Debnath Dhrubajyoti J, Rai Sanjay K, Kamble Suchit, Gawade Nilesh, Thakare Meenal M, Giri Purushottam, Javadekar Shubhada Suresh
Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India.
Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Indian J Community Med. 2024 Dec;49(Suppl 2):S191-S201. doi: 10.4103/ijcm.ijcm_787_24. Epub 2024 Dec 30.
Human immunodeficiency virus (HIV) can be transmitted through vertical route from the mother to her child during the period of pregnancy, process of childbirth, or through the breastfeeding. This is still a worldwide health issue, especially in environments with low resources. Without intervention, the transmission rate ranges from 15 to 45%, influenced by breastfeeding practices. Effective interventions, including antiretroviral therapy (ART), can reduce the transmission likelihood to about 2% with breastfeeding and 1% without breastfeeding. A further expansion of access to prevention of mother-to-child transmission of HIV (PMTCT) services was made possible by the year 2011 through the Global Plan toward the Elimination of New HIV Infections among Children and Keeping their Mothers Alive. By 2022, there were 130,000 new HIV infections in children under five, down from 310,000 in 2010. Nevertheless, the Joint United Nations Programme on HIV/AIDS (UNAIDS) Global Strategy to End AIDS's 2025 targets cannot be met with the current level of progress. To prevent new infections in children, pregnant and breastfeeding women with HIV must receive faster medical attention. This position paper discusses the primary prevention of HIV and the healthcare system's role in providing comprehensive care to HIV-positive women and their families. The continuum of care includes antenatal, intrapartum, post-delivery, and pediatric services, addressing the unique needs of each woman and her family. Individual-level interventions highlight the importance of partner selection, consistent condom use, avoiding needle sharing, and reducing risky sexual behaviors. Overcoming barriers to medication adherence, such as stigma and discrimination, is crucial for effective prevention and treatment. Community-level interventions are equally important in reducing stigma and discrimination and fostering healthcare-seeking behavior. The paper emphasizes a multi-faceted approach, involving healthcare systems, individuals, and communities, to accomplish the objective of an HIV-free generation by stopping HIV from spreading through the vertical route. Collaboration across these levels is essential to realizing this vision and ensuring optimal health outcomes for HIV-infected individuals, their children, and families.
人类免疫缺陷病毒（HIV）可在孕期、分娩过程中通过母婴垂直传播途径，或通过母乳喂养传播给孩子。这仍是一个全球性的健康问题，尤其是在资源匮乏的环境中。若不进行干预，传播率在15%至45%之间，受母乳喂养方式影响。有效的干预措施，包括抗逆转录病毒疗法（ART），可将母乳喂养情况下的传播可能性降低至约2%，非母乳喂养情况下降低至1%。2011年通过《全球消除儿童新发艾滋病毒感染并确保其母亲存活计划》，进一步扩大了预防母婴传播艾滋病毒（PMTCT）服务的可及性。到2022年，五岁以下儿童新感染艾滋病毒的人数为13万，低于2010年的31万。然而，按照目前的进展水平，无法实现联合国艾滋病规划署（UNAIDS）《终结艾滋病全球战略》的2025年目标。为预防儿童新感染，感染艾滋病毒的孕妇和哺乳期妇女必须更快地获得医疗救治。本立场文件讨论了艾滋病毒的一级预防以及医疗保健系统在为艾滋病毒呈阳性的妇女及其家庭提供全面护理方面的作用。连续护理包括产前、产时、产后和儿科服务，满足每位妇女及其家庭的独特需求。个人层面的干预措施强调了伴侣选择、坚持使用避孕套、避免共用针头以及减少危险性行为的重要性。克服诸如耻辱感和歧视等妨碍坚持服药的障碍，对于有效预防和治疗至关重要。社区层面的干预措施在减少耻辱感和歧视以及促进寻求医疗行为方面同样重要。该文件强调采取多方面的方法，涉及医疗保健系统、个人和社区，通过阻止艾滋病毒通过垂直传播途径传播，实现无艾滋病毒一代的目标。这些层面之间的合作对于实现这一愿景以及确保艾滋病毒感染者及其子女和家庭获得最佳健康结果至关重要。
