference in Geneva, which began at the weekend. UNAIDS is the umbrella group of United Nations Aids organisations.

Over two and a half million children have died of Aids since the epidemic began and one million were infected with the virus at the end of 1997. Half of these became infected in 1997.

Infection inequalities

Most were infected at or before birth or through breastfeeding. The risk of children becoming infected is up to seven times higher in developing countries than in rich countries like the USA and France.


[ image: Over two million children have died from Aids]
Over two million children have died from Aids
Up to 35% of children born to HIV positive mothers become infected in developing countries, compared with just 5% in France and the USA.

In Zimbabwe, the number of children dying from Aids more than doubled between 1990 and 1996.

The reason for the difference in infection rates is that HIV positive mothers in the West have access to expensive drugs and are less likely to breastfeed.

Cheap and convenient

Health experts say it is not simply a matter of getting infected mothers to stop breastfeeding since more than nine out of 10 women do not know they are HIV positive.

Moreover, there are economic and health reasons for continuing with breast milk in the developing world.

Breastfeeding is cheap and convenient and the alternative - baby milk formula - can cause other infections if mixed with unclean water.

Controversy

Yet the United Nations has been making moves towards baby milk companies in recent months. In April, it invited business representatives to talks on alternatives to breast milk for the first time.

A spokesman for UNAIDS said: "We have now a new equation. HIV is now living proof of that in many countries, especially in the young population. We cannot just sit back maintain our position. We are not happy to ask women not to breastfeed, but we have to do it."

But many are not happy that alternatives to baby formula are not being put forward. They are wary of baby milk companies, given the controversy over the way they have promoted their products in developing countries in the past.

Long-term moves

In the long-term, it is hoped that drugs will be found which can reduce the risk of mother-to-baby transmission.


[ image: AZT is too expensive for the developing world]
AZT is too expensive for the developing world
In addition to the new programme, there are other trials going on to extend the use of drugs which reduce breast milk infection.

Thailand has done trials on a cheap alternative to AZT which has halved transmission rates. AZT costs $1,000 per pregnancy - far too expensive for most countries.

But the World Health Organisation says the first step is to inform women about the risk of transmission.

Vaccine money

The UNAIDS conference is also expected to discuss the progress of vaccines against HIV.

On Sunday, the International Aids Vaccine Initiative announced plans to raise up to $500m for vaccine development over the next nine years.

The money will go towards developing a 'fast track' approach to Aids vaccines and increasing the number of human trials of drugs. Over 30 million people in the world are HIV positive.

US president Bill Clinton has set a date of 2007 for a vaccine, but the IAVI says this will not be realisable if governments do not invest more in finding one.

One of the IAVI's biggest donors so far has been Bill Gates' William H Gates Foundation, which has given $1.5m. Britain has donated £200,000.



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