Primary prevention

The best way to prevent HIV infection of children through mother-to-child transmission, including transmission through breast milk, is to prevent HIV infection of young girls and women of childbearing age. In sub-Saharan Africa, Asia and the Caribbean the main mode of HIV transmission is heterosexual contact. In industrialized countries, although most women with HIV have a history of injecting drug use (IDU), or sexual partners with a history of IDU or bi-sexuality, heterosexual transmission is becoming an increasingly important route of infection (Wortley and Fleming, 1997; Gabiano et al., 1992; Holmes, 1991).

The risk of HIV infection in women is increased by such factors as immaturity of the genital tract, cervical ectopy, sexually transmitted diseases, and poor nutritional status (Mostad and Kreiss, 1996; Leroy et al., 1994; Plummer et al., 1994;). Cultural, social and economic factors also contribute to HIV transmission by increasing the vulnerability of girls and women (Ankrah et al., 1994; UNDP, 1994).

Strategies to prevent all mother-to-child transmission of HIV, including through breast-milk, should be linked to primary prevention programmes that provide education about safer sex, condoms, and diagnosis and treatment of sexually transmitted diseases, and that ensure the safety of medical procedures. HIV prevention should be emphasized for women who test seronegative in pregnancy because of the particularly high risk of MTCT if mothers are infected with HIV during pregnancy and breastfeeding.