'Human Immunodeficiency Virus' (or HIV) is the term used to describe a virus present in the

blood stream that can at some stage lead to a health condition called 'Acquired Immune
Deficiency Syndrome' (or AIDS). AIDS is a condition where the person has a weakened immune
system making them very susceptible to relatively normal infections such as the common cold or
diarrhoea, sometimes being ill to the point that the otherwise mild (or 'opportunistic') infection
becomes life-threatening. A person can have a blood test that shows they are 'HIV positive', but
they may not be ill and may never actually progress on to having AIDS.
HIV was first identified in the early 1980's and a blood test to detect the virus became available
in May 1985. Australia has screened all blood and organ donations for HIV-AIDS since May
1985. This has virtually eliminated contracting the HIV virus through a blood transfusion, or by
receiving other blood or body products.
HIV is a notifiable disease within Australia, reported by health professionals to the Department
of Health's National Centre for Disease Control (NCDC). However, these reports do not contain
information that identifies an individual person. Around 60 to 90 women are diagnosed with HIV
in Australia every year. About 1% of all HIV positive people in Australia are babies.
The HIV virus can be passed onto others by coming in contact with the blood, semen or the
vaginal fluid of an infected person. HIV is NOT spread by ordinary social contact such as
hugging, kissing, shaking hands, sharing food, plates, cups and glasses, using the same shower
and toilet facilities or using the same washing machine. The virus is also NOT present in an
infected person's sweat, tears, vomit or bowel motions and cannot be transmitted through
mosquito bites.
The HIV virus can be transmitted through:

Unsafe heterosexual or homosexual sex (no condoms) with an infected person.

This is the most likely way a person will become infected. Oral sex is considered
low risk, but using a dam is advised and avoiding ejaculation into the mouth,
especially if your partner has cuts or sores on their lips or mouth.
Using the semen of an infected man for artificial insemination.
Professional dealings with infected blood (for example needle stick injuries or
blood splashes).
Sharing needles when injecting drugs. This actually has a relatively low risk of
infection, because the virus does not live for very long outside the body. It is
actually much easier to be infected with other viruses such as hepatitis B and C
through the sharing of injecting equipment, than it is to be infected with HIV.

Physical signs

When a person first becomes infected with HIV they will not show any physical signs of being
ill. After about 1 to 6 weeks they may experience an illness similar to the flu and perhaps have
other symptoms such as feeling tired, having a headache, sore throat, a fever, a mild rash,
enlarged lymph nodes, vomiting and diarrhoea. This illness is temporary and is known as a
'primary HIV infection' (or 'PHI'). The person feels well again after recovering, but still carries
HIV and is still capable of infecting others.
If a person with HIV is not given any medical treatments, the virus may progress onto AIDS,
usually within 8 to 10 years (called 'seroconversion'). A person who has AIDS usually
experiences being unwell with minor infections and illnesses as their immune system becomes
depleted. Over time the illnesses become increasingly serious, eventually becoming lifethreatening. However, there are now medications available that can slow or stop the progress of
HIV-AIDS and protect the person from many of these 'opportunistic infections'.
Tests and treatments
In recent years, the testing of pregnant women for HIV has become increasingly accepted as
'routine' by many maternity caregivers. However, testing for HIV is not compulsory and some
women do decline it if they do not wish to be tested. In some places, only women considered 'at
risk' are offered the test. For example, women with a history of IV drug use or women with past
or present partners who are bisexual. Some lesbian women ask for the test if they have conceived
their baby with a friend who they know is a sexually active homosexual.
Ideally, pregnant women being offered a HIV test should be counselled before they have the test
and given an opportunity to discuss the social, physical and emotional implications of receiving a
possible 'positive' result. Your test result should also be kept confidential.
If you choose to accept a HIV blood test, this will be done at or before the first pregnancy visit,
(usually before about 12 to 14 weeks of the pregnancy). If you are found to be carrying the HIV
virus, the blood test result will show as being 'antibody positive' (also written as 'HIV+').
However, if the blood test comes back as 'antibody negative', you do not have the virus. Be
aware that a HIV blood test will show as being 'negative' if it has been less than 3 months since
you were exposed to the virus. This 3 month period of being infected, but not showing up on a
blood test, is known as a 'window period'. If you think you may have been exposed to HIV, you
should wait at least 3 months to be tested.
It takes 10 days for the results of a HIV blood test to become available. This can be a stressful
time if you think you may be at risk of having HIV. The results of a HIV test usually have to be
given in person, meaning they cannot be given over the phone. If the result is 'positive' (meaning
you have the virus) your caregiver will need to provide comprehensive post-test counselling to
provide information and access to support services and discuss the implications of having HIV.
There is currently no cure for HIV and no vaccine available to prevent a person becoming
infected. However, there are a variety of medications available that are fairly successful in

