Counsellors' perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in northern Tanzania

This study investigated the infant feeding advice that counsellors were giving HIV-infected pregnant women in Moshi, Tanzania, the factors they thought had an impact on women’s infant feeding choices and their role in influencing these decisions. The data are drawn from in-depth interviews with 16 nurses working as counsellors in their spare time in an antenatal trial of prevention of mother-to-child transmission, five local HIV/AIDS counsellors and two medical doctors, whose counselling experience ranged from less than six months to nine years. Informed choice of infant feeding method by HIV-infected women, as recommended by UNAIDS/WHO/UNICEF Guidelines, was seriously compromised by the actual advice given, directive counselling, lack of time to cope with a positive HIV test result, and lack of follow-up support, regardless of socio-economic status. Infant feeding options were not always accurately explained, but counsellors believed most women had little choice but to breastfeed and were unlikely to exclusively breastfeed, despite advice. It was apparent that the risks and benefits of the options open to HIV-infected women were complicated for the counsellors, not only the women. Counsellors needed additional training in non-directive counselling and infant feeding options to ensure a better quality of advice-giving and support to follow-up women at home.     

Traditional birth attendants in developing countries cannot be expected to carry out HIV/AIDS prevention and treatment activities

Pregnancy and birth, fertility and fertility regulation are all greatly affected by the exigencies of HIV and AIDS, and vice versa. Women and infants can only benefit if the respective policymakers, researchers and service providers in sexual and reproductive health and HIV/AIDS, particularly those involved in prevention of mother-to-child transmission of HIV, gain greater knowledge of each others' expertise and seek to integrate the best of both into the care they each offer. The growth in access to antiretroviral treatment for mothers as well as infants, including during pregnancy and the breastfeeding period, makes such efforts even more timely and crucial. Yet there are worrying signs that specialists in both camps are making inappropriate policy and service delivery recommendations based on too little knowledge of each others' patches. As an example of this problem, this article discusses and rejects a recommendation in a recent BMJ article that traditional birth attendants could be trained to carry out HIV prevention and possibly provide HIV tests and drugs for prevention of HIV transmission during home deliveries in developing countries.     

Preventing mother-to-child transmission of HIV in developing countries: Recent developments and ethnical implications

Various regimens of antiretroviral (ARV) therapy during pregnancy and labourhave been found to be effective in reducing the risk of mother-to-child transmission of HIV Cost and late identification of women with HIV infection d wring pregnancy in many developing countries have been the impetus to study inexpensive, short-course ARV regimens. Recently, it was shown that a single dose of nevirapine given orally once during labour to the mother and once to the infant greatly reduces the risk of HIV transmission. As a result, it has been proposed that in high HIV prevalence areas, this drug regimen be offered routinely to all pregnant women and their infants, without the need for an HIV test. This is seen as a cost-effective alternative to trying to make voluntary HIV testing and counselling universally available to pregnant women, which would require improved antenatal uptake and care, high uptake of HIV testing and high rates of return to learn results before women could make decisions regarding ARV prophylaxis. The ethical dilemmas arising from both these options are currently under debate, against a backdrop of concerns about breastfeeding and breastmilk substitutes, what to do about the increasing numbers of AIDS orphans and how to prevent HIV transmission to women in the first place.     

The evolving art of caring for pregnant women with HIV infection

Care for the pregnant woman who has human immunodeficiency virus (HIV) is highly complex and constantly evolving. The purpose of this article is to describe the pertinent issues regarding women and HIV during pregnancy, including epidemiology of mother-to-child transmission, the effect of the disease on pregnancy, care issues in the perinatal period, and the issues in women's lives that place them at risk for HIV infection. Antiretroviral therapy offers significant reduction in the rate of mother-to-child transmission, and this is presently the cornerstone of therapy for the pregnant woman with HIV. Careful intrapartum management may also reduce the risk of transmission. Clinical studies of treatment modalities continue to offer new hope to prevent transmission of the virus to the fetus.     

Management of breech presentation in areas with high prevalence of HIV infection.

OBJECTIVE: To provide recommendations for the management of breech presentation in areas of high prevalence of human immunodeficiency virus (HIV) infection. METHOD: Review of relevant literature. RESULTS: Studies show that elective cesarean section (CS) is safer than vaginal delivery for breech presentation, external cephalic version (ECV) at term increases the chance of vaginal cephalic delivery. Although there are no studies of the risk of mother-to-child transmission of HIV from ECV, indirect evidence suggests that any increased risk is likely to be very small. RECOMMENDATIONS: Where CS is available and safe, HIV-positive women, or women who might be at risk of HIV, with a fetus at term with breech presentation, should be offered elective CS to reduce the risks of both vaginal breech delivery and mother-to-child HIV infection. HIV-negative women can be offered ECV at term to try to avoid CS. Where women do not have access to a safe CS, or prefer vaginal delivery, the benefit for both mother and child of attempting ECV at term is likely to outweigh the theoretical, very small, risk of facilitating HIV transmission.     

