3.8 Access to interventions to prevent mother-to-child transmission of HIV, specialist antenatal care and family planning services

In developing countries cheap and feasible methods to significantly reduce mother-to-child transmission (MTCT) of HIV (CDC, 1998¹⁵⁸, Guayet al., 1999¹⁵⁹), and advice on modifying infant feeding practices for seropositive women (Coutsoudis et al., 1999¹⁶⁰, Van de Perre, 1999¹⁶¹) are now available. These can reduce HIV transmission from mother-to-child to 10% or less. For women and their children to benefit from these MTCT interventions it is important for women to be offered VCT during the ante-natal period. Counselling may also need to be ongoing after the initial post-test coun-selling session for seropositive mothers who take part in MTCT interventions, including modifying infant feeding practices (Chopra et al., 2000¹⁶², Kibuuka et al., 2000¹⁶³). VCT associated with MTCT interventions should not be limited to ensuring uptake of and adherence to MTCT interventions. It is a much more effective intervention if coun-selling about HIV transmission to and from sexual partners is discussed and if men can be involved and agree to VCT as well. In a small study from Uganda, women attending VCT associated with MTCT seronegative mothers chose abstinence or condom use until their partners accepted VCT (Matovu et al., 2000¹⁶⁴). The length of follow-up is currently short and it would be useful to know how long safer sex behaviour was maintained and what proportion of male partners accepted testing.