BCH Physician Travels to Zimbabwe to Help Prevent the Spread of AIDS

Forty million people in the world are infected with HIV, the virus that causes AIDS. Over five million cases were newly diagnosed worldwide in 2001. Of those cases, more than 95 percent are found in resource-poor countries, where treatment options are generally unavailable, unaffordable, and socially taboo. 

Dr. Avinash Shetty, a pediatric infectious disease specialist at Brenner Children's Hospital, visits Harare, Zimbabwe four times each year. He educates women on how HIV is transmitted, hoping to prevent further spread of this global epidemic. 

Zimbabwe has one of the highest HIV prevalence rates in the world. A third of Zimbabwe's HIV-infected population is pregnant women who pass the virus to their infants during pregnancy, at the time of labor and delivery, and through breastfeeding. Through community mobilization, education and research Dr. Shetty hopes to stop the spread of the disease and provide new, cost-effective preventive regimens to prevent mother-to-child transmission of HIV in Zimbabwe, including breast milk transmission. 

"Overall, breastfeeding accounts for 33-50% of HIV transmission in infants," Dr. Shetty said. "By increasing HIV awareness in the community, educating couples and new mothers to the risks of breastfeeding when HIV positive, and encouraging them to seek testing and opt for preventive treatment, we can reduce the alarming number of new AIDS cases in infants and children diagnosed each year." 

Breastfeeding is vital for a baby's health and confers nutritional, immunological, developmental, psychological, social and economic benefits. In resource-poor settings, formula feeding is unaffordable, expensive, not feasible, and even dangerous (due to unsafe water, and poor hygiene) leading to significant risk of infant deaths due to diarrhea and respiratory tract infections. Furthermore, breastfeeding is the social norm in many developing countries, where new moms are expected to breastfeed their infants for as long as 24 months. 

"We know that 75% of breast milk transmission of the AIDS virus occur during the first 4-6 months of a baby's life," Shetty said. "Each month that an HIV-infected mother breastfeeds her infant increases the chance that the baby will test positive for HIV." Developing safe and effective strategies for reducing the risk of breast milk transmission during the first 4-6 months of life and making breastfeeding "safer" in these infants is a pressing research issue. 

However significant barriers to effective HIV/AIDS prevention and care exist. "New moms don't want to be tested to see if they are HIV positive," Shetty said. "They fear being ostracized from their families and often are beaten by their husbands if they test positive for the virus." 

"Another barrier to treatment is the cost of current medications," Dr. Shetty said. "Most people in resource-poor countries cannot afford the medications that would help them. Lack of political will further compound the problem. Studies need to be conducted to develop new, more efficient methods of treating the HIV infection so that more people can receive the necessary medical care and reduce the spread of the disease." 

Most HIV transmissions in this region occur through heterosexual contact and many women are infected by their spouses and do not know they are HIV positive until they come to the clinic for prenatal care. 

Shetty and his research team see over 10,000 women each year - a third or more are pregnant women who are HIV positive. Many effective regimens for preventing mother-to-child transmission have been developed, but political will to implement these strategies is urgently needed.