Dr. Laura Guay, the Foundation’s Vice President of Research, also conducted a journalist training today sponsored by the National Press Foundation, teaching reporters about some of the most misunderstood issues concerning HIV and children

1. HIV in Children: Preventing Mother-to-Child Transmission Dr. Laura Guay Vice President for Research Elizabeth Glaser Pediatric AIDS Foundation J2J Global Media Training on HIV/AIDS July 14, 2010 Vienna, Austria

2. Elizabeth Glaser

3. Ariel and Jake Glaser

4. The Elizabeth Glaser Pediatric AIDS Foundation

5. HIV Disease Course

7. When exposed to HIV (or any infection) the body makes antibodies to fight the infection

8. Standard HIV tests measure these antibodies (EIA, rapid tests, western blot)

9. HIV antibodies from an HIV-infected woman cross the placenta and enter the baby’s blood

10. HIV detection tests

11. These tests measure the actual parts of the HIV virus itself (PCR, p24 antigen, viral culture)

14. 600 000 500 000 400 000 300 000 200 000 100 000 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year This bar indicates the range New infections among children, 1990–2007

15. Provision of Antiretroviral Drugs 55% of pregnant womennot receiving PMTCT drugs 68% of HIV-exposed infantsnot receiving PMTCT drugs WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009

17. Provides opportunity for prevention of HIV infection in children

18. Provides opportunity as an entry point into HIV Care for large number of HIV-infected women and their infected infants

20. Timing of HIV transmission to the infant During pregnancyAround labour/deliveryDuring Breastfeeding

21. If women and newborns take 1 dose of the drug nevirapine around the time the baby is born - - only ~16 out of 100 babies will getHIV from their mothers.

22. If women and newborns take a combination of HIV drugs during pregnancy and after delivery - - as few as 4-6 out of 100 babies will get HIV from their mothers.

23. Breast Feeding vs Bottle Feeding

24. 2009 Revised WHO guidelines

26. Start ARV prophylaxis earlier in pregnancy

27. Provide ARV prophylaxis during breastfeeding

28. Provide single drug Nevirapine daily to infants OR

29. Provide three drug ARV prophylaxis to the mother

30. National authorities should decide whether MCH services will recommend HIV-infected mothers to:

31. Breastfeed and receive ARV interventions OR

32. Avoid all breastfeeding(Taking into account socioeconomics, health services, and local infant mortality and under-nutrition)

34. Allows early identification of children who will benefit from antiretroviral treatment, appropriate infant feeding choices, prophylaxis, and close medical follow-up

35. Decreases the psychological stress of uncertainty for the parents

36. HIV detection tests must be used in first 12-18 mos., then standard antibody tests are accurate

39. Early identification of complications and their appropriate management

40. Use of antiretroviral therapy to maintain and restore the immune system

41. Provision of support for HIV-infected persons, including psychosocial

42. Engage patients/families in HIV care and prevention through education, support and outreach

44. Vitamin A Supplementation

45. General Health Education (safe water, bednets)

46. Management of Diarrhea

47. Growth Monitoring & Nutrition Education - Early intervention/support

49. Studies in infants showed that there was a ~75% decrease in death when ART was started immediately rather than waiting

50. WHO revised recommendations in April 2008 such that ALL infants < 1 yr diagnosed with HIV infection should receive ART immediately

52. Negotiating the PMTCT Activities (PMTCT = MCH)

54. Community sensitization/mobilization lacking

55. Integration of PMTCT within antenatal clinic can be difficult

56. Access to women who don’t deliver in health facility

57. Very low numbers of partners involved

58. Inadequate infant feeding education