Vaginal disinfection for preventing mother-to-child transmission of HIV infection
RHL practical aspects by Temmerman M
Primary prevention of HIV remains the key to reducing perinatal HIV transmission. Preventing HIV infection in young women is by far the most cost-effective intervention, but it is also the most difficult end-point to achieve. Once HIV infected women become pregnant several interventions are available to reduce successfully the risks of transmitting the virus from the mother to the child. The combination of antiretroviral therapy, elective caesarean section before the onset of labour, and bottle-feeding have resulted in a dramatic reduction (less than 2%)of perinatal transmission in developed countries.
Unfortunately, these interventions are still unavailable to most women in sub-Saharan Africa, where HIV is epidemic. Hence, the search for simple, low-cost, safe, and women-friendly alternatives continues. However at the present time, vaginal disinfection cannot be recommended as a strategy to reduce mother-to-child transmission during labour and delivery.
FIRST CONTACT (PRIMARY CARE) LEVEL
All pregnant women should have access to voluntary counselling and HIV-testing, (VCT). They should be provided with all available information on HIV infection and treatment options. They should be given the opportunity to invite their partner to the health care facility, but should not be forced to bring them, or denied treatment when their partner refuses to attend. Women should be informed about breastfeeding (including the associated risks in terms of HIV transmission to their babies) as well as about reproductive health services and contraception.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
VCT should be widely available, and the hospital should have a clear policy on HIV testing during pregnancy and labour. Where possible women should be given antiretroviral treatment and caesarean section should be offered where it is considered safe for the mother and the child.
AT HOME OR IN THE COMMUNITY
Educating the community about HIV and ways of preventing infection are important components of primary prevention of HIV infection. This education should include information that helps to reduce stigmatization of women who elect not to breastfeed their infants to reduce the risk of HIV transmission. These women need community support.
This document should be cited as: Temmerman M. Vaginal disinfection for preventing mother-to-child transmission of HIV infection: RHL practical aspects (last revised: 8 September 2003). The WHO Reproductive Health Library; Geneva: World Health Organization.