Mario Osava

RIO DE JANEIRO, Nov 30 2005 (IPS) – Brazil is pushing ahead with its widely-praised anti-AIDS programme by setting itself the goal of reducing vertical transmission of HIV, the AIDS virus, to less than one percent within three years.
At present the proportion of infants infected by their mothers is estimated at 3.7 percent, and vertical transmission from mother to child during pregnancy or birth accounts for 88 percent of HIV/AIDS cases in children up to 13 years of age, according to data from the Brazilian Health Ministry s National Programme for Sexually Transmitted Diseases and AIDS (STD/AIDS).

>From 1983 until last June, 10,077 cases of mother-to-baby transmission were recorded in Brazil. But this form of contagion is preventable if the HIV-positive expectant mother takes antiretroviral medications, gives birth by c-section, and avoids breastfeeding.

Reducing vertical transmission to almost zero in this country is possible, with a little extra effort, said Sister Maria Thereza Alves da Silva, who heads Casa Vida ( House of Life ), a shelter for children abandoned by seropositive mothers in Sao Paulo. She pointed out that Brazil s anti-AIDS programme, which provides antiretroviral treatment to all patients free of charge, is considered exemplary around the world.

Casa Verde was founded in 1991, and has already taken in about 150 girls and boys, 14 of whom have died, the Roman Catholic nun told IPS. Many babies are simply left behind at the maternity ward by poor and misinformed women, she said. Some are the children of drug users, and their fathers are in jail. Here they receive health care, education and affection, she added.

Many of the children escape contagion even if the initial tests show them to be HIV-positive due to the antibodies passed on from their mothers. Some are adopted, usually by foreigners. Most have no contact with their parents, many of whom are, indeed, already dead.
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Casa Vida is divided into House 1, which receives the children aged 0 to 12 years, and House 2 where the older children live. One baby who arrived with a prognosis of only two months of life is now nine years old and is in third grade, Sister Maria Thereza said with a smile.

The number of infections in children under five has fallen steadily since 1998, when there were 943 notified cases. By 2004 that total had dropped to 703 cases, and in the first six months of this year only 221 cases were reported, said Health Minister José Saraiva Felipe, presenting this year s Epidemiological Bulletin on AIDS and STDs Wednesday, on the eve of World AIDS Day (Dec. 1).

These impressive results are due to the prevention and control programme launched by the government in the mid-1990s, but there is still much to be done if the goal of reducing vertical transmission to almost zero over the next three years is to be achieved, he acknowledged.

The annual statistical bulletin states that 371,827 cases of HIV/AIDS were registered in Brazil between 1980 and June 2005. There has also been a reduction in new cases among young adults and intravenous drug users, but in contrast there has been an increase in infections in women of all ages and in men over the age of 40.

In order to reduce vertical transmission, several aspects of care need to be strengthened, but the key factor is early access by pregnant women to AIDS tests in order to diagnose the disease on time for them to receive the necessary treatment, said Débora Fontenelle, a doctor at the Pedro Ernesto university hospital in Rio de Janeiro.

The Brazilian Interdisciplinary AIDS Association (ABIA) recently complained that AIDS tests carried out at the specialised centres in Rio de Janeiro take an extremely long time, and that results are sometimes delayed by up to six months, by which time the baby is born. Many women do not even bother to pick up the results, says ABIA.

If the expectant mother is unaware of her HIV-positive status, the precautions needed before and during labour are not taken, making it much more difficult to avoid transmission to the baby. Even less useful is to receive an HIV-positive result after childbirth, when the baby has already been breast-fed, remarked Fontenelle.

Even so, she said she knew of a case in which a baby was breast-fed for months yet was not infected, either by luck or because the mother had a low viral load due to being recently infected.

The STD/AIDS programme has announced it will distribute 50,000 kits for rapid diagnosis of pregnant women in the poorest states of northeastern Brazil, as part of a campaign supported by the United Nations Children s Fund (Unicef) which also seeks to prevent AIDS in adolescents

It is currently estimated that 70 percent of pregnant women in this country of 184 million undergo an AIDS test. But access to the tests, and to information about HIV/AIDS, is more limited in poor, remote regions.

The problem in Roraima, a state in the extreme north of Brazil, is not so much the availability of tests nor the delays in receiving results, which arrive in 20 or 30 days, but that many women are afraid of the diagnosis and refuse to be tested, Sumaia dos Santos Dias told IPS. Dos Santos Dias is responsible for the local STD/AIDS programme s preventive actions and medication, and is herself seropositive.

There are still prejudices, and people fear discrimination in small towns and villages where everybody knows everybody else, explained Dos Santos Dias, who is also an activist in the NGO Association for the Struggle for Life (Associação de Luta pela Vida). Our job is to convince pregnant women to have the test done, but we can t force them.