By staff reporter ETHEL LU

Mother-to-Child HIV/AIDS Transmission Clinical studies indicate that the risk of perinatal HIV/AIDS transmission, if not interrupted, is between 15 and 50 percent. International statistics show that every year, there are 2.4 million HIV/AIDS infected pregnant women who give birth to 800,000 infected babies. HIV infection has caused world infant mortality to rise by 75 percent. Statistics published by the Chinese Ministry of Health show that in some areas, perinatal HIV/AIDS transmission has increased from 0.1 percent to 0.6 percent, and that 30 to 40 percent of infected mothers pass the killer virus on to their babies.

Neighborhood committees are encouraged to promote public awareness of AIDS.

Five years ago when Zhou Zengquan was vice president of Kunming’s No. 3 People’s Hospital, he launched and led a project aimed at preventing the mother-to-child (perinatal) transmission of HIV/AIDS. In late 2004, he concluded the life-saving project with a report confirming that of the 23 HIV/AIDS-infected pregnant women that received intervention therapy, 22 delivered healthy babies.

“The Hefei Journey of AIDS orphans” aims to eliminate discrimination against AIDS orphans.	Distinguished Chinese actor Pu Cunxin (second from left) and actress Jiang Wenli (first left) are China’s AIDS Campaign spokespersons at a charity sale during the 15th World AIDS Conference in Bangkok in July 2004.

Effective Perinatal Intervention

Back in 2000, Zhou met a mother who was infected with HIV/AIDS. She had no idea that she was carrying the virus, and learned of it only after her baby was born. Unfortunately, her child was also infected. That year, Zhou’s hospital received a donation from overseas of AIDS treatments, and he immediately thought of the poor mother. However, she refused to take the medication. Her reason was simple: since there was at the time no medicine available to treat her child, she would rather die than suffer life without her baby. “I was deeply moved by this woman’s attitude,” says Zhou. “At the time, many people believed that intervention therapies were not worth carrying out, because they could only save the child’s life, not that of the mother. This woman convinced me that a mother values her child more than herself, and that a healthy baby can be the very reason that makes an infected woman want to carry on living.” Zhou Zengquan then started the clinical experiment of interrupting perinatal transmission of HIV/AIDS.

Zhou’s intervention therapy is surprisingly straightforward. The pregnant woman must take an HIV quantitative test as well as 200mg of NVP, a WHO-approved medicine for the prevention of perinatal HIV/AIDS transmission, before undergoing a cesarean section. After the baby is delivered, the woman must take a second HIV quantitative test. The newborn’s umbilical blood is tested within 72 hours of its birth, and it is treated with a small amount of NVP, and fed with artificial breast milk. When the baby reaches eighteen months, it is given a HIV quantitative test. If the amount of HIV in its blood is below a certain level, the intervention is considered a success.

Zhou says that the medicine that the mother and child take during the therapy costs only four yuan (US $0.5). In late 2004, Zhou Zengquan was delighted to learn that his therapy was included in a list of clinical therapies for the prevention of mother-to-child HIV/AIDS transmission published by the Chinese government.

Social Discrimination

Ironically, over the four years it took, Zhou Zengquan had to conduct his rewarding project in the dark, trying to avoid attention from the general public. His volunteer HIV/AIDS mothers-to-be were from Kunming and nearby areas in Yunnan Province. They were not openly solicited. Most of them were referred to Zhou through his connections in local hospitals’ obstetrical departments. “In four years we managed to find only 23 cases. The situation was worst in the first year, when we only got two volunteers,” Zhou lamented.

Owing to heavy discrimination against AIDS sufferers, staff at Kunming’s No 3 People’s Hospital feared that open solicitation of HIV/AIDS mothers-to-be would keep other patients away. The project was originally planned to run for two years, but it was extended to four years because of the difficulty in finding volunteers.

Fearing discrimination, the women that did come forward wanted to keep their situation strictly confidential. In some cases, they even hid the facts from their families. So the project was carried out discreetly, and protecting the volunteers’ privacy became a paramount task for Zhou and his staff. “We never asked for their real names and addresses as long as they provided us with some way to contact them,” Zhou said. In fact most of the women’s personal information was fabricated.

As a “confidential” project, “confidential” measures were often employed at the request of the volunteers. Of the 23 cases, only ten went through the therapy in Kunming; the others preferred venues in Yuxi, Simao and Honghe prefectures. According to Zhou, one-third of the volunteers refused intervention therapy at his hospital in Kunming, fearing that their relatives, friends, colleagues, or neighbors might discover their condition. In most cases, project workers drove an ambulance to an appointed place to pick up a volunteer, before hurrying off to take a blood sample. “We felt we were acting like special agents on a secret mission,” sighed Zhou Zengquan. Sometimes volunteers failed to appear at the appointed time and place, and Zhou and his colleagues had to drive around the block several times in case they showed up late. On one occasion, they drove around for 500 kilometers before finally giving up.

Enhanced Intervention Efforts

When the project came to an end, Zhou Zengquan was transferred to the Yunnan Provincial Center for Disease Prevention and Control. Soon after, he moved on to the recently founded AIDS Prevention and Care Center of Yunnan Province, where he continues his intervention therapy.

“The high success rate of our intervention therapy does not mean we now have the technology to prevent all perinatal transmission,” said Zhou. In fact, many infected pregnant women in China do not know about their condition, which makes prevention very difficult. In many foreign countries research in preventing perinatal HIV/AIDS transmission is quite developed, but in China, the clinical research has only just started. Zhou believes that government policy is crucial to effective prevention of perinatal transmission.

On November 17, 2004, the Chinese Ministry of Health issued a circular requesting enhanced efforts in promoting the prevention of mother-to-child HIV/AIDS transmission in pilot areas. The pilot project, started in 2003, covered a population of 13.6 million, including 3.22 million women of childbearing age.

A few days earlier on November 8, the ministry issued Implementation Measures for the Prevention of Mother-to-Child HIV/AIDS Transmission (Trial), which offered free prevention and treatment services in 15 demonstration areas of Henan, Hebei and Shanxi provinces. These free services include: perinatal and pre-marriage HIV/AIDS consultation; HIV antibody tests for pregnant and perinatal women; HIV treatments and follow-up tests for infected mothers and babies; and quick HIV antibody tests for expectant mothers who do not know their HIV status. These services have done much to meet the needs of the prevention project and reduce the number of HIV/AIDS cases in these areas.