THE main source of HIV Infection in children is the mother. The United Nations agencies estimate that over 1900 infected children are born daily worldwide, the overwhelming majority in the developing world especially in Sub-Saharan Africa.

The prevention of mother-to-child-transmission encompasses three aspects – the primary prevention of HIV infection among parents to be, the prevention of unwanted pregnancies in HIV positive women, and the prevention of viral transmission from mother to child.

Mother-to-child transmission prevention should be integrated into a continuum of care that includes expanded access to care and support for HIV-positive mothers and their families, reproductive healthcare and family planning, treatment of opportunistic infections and access to antiretroviral treatment.

HIV can be transmitted from mother to infant in three ways. infection may occur in uterus, the virus can be transmitted to the infant at the time of delivery (by ascending infection, by ingestion of maternal blood or other fluids, or by breaks in the skin and subsequent direct exposure to infected blood or secretions, or it can be transmitted through breast milk.

The relative contribution of each of these routes will depend on the presence or duration of breast feeding. In non-breast fed infants, around one-third of transmission occurs in the intrauterine period and two-thirds during or close to delivery.

Where infants are breastfed, about half of the transmission occurs around the time of delivery, around one-third through breastfeeding, and a smaller proportion in utero.

Three strategies have been shown to have a major effect in preventing mother-to-child transmission – antiretroviral prophylaxis, elective caesarean section, and modification of infant feeding.

Where antiretrovirals are available, the decision about the need for treatment in pregnancy should be based on the woman’s own immological, virological and clinical condition.

Optimal antiretroviral therapy should not be withheld during pregnancy unless the risk of adverse effects to the mother, fetus or infant, outweighs antiretroviral therapy to reduce the risk of mother-;child-transmission is recommended for pregnant women who do not yet need such treatment for their own disease.

Several antiretroviral regimens have been shown to be effective in reducing mother to child transmission of HIV, varying in length and complexity. All these regimes include intrapartum treatment, with differing lengths of antepartum and postpartum treatment.

The choice of regimen will depend upon the effectiveness of the intervention, and the safety of the drugs.

Several studies have shown that caesarean section before the onset of labour reduces the risk of mother-child-transmission.

In contrast, effective caesarean section for reducing mother-to-child, transmission will not be an accessible option in most developing countries, where resources to perform the operation are not available and the prevalence of HIV is very high.