Preventing mother-to-child transmission of HIV

HIV transmission from mother-to-child remains a major cause of infant morbidity and mortality in resource-poor settings. There is consensus that women who need antiretroviral treatment should receive this during pregnancy and beyond, and that an appropriate antiretroviral prophylactic regimen should be given to those who do not yet need ongoing therapy. Infant feeding remains a major source of infection and new antiretroviral strategies, for mothers or children, are emerging with the potential to control this. Access to HIV testing and antiretroviral treatment or prophylaxis remain very limited in low resource settings and needs to be expanded.     

Women and HIV/AIDS: act local/think global

The numbers of those affected by the HIV virus worldwide are staggering. Emerging research demonstrates a number of lower cost medical approaches that would significantly reduce the rates of transmission of the virus. Nursing plays a critical role in quality-of-life issues at time of diagnosis. Supportive caregiving by compassionate use of vocabulary and knowledgeable resourcing for patients is part of nursing practice in HIV/AIDS care.     

HIV exposure: neonatal considerations

The presence of human immunodeficiency virus (HIV) in pregnant women puts infants at risk for exposure through placental infection and contact with contaminated maternal blood and genital secretions. Efforts to combat this inevitably fatal disease continue to focus on preventing transmission of the virus from a mother who has HIV to her newborn during the prenatal, intrapartum, and postnatal periods. Prophylaxis against transmission and vigilant assessment for indicators of infection are hallmarks of appropriate health care for infants exposed to HIV.     

Mothers, midwives, and HIV/AIDS in Sub-Saharan Africa

This article reviews clinical and program issues in the prevention of mother to child transmission (PMTCT) of HIV in sub-Saharan Africa. Topics include prevention of infection, voluntary counseling and testing, prenatal care, labor and birth, postpartum, family planning, infant feeding, and the role of traditional birth attendants. Programs providing short-course antiretroviral therapy to prevent infant infection are contrasted with comprehensive programs offering antiretroviral therapy and medical care to mothers, children, and families. Feminization of the epidemic is related to gender inequalities that facilitate the spread of HIV and make pregnant women an especially vulnerable group. Nurses and midwives are the primary health care providers for most of the population in sub-Saharan Africa. They are the backbone of the new PMTCT programs and will be the largest group of health workers available to diagnose and treat opportunistic infections and dispense antiretroviral therapy. But they have received little training and support to provide AIDS care and treatment and are rarely consulted when plans are made about workforce issues and capacity development in the health sector. Clinical training, leadership skills, salary support, expansion of the nursing workforce, and development of expanded roles for nurses and midwives in AIDS care are needed to help them turn the tide of the epidemic.     

产后哺乳妇女首次排卵与婴儿喂养时间的研究

目的 探讨产后哺乳妇女首次排卵时间与婴儿喂养的关系,为哺乳妇女采取避孕措施提供科学依据。方法 对１０１例哺乳妇女进行Ｂ超监测排卵,并结合基础体温测量及宫颈粘液评分进行连续观察;记录乳妇女的月经复潮时间和婴儿添加辅食的时间。结果 （１）通过Ｂ超监测发现,１０１例哺乳妇女中,有５３例（５２．５％）平均产后１５４天（５．１个月）监测到直径〉１．８ｃｍ的成熟卵泡。产后４个月内首次排卵者１１例（１０．９％）     

Current guidelines on management of HIV-infected pregnant women: impact on mode of delivery

OBJECTIVE: To evaluate acceptance, feasibility and difficulties in the application of a policy of vaginal delivery in selected cases in HIV-infected women. STUDY DESIGN: HIV-infected women delivering March 2002 to December 2004 and enrolled in a prospective observational study in a University hospital tertiary care center were included. A vaginal delivery was not considered if labor before 36 weeks of pregnancy, preterm premature rupture of membranes, on non-highly active antiretroviral therapy (HAART) or viral load >1000copies/mL. Main outcome measures were mode of delivery, prematurity, acceptance of vaginal delivery and mother-to-child transmission of HIV infection. RESULTS: The study included 91 pregnancies, with a total of 95 fetuses. Eighty percent (n=73) of women knew their HIV infection status before becoming pregnant and 57 (63%) were on HAART at conception. Median gestational age at delivery was 37 weeks (range 22-41). Twelve women delivered a live-born before 36 weeks, all with a caesarean section. Among 74 women who reached 36 weeks gestation, 47 (64%) met the pre-established criteria for vaginal delivery, of whom 21 (45%) delivered vaginally. The most common reason for not having a vaginal delivery was the woman's request for a caesarean section. No cases of HIV vertical transmission occurred (0/90, 95% CI 0-4.02%). CONCLUSION: Recommending vaginal delivery among HIV-infected women in selected cases was well accepted, particularly once the policy became established. Nevertheless, a high proportion of HIV-infected women will continue to require caesarean section delivery.     