slowing the progression of HIV and making it less likely for the person to become ill. These are
discussed in the next section under pregnancy, birth and breastfeeding. Some people will also
use natural therapies to help boost their immune system.
Pregnancy, birth and breastfeeding

In Australia, about 50% of HIV positive women are also mothers. Some women had children
before they knew they had the virus, some found out during the pregnancy and others have had
children knowing they were HIV positive. It is possible for the baby of a mother infected with
HIV to become infected with the virus during the pregnancy, at the birth or through
breastfeeding.
Babies in developed countries (such as Australia, New Zealand, Europe and the United States)
are thought to have a 15 to 30% risk of becoming infected by HIV from their mother. Babies in
developing countries are thought to have about a 30 to 45% (in places such as South East Asia,
Africa and South America). This is called mother to child transmission (MTCT) or 'vertical
transmission'.
In recent years, the risks of a baby becoming infected from their mother has been greatly
decreased to less than 2%. However, this is limited to countries that can afford the advanced
treatments required to achieve this. Medical interventions and treatments that may be suggested
to reduce the chances of a baby becoming infected can include:
Antiretroviral medications. Antiretroviral medications aim to decrease the amount of HIV in a
person's blood stream. The amount of virus circulating in person's system is called a viral load. A
person's viral load can be measured with a blood test. The lower a woman's viral load, the less
likely she will be to transmit HIV to her baby during pregnancy and the birth.
Zidovine (AZT) is the most common antiretroviral medication and has been used to treat HIV
since 1987. It is also the drug that has been used most extensively during pregnancy. Zidovudine
works by inhibiting HIV replication (or the growth of the virus).
A course of zidovudine has been shown to reduce mother to child transmission and decreases the
risk of the baby being stillborn or dying soon after birth. The medication is given to the mother
from 28 to 35 weeks of the pregnancy and to the baby from birth up until they are 3 days or up to
6 weeks old (depending on what is prescribed). Studies where women have taken Zidovudine
during their pregnancy have so far not shown any adverse effects on babies and children who
have been followed up to 4 years of age. Other similar medications are lamivudine (3TC),
didanosine (ddI), stavudine (d4T) and abacavir (ABC).

Nevirapine (NVP) . Another type of antiretroviral medication is 'nevirapine'. This is usually

given to the woman as a single dose during labour, as well as a single dose to the baby within 72
hours of the birth. It aims to provide protection for the baby against the virus at birth and reduces
the chances of them becoming infected.
Protease inhibitors. Evidence over the past 5 years suggests that combining the above drugs
(called combination therapy), usually using 3 or more medications at one time can reduce the
woman's viral load even further and perhaps prevent her becoming resistant to some medications
used to treat HIV. This type of approach is already being recommended and prescribed by many
caregivers. However, it involves the use of 'protease inhibitors' (such as indinavir, ritonavir,
nelfinavir or saquinavir). The safety of protease inhibitors for the unborn baby has not been
extensively researched, nor have the effects on the newborn baby in regards to their growth and
development after the birth. Essentially, the consequences of using these drugs are unknown.
One French study published in 1999 used this approach on 200 pregnant women over several
weeks (from 34 weeks of the pregnancy), resulting in 2 babies dying during the pregnancy from
a very rare neurological disorder. However, other studies since then have not been able to
replicate these findings.
Caesarean birth.Observational studies suggest that Caesarean birth may decrease the chances of
the virus being transmitted to the baby by up to 50%, when compared to vaginal birth. Having
broken waters for a long period of time (over 18 to 24 hours) and having a prolonged labour may
also increase the chances of the baby being infected, encouraging caregivers to take steps to
avoid these scenarios for HIV positive women.
Vaginal lavage. It has been suggested that the woman's vagina be disinfected during labour with
an antiseptic solution to prevent transmission of HIV to the baby during birth. While the benefits
of doing this have not been proven, it has been suggested that this may be an easy, low cost
intervention for women in developing countries.
Avoiding breastfeeding. Breastfeeding is associated with doubling the risk of a baby becoming
infected with HIV from their mother. At this stage, HIV positive women are discouraged from
breastfeeding their baby(s) and are advised to formula feed with bottles.
Vitamin A supplements. In developing countries with high levels of malnutrition and vitamin A
deficiency, it has been suggested that vitamin A supplements for the woman during her
pregnancy may reduce the chances of her baby becoming infected. This is because Vitamin A
plays a role in helping the body's immune function. However, vitamin A supplements have not
been proven to be of any benefit and vitamin A (or retinol) is known to cause birth defects in
unborn babies. As a general rule, vitamin A supplements should be avoided during pregnancy.
You can read more in vitamin A.

