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)
