Babies of a pandemic

Infant development and maternal HIV T he effect of maternal HIV on infant development is a major concern because the virus has become so widespread among women of childbearing age. According to a United Nations report published in October 2003, half the new cases of HIV infection that occur across the world each year are among 15-24 year olds. 1 This group, constituting two and a half million people, are the next generation of parents. The situation is particularly catastrophic in sub-Saharan Africa where widespread poverty and underdevelopment already undermine children's health and wellbeing. 2 It is estimated that 10 million people in this region between the ages of 15 and 24, and up to 45% of pregnant women, are infected. ith this recognition of the high prevalence of HIV in pregnant women in parts of sub-Saharan Africa, major efforts have been directed at developing and implementing interventions to prevent mother-to-child transmission. These efforts have been largely successful: antiretroviral medication, caesarean section, and locally appropriate feeding practice can now reduce transmission from 40% to below 10%. rphaning is increasing in sub-Saharan Africa as rates of adult mortality have started to accelerate. 5 However, by far the largest group of vulnerable young children are those living with an HIV infected mother. In sub-Saharan Africa approximately 70% of infected mothers survive for at least the first five years of their children's lives, It is known that the early years of life are crucial for a child's development, and it is likely that maternal HIV disrupts the rearing environment, thereby putting these children at risk.