HIV/AIDS during Pregnancy

HIV transmission from mother to child during pregnancy, labor, delivery or breastfeeding is
called perinatal transmission. Perinatal HIV transmission is the most common way children are
infected with HIV.

What is HIV/AIDS?
HIV (Human Immunodeficiency Virus) is a virus that causes AIDS (Acquired Immunodeficiency
Syndrome). A person may be HIV positive but not have AIDS. An HIV infected person may
not develop AIDS for 10 years or longer. A person who is HIV positive can transmit the virus to
others when infected blood, semen or vaginal fluids come in contact with broken skin or mucus
membranes.
An AIDS infected person cannot fight off diseases as they would normally and are more
susceptible to infections, certain cancers and other health problems that can be life-threatening or
fatal.

What are the risk factors for transmitting HIV during

pregnancy?

If a woman is infected with HIV, her risk of transmitting the virus to her baby is reduced if she
stays as healthy as possible. According to the March of Dimes, new treatments can reduce the
risk of a treated mother passing HIV to her baby to a 2 percent or less chance.
Factors which increase the risk of transmission include:

Smoking

Substance abuse

Vitamin A deficiency

Malnutrition

Infections such as STDs

Clinical stage of HIV, including viral load (quantity of HIV virus in the blood)

Factors related to labor and childbirth

Breastfeeding

Should pregnant women get tested for HIV? How is testing

done?
Women who are planning on becoming pregnant or who are pregnant should be tested for HIV as
soon as possible. The womans partner should also be tested. The March of Dimes recommends
that all women of childbearing age who may have been exposed to HIV should be tested before
becoming pregnant. Women who have not been tested before becoming pregnant should be
offered counseling and voluntary testing during pregnancy. Women who have not been tested
during pregnancy can be screened during labor and delivery with rapid tests which can produce
results in less than one hour. This allows for treatment to protect the baby should the results be
positive.
HIV/AIDS testing is conducted with a blood test.
A womans health care provider may offer testing and counseling or may refer her to a local
testing sight. Additional information about testing can be obtained from:

National IV Testing Resources http://www.hivtest.org

CDC-INFO 24 hours/day at 1-800-232-4636

National Aids Hotline at 1-800-342-AIDS

The Food and Drug Administration has approved the Home Access HIV Test System. This
testing system allows for confidential testing with the use of a home testing kit.

How can HIV/AIDS affect my pregnancy?

In most cases, HIV will not cross through the placenta from mother to baby. If the mother is
healthy in other aspects, the placenta helps provide protection for the developing infant. Factors
that could reduce the protective ability of the placenta include in-uterine infections, a recent HIV
infection, advanced HIV infection or malnutrition.
Unless a complication should arise, there is no need to increase the number of prenatal visits.
Special counseling about a healthy diet with attention given to preventing iron or vitamin
deficiencies and weight loss as well as special interventions for sexually transmitted diseases or
other infections (such as malaria, urinary tract infections, tuberculosis or respiratory infections)
should be part of the prenatal care of HIV infected women.
Health care providers should watch for symptoms of AIDS and pregnancy-related complications
of HIV infection. In addition, providers should avoid performing any unnecessary invasive
procedures such as amniocentesis in an effort to avoid transmitting HIV to the baby.

