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Preventing Parent to Child Transmission

Acquired Immune Deficiency Syndrome or AIDS as it is popularly known is a pandemic with an estimated 38.6 million people now living with the disease worldwide. As of estimates conducted by WHO and UNAIDS, AIDS has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. The first case of AIDS in a Pakistani citizen was reported in 1987 in Lahore. In 1993, the first recognized transmission of HIV infection through breastfeeding in Pakistan was reported in Rawalpindi.

Wearing an electric blue long frock, multi-colored glass bangles dangling in both hands, 16-year-old Lalima sits on a chair cuddling Sher Khan, her ten month old. Numerous clips tugged in her light hair glisten every time she tries to rearrange her heavily embroidered magenta chaddar to cover her head. Three years ago Lalima was bought by Wazir Khan, for Rs 2 lakh 25 thousands and became his second wife at the age of 13. Khan’s first wife, a mother of seven, after staying sick for the past two years allowed her husband to marry again. Continuously being distracted by her son, Lalima is trying to concentrate on what the councilor sitting opposite her is trying to convey. The news has just been broken to her. Lalima has tested positive for HIV.

In another room sits Noor Jehan with her baby girl. Three years ago Noor Jehan was married to ‘a rich man from Saudia’ to become his second wife. She was 15 while her groom was in his late 40s. Her parents wanted her to be married in a rich family, be happy and have a comfortable life, so what if her husband was old or she was his second wife. What she did not know was that he was HIV positive. Noor Jehan started living happily with her husband in Riyadh. But the Cinderella story didn’t last long. Seven months pregnant she returned to Pakistan as her husband fell sick and they were deported. Two months later, her husband died and she came to know that her new born had tested positive.

According to Nighat Kamdar of AWARD, a Peshawar based NGO that works for women’s awareness and counseling on HIV and AIDS, in most cases when women come to them, the husbands are in their last stages and the wives are not aware of the whole truth. In many cases, it seems that every body knows about the husband’s disease, but the wife.

At the beginning, many people thought of AIDS as a disease striking mainly men, as statistics indicated that women were less affected. Unfortunately, all over the world in changing patterns women are increasingly bearing the brunt of this epidemic. The rapid spread of HIV infection among women is alarming. Roughly 47 percent of the new infections each day are in women of child bearing age. Women are biologically more vulnerable to HIV infection and other Sexually Transmitted Infections (STIs). According to a UNAIDS report, among people younger than 24, girls and young women now make up nearly two thirds of those living with HIV.  If these rates of infection continue, women will soon become the majority of the global total of people infected.

National HIV infection levels in Asia are low compared with some other continents, notably Africa. However, the population of many Asian nations is so large that even low HIV prevalence means that large numbers of people are living with HIV. “Pakistan is a low prevalence, but high risk country where women are more susceptible to the virus. Other than biological, increased levels of poverty, low level of literacy, economic dependence and lack of health services especially reproductive, has added women’s vulnerability to HIV and AIDS in South Asia,” says Asma Bokhari, Manager, National AIDS Control Programme, Ministry of Health, Islamabad.

Every year, more than 700,000 children become HIV positive via transmission from their parents. Some 15 to 20 percent are infected during pregnancy, 50 percent during delivery and 33 percent through breastfeeding. Pregnant women who are HIV positive can halve the chances of passing HIV on to their babies if they are given appropriate antiretroviral (ARV) or safe alternatives to breast milk. It can be cut by almost three quarters if women receive both ARV and breast milk substitutes. Obstetrical procedures such as Caesarean section may also reduce transmission, but is often not feasible because of its financial implications. If an HIV positive woman becomes pregnant, there is a 35 percent chance that she will transmit the virus to her child if no preventive action is taken.

UNICEFhas launched afive-year global campaign to give children the prominent place on the AIDS agenda. The campaign focuses on four key areas known as the “Four Ps”, which include Prevent mother-to-child HIV transmission; Provide pediatric treatment; Prevent infection among adolescents and young people; Protect and support children affected by HIV and AIDS. The campaign aims to scale up efforts in all of these areas, which are in line with the Millennium Development Goals and recent commitments on AIDS.

Pregnant women need to have access to information about HIV and AIDS and voluntary testing. Once tested, women and their partners will know if they are HIV positive and can then take precautions, minimizing the possibility of passing the virus to their children.


Society’s inequalities put women at greater risk and thus women are increasingly bearing the brunt of this epidemic. The low status accorded to women in Asia contributes to their vulnerability by limiting access to the means and resources that they need to protect themselves, such as knowledge and awareness, health care services and critically, decision-making power.  Cultural norms, especially in the rural areas and among the urban poor, give no encouragement or support to a wife who resists her husband for any reason. In most areas of her life, including sex, she has no choice. Many married women find themselves in a dilemma when they become pregnant. Thus, many mothers and children suffer in silence.

There is an urgent need to step up comprehensive services on HIV/AIDS prevention in Pakistan. Contrary to popular belief, AIDS is on the rise here and unless immediate actions are taken, the number of infected persons will reach alarming rates. The prevalence of AIDS among some vulnerable groups like injecting drug users is already on the rise and will spread to the general population in no time unless programmes that are working for the prevention of AIDS reach the marginalized sections, especially women and also look at the contexts that make people vulnerable.


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