The thesis comprises a literature review, a histopathology study of placentas from Kenya in addition to observations and reflections from a field study in primary health care clinics in Moshi, Tanzania.
Transmission of HIV from a HIV-positive woman to her unborn child or infant is defined as Mother-To-Child-Transmission, MTCT. The virus can be transmitted during pregnancy, delivery or after birth through breast milk. Ante partum transmission can take place blood borne through placenta or ascending from cervico-vaginal secretions. Morphologically the placentas of HIV-positives show higher incidence of chorioamnionitis. There are no placental changes known as specific HIV-features. Three interventions are proven efficient in reducing the MTCT. They are antiretroviral therapy to the woman before and during delivery and to the newborn, caesarean section and avoiding breastfeeding, alternatively exclusive breastfeeding. In industrialized countries these interventions have reduced the MTCT-rate from up to 45% to less than 2%.
WHO estimate that more than 40 million people currently live with HIV/AIDS. 25-28 million of these live in Sub-Saharan Africa, including over 2 million infected in Tanzania. Several years with HIV focus by the Tanzanian government and increasing international and private support have resulted in programs for fighting the HIV epidemic, including national pilot programs against MTCT.
In June/July 2003 I worked in an ongoing local MTCT pilot program in health clinics in Moshi, a small town close to Kilimanjaro. I observed HIV s role and influence in an African community and how health personnel handled the problem with limited resources.
Despite international engagement, improved financing and focus on HIV, the HIV-fighting programs in developing countries have not showed the expected results. HIV is still spreading and the situation is far from being under control. Efficient use of financial resources is threatened by capacity shortfalls in health service systems at district level, lack of health- and administrative personnel as well as dysfunctional infrastructure. An even larger problem is low compliance in populations to use services being offered in HIV-programs. Lack of knowledge and delusions influenced by local culture, religion and witchcraft have been identified. Stigma however, is the most important obstacle to compliance. HIV is still associated with personal guilt and shame. HIV-positives are maltreated and discriminated in their local community. People thus often choose not to tell they are infected. They don t use preventive methods as condoms and they breastfeed their children to avoid rumours in the community. People additionally consider HIV-infection as a death sentence no point knowing.
Primary prevention to avoid HIV-infection must be the global number one goal, also in the work against MTCT. In order to succeed in HIV-combat programs it is also important to eradicate stigma, demystify HIV/AIDS, focus on human rights and support the HIV-infected to give them hope for a decent future.