What is the chance that my baby will become HIV positive?

A baby can become infected with HIV in the womb, during delivery or while breast-feeding. If
the mother does not receive treatment, 25 percent of babies born to women with HIV will be
infected by the virus. With treatment that percentage can be reduced to less than 2 percent,
according to the March of Dimes.

How will my prenatal care be handled differently if I am

HIV positive?
A multi-care approach is the most effective way for pregnant women with HIV infection to have
a healthy pregnancy and delivery. This approach will address the medical, psychological, social
and practical challenges of pregnancy with HIV. While the womans pregnancy is being managed
by a health care provider and HIV specialist, she may also receive assistance from a social
services agency to help her with housing, food, child care and parenting concerns. She would
also be receiving counseling support for herself and her partner. Additional care could be
provided in the areas of substance abuse and lifestyle counseling. This team effort will provide
the best prenatal care plan for women infected with HIV. Many of these services could continue
during her postpartum period.

Is there safe treatment for women during pregnancy?

The United States Public Health Service recommends that HIV-infected pregnant women be
offered a combination treatment with HIV-fighting drugs to help protect her health and to help
prevent the infection from passing to the unborn baby.
Zidovudine (also known as ZDV, AZT and Retrovir) was the first drug licensed to treat HIV.
Now it is used in combination with other anti-HIV drugs and is often used to prevent perinatal
transmission of HIV. ZDV should be given to HIV-infected women beginning in the second
trimester and continuing throughout pregnancy, labor and delivery. Side effects include nausea,
vomiting and low red or white blood cell counts.

How does HIV affect my labor and birth?

If no preventative steps are taken, the risk of HIV transmission during childbirth is estimated to
be 10-20%. The chance of transmission is even greater if the baby is exposed to HIV-infected
blood or fluids. Health care providers should avoid performing amniotomies (intentionally
rupturing the amniotic sac to induce labor), episiotomies and other procedures that expose the
baby to the mothers blood. The risk of transmission increases by 2% for every hour after
membranes have been ruptured.
Cesarean sections performed before labor and/or the rupture of membranes may significantly
reduce the risk of perinatal transmission of HIV.
Women who have not received any drug treatment before labor should be treated during labor
with one of several possible drug regimens. These may include a combination of ZDV and
another drug called 3TC or Nevirapine. Studies suggest that these treatments, even for short
durations, may help reduce the risk to the baby.

Will my baby need treatment after delivery?

A 1994 study by the National Institutes of Health found that giving ZDV to an HIV-positive
pregnant woman during her pregnancy and to her baby (within 8-12 hours of birth) decreased the
risk of passing the infection on to the baby by 66%. The baby should be treated with ZDV for the
first six weeks of life. Eight percent of babies of women treated with ZDV became infected,
compared with 25 percent of babies of untreated women. No significant side effects of the drug
have been observed other than a mild anemia in some infants that cleared up when the drug was
stopped. Follow-up studies show that the HIV-negative treated babies continued to develop
normally.

Can I breastfeed if I am HIV positive?

About 15% of newborns born to HIV-positive women will become infected if they breastfeed for
24 months or longer.
The risk of transmission is dependent upon:

Whether the mother breastfeeds exclusively

The duration of breastfeeding

The mothers breast health

The mothers nutritional and immune status

The risk is greater if the mother becomes infected with HIV while she is breastfeeding.
The Maternal & Neonatal Health Program supports the following guidelines for breastfeeding by
women infected with HIV:

A woman who is HIV-negative or does not know her HIV status should exclusively
breastfeed for six months.

A woman who is HIV-positive and chooses to use replacement feedings should be

counseled on the safety and appropriate use of formula.

A woman who is HIV-positive and chooses to breastfeed should exclusively breastfeed

for six months. The woman should also be advised regarding the changing risks to her
baby during that six months, preventative treatments and early treatment of mastitis and
oral problems, weaning plans and how to determine the appropriate time to switch to
formula feeding.