Tracey-Ann Wisdom, Sunday Gleaner Writer

Jamaica's mother-to-child HIV transmission rate is now approximately 10 per cent. This represents a significant drop from the rate in 2004, which was above 25 per cent.

Dr. Debbie Carrington, coordinator of the Treatment, Care and Support for Persons Living with HIV/AIDS programme in the Ministry of Health, says this is due to changes in the ministry's treatment programme.

"Initially, we had monotherapy, where one drug was used. We now use triple therapy, which combines three drugs, so we expect our transmission rate to decrease even further," she says.

The ministry's prevention of mother-to-child transmission programme (pMTCT), funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, provides free antiretroviral (ARV) therapy to HIV-positive mothers.

Post-delivery treatment

The therapy works by slowing down the reproduction rate of HIV. The pMTCT programme has two phases: providing antiretroviral treatment for HIV-positive mothers, and providing post-delivery treat-ment for mother and baby.

"Once the mothers come in (to the health-care facilities), they are offered an HIV test. They can refuse if they so desire, but the majority of them accept," Carrington says, "If a mom turns out to be positive, she is referred to the high-risk clinic where she receives care, which includes ARVs.

"Now that we have a public-access system, we can offer ARV treatment to the mothers for their own health. Prior to 2004, monotherapy was just to prevent mother-to-child transmission. There was none for the mothers (after the baby is born), so poor mommy was left uncared for," she discloses.

However, pregnancy and childbirth are not the only ways in which a mother can pass on HIV to her baby. The virus can also be transmitted through breastfeeding. As a result, the Ministry of Health has developed a pMTCT protocol guiding health-care workers, which includes infant-feeding guidelines for HIV-positive mothers.

The ministry's 'Integrating Treatment Care and Support with Prevention of Mother-to-Child Transmission of HIV Services' booklet states that HIV-positive mothers are encouraged to avoid breastfeeding their babies.

Health-care workers then help them to decide if replacement feeding (formula) is acceptable, sustainable and safe.

Breastfeeding

The mothers are also advised that if they choose to breastfeed, they should do so exclusively and wean the baby as early as possible - at four to six months - in order to limit the child's exposure to HIV.

Mothers are cautioned against mixing baby formula because it can irritate the lining of the baby's stomach, which makes it easier for the HIV in breast milk to enter the baby's bloodstream and cause infection.

To assist the mothers, the Health Promotion and Protection division of the Ministry of Health provides infant formula for the first six months of the child's life, beginning with an initial eight-week supply just before mother and baby are discharged, and a two-week supply thereafter. The babies also have access to regular clinical services which to monitor overall health and development.

Don't want baby infected

A nurse in the maternity ward at the Spanish Town Hospital says most of the mothers she works with adhere to the advice and do not breastfeed their babies. "They've been prepared from the clinic (when they started ARV treatment), and they don't want their babies to get infected, so they go along with it," she says.

Kerry-Ann Brown, a 39-year-old mother of four, decided not to breastfeed her baby when she discovered she was HIV-positive. She gets his replacement formula from the clinic she attends. "He got medicine (ARV treatment) up to three months and God work it out so him healthy and everything. The last test was negative," she says.

Currently, there are over 500 children, 0-10 years old, living with HIV in Jamaica. Most of these cases are as a result of mother-to-child transmission. The Ministry of Health reports that last year, 442 HIV-positive mothers gave birth in the island's public-health facilities, with about 435 of these being live births.

Not her real name.