上海低年级大学生HIV/AIDS知识与态度的调查分析

目的:研究低年级大学生有关HIV/AIDS的相关知识和态度。方法:以横断面研究方式,对上海市5所高校一、二年级1309名学生进行匿名式问卷调查。结果:低年级大学生对HIV/AIDS知识的掌握情况不全面。男生掌握知识情况比女生好。大众媒体是获取HIV/AIDS信息的最主要途径;大学生群体对HIV感染者患者存在歧视态度,同时又低估自身感染的风险。知识得分高的调查对象表现出对HIV感染者患者的平等、宽容态度。结论:高校需加强艾滋病健康教育,尤其培养女生的自我保护意识。全社会整体良性互动,落实遏制HIV/AIDS的有效干预措施。     

中国部分地区HIV阳性孕产妇的调查分析

目的:了解我国部分地区育龄妇女感染人类免疫缺陷病毒(HIV)的情况;调查研究各种阻断方式的效果,探讨适合我国国情的HIV母婴阻断措施。方法:2004年至2007年间,选择我国部分地区为调查地点,对来院进行孕检的妇女及孕期未曾检测HIV住院分娩的产妇进行HIV抗体筛查检测;对HIV阳性孕产妇采取相应阻断措施,此后追踪检测HIV母婴传播状况,综合分析各阻断方案的效果。结果:共筛查119616例孕产妇,检测HIV阳性65例,阳性率0.05%。65例阳性孕产妇中终止妊娠24例,分娩40例,待产1例;孕期、产时及产后发现的HIV阳性孕产妇分别占60.0%、15.4%及24.6%;性途径感染44例(67.7%),血途径感染21例(32.3%),以性传播途径为主;采取完全阻断措施20例(50.0%),1例HIV(+);不完全阻断措施15例(37.5%),1岁内死亡3例,失访2例;未实施阻断5例(12.5%),3例死产,1例HIV(+)。结论:孕产期做好HIV的自愿检测,有利于预防艾滋病母婴传播及阻断工作的开展,根据疫情不同,筛检措施应因地制宜;目前我国部分地区艾滋病流行以性传播为主;HIV母婴阻断应提倡早期发现早期预防,以免错过接受阻断传播的最佳时机;当前预防HIV母婴传播的策略降低了传播率,但也存在一些问题。     

Fathers and breast feeding very-low-birthweight preterm babies

Objective

to explore fathers’ experiences of the breast feeding of their very-low-birthweight preterm babies from birth to 12 months of age.

Design

a qualitative study using interpretive phenomenology. Data were collected via longitudinal in-depth individual interviews.

Setting

publicly funded tertiary level hospital, Australia.

Participants

a purposive sample of 17 Australian parents took part in the broader study. This paper reports on data from the seven participant fathers.

Findings

this paper explores the discursive changes in fathers’ accounts of their perspectives on and support of the breast feeding of their preterm baby. The fathers’ accounts highlight their marked influence on breast feeding, their ambivalent experiences related to breast feeding and their struggle in negotiating a parenting role related to baby feeding.

Key conclusions

this study highlights the role and influence that fathers of preterm babies have on breast feeding, and explores the tensions and paradoxes inherent in promoting the ideology of breast feeding while valuing the practice of bottle feeding.

Implications for practice

this study highlights the need to encourage and involve fathers in breast-feeding education including the impact of bottle feeding on breast-feeding outcomes. The active and positive contribution that fathers make towards preterm breast feeding should be acknowledged and encouraged.     

Improved outcomes of feeding low birth weight infants with predominantly raw human milk versus donor banked milk and formula

Objectives: To investigate the benefits of treating low birth weight infants predominantly with mother’s own raw milk and early initiation of breastfeeding (raw human milk/breast-fed infants), in comparison to feeding only with donor banked milk (until the third week of life) and afterwards a preterm formula until hospital discharge (donor banked/formula-fed infants).

Methods: One hundred and ninety-two predominantly raw human milk-fed infants (70% of raw and 30% of donor milk) were matched to 192 donor/formula-fed ones (on 1:1 ratio). Aggressive nutrition policy and targeted fortification of human milk were implemented in both groups.

Results: The two groups show similar demographic and perinatal characteristics. Predominantly raw milk-fed infants regained earlier their birth weight, suffered less episodes of feeding intolerance and presented a higher body length and head circumference at discharge (p?<?0.001). Those treated mainly with their mothers’ milk were able to initiate breastfeeding almost 2 weeks earlier compared to those fed with donor milk who achieved to be bottle-fed later on post-conceptual age (p?<?0.001). Infants being breastfed until the 8th month of life conducted less visits for a viral infection to a pediatrician compared to those in the other group (p?<?0.001).

Conclusions: Feeding predominantly with mother’s raw milk seems to result in optimal neonatal outcomes.     

Microorganisms in human milk: lights and shadows

Abstract

Human milk has been traditionally considered germ free, however, recent studies have shown that it represents a continuous supply of commensal and potentially probiotic bacteria to the infant gut. Mammary microbioma may exercise anti-infective, anti-inflammatory, immunomodulatory and metabolic properties. Moreover human milk may be a source of pathogenic microorganism during maternal infection, if contaminated during expression or in case of vaccination of the mother. The non-sterility of breast milk can, thus, be seen as a protective factor, or rarely, as a risk factor for the newborn.