Xiaoli (not her real name) is an ordinary villager living in
Fumin County, Yunnan
Province. But in 1998, when she became pregnant, she learned
that she was HIV positive. Her doctor suggested that she terminate
the pregnancy, but Xiaoli held firm to her belief in her duty to
raise a son to carry on the family line. Fate, she thought, would
determine the outcome, even though the risk of transmitting the
virus to her baby was as high as 80 percent.
Fate was on her side. Xiaoli was referred to a hospital in the
provincial capital of Kunming that operates an AIDS treatment
center. She and her baby received short-course antiretroviral
therapy (ART) and now, six years later, Xiaoli's son is as healthy
and happy as any other child in their village.
Xiaoli is one of the 31 women infected with HIV to receive ART
at the hospital. Follow-up care shows that among those 31, only one
baby has tested positive for the virus.
The Kunming AIDS Treatment Center, which will open formally
under that name in November, is currently a department of an
infectious disease hospital in the city. Hospital officials
requested that its name not be disclosed, as public
misunderstandings and fears about AIDS may lead people to avoid
going there for treatment.
However, as an infectious disease center the hospital had
accumulated extensive experience in using ART to prevent
mother-to-child transmission of hepatitis B. In 1997, the doctors
began researching applications for HIV-positive expectant mothers
and in 2000, the hospital established an AIDS ART clinic.
ART uses various drugs or combinations of drugs to prevent
transmission of the virus from mother to infant. Existing
treatments include a long course, which is carried out through the
entire term of the pregnancy, and variants of the short course.
In the absence of breastfeeding, global research has shown that
the long course reduces transmission by about 65 percent. However,
at an average cost of US$1,000 per pregnancy this regime is far
beyond the means of most Chinese villagers. The short course
treatments used in various places around the world, and which vary
from one month to a single dose each to mother and infant, were
later found also to be highly effective in reducing transmission --
as much as 50 percent -- and for a cost as low as US$4.
Researchers in Kunming found that, aside from the cost, the long
course could have adverse effects on the development of the fetus.
They developed a short course that consists of administering drugs
to the mother a day or two before delivery and to the infants for
six weeks following birth.
The babies have blood tests every six months for their first
year, but after that testing may be reduced to once a year. There
is still some risk of infection, particularly in babies that are
breastfed, but results so far have been very encouraging.
One expert at the center, who requested anonymity, said that the
entire cost of the treatment, including testing, drugs, Caesarean
delivery and concomitant care, is strictly controlled at 5,000 yuan
(US$604), about half the actual expense. The follow-up blood tests
for the children are given free.
The Joint United Nations Program on HIV/AIDS (UNAIDS) recommends
a threefold strategy to prevent babies from acquiring HIV from
their infected mothers: First and most important is preventing
women and girls of childbearing age from becoming infected with
HIV. Additionally, HIV-positive women should avoid unwanted and
unplanned pregnancies. Finally, transmission of the virus should be
prevented during pregnancy, labor, delivery, and breastfeeding by
providing voluntary counseling and testing, ART, safe delivering
practices and breast milk substitutes.
(China.org.cn by staff reporter Wu Nanlan, October 25,
2004)