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' ..Just as you did it to one of the least of these who are members of my family. you did It to me.' Matthew 25:40 (NRSV) From EROs Mandate-Mallhew 25:37-40

A PUBLICATION OF EPISCOPAL RELIEF AND DEVELOPMENT - Volume 4 . Nu er 5 - December 2007

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"For I was sick) andyou visited me. .. " Matthew 25:36

e Youngest Victims: Mot er-to-Child HIV Transmission

INSIDE: Preventing Mother-to-Child Transmission in Zambia.

ver half a million children were ~~-..:.::

infected with HIV/AIDS in 2006. It 's est imated that 90 percent of those children acquired the virus from their mothe rs during pregnancy, birth or breastfeeding.

Sub-Saharan Af rica is home to the vast majority of children infect ed through mother-to-ch ild tra nsm ission. The subsequent rise of child mortality rat es from HIV/ AIDS is reversing decades of improved child survival rates throughout th e continent.

We can help prot ect many of these ch ildren. Mother-to-child HIV t ransm ission has been nearly elim inated in developed count ries through basic interventions that can be applied in remote and impoverished regions of the world:

• Increasing awareness and - - -Pre>.<eRtWe-educatic:)O..­ - - - --_iiiii'ii...

• Providing counseling and testing to pregnant women.

• Administering ant iret roviral dru gs (ARVs) to mothers during pregnancy and to infants at birth.

• Avoiding risks associated with delivery and breastfeedlng.

No child should start life with the death sentence of HIV/AIDS. This issue highlights a pilot progr am funded by the M •A· C AIDS Fund whereby Episcopa l Relief and Development is saving young lives through a partnershi p with the Zambian Anglican Council and the Livingstone Anglica n Children's Project.

Preventing Mother-to-Child fran mn•

ZAMBIA: Key Statistics

Populat ion: 11.7 million

Number of people with HIV/ AIDS: 1.1 million

Number of children with HIV/AIDS: 1.20,000

It's hard to imagine a mo re heartbreaking scenario than this:

An estima ted 30,000 infants contract HIV each year in Zambia through mother-to-child transmission. One in three of these newborns will die befo re the age of one. Over half die before reaching their second bi rt hday. And many children die before they are five years old.

Sadder yet is the fact that Mother-to-Child Transmission can be prevented, even in the most impoverished communities. With proper care during pregn ancy, a single dose of the antiretroviral drug nevirapine during delivery, and cons istent follow-up treatment, the number of newborns who acquire HIV can be dramatically reduced. These interventions are collectively known as Preventing Mother-to ­Child Transm ission (PMTCT).

Because HIV-posi t ive pregnant women in developed count ries have access to the best care, less than 2 percent of infants cont ract the virus. In many countries throughout sub-Saharan Afr ica, it 's estimated less than 10 percent of

women receive any type of PMTCT.

In 2007, Episcopa l Relief and Development launched a pilot Prevent ing Mother-to-Child Transm ission program in Zambia with fun ding fro m the M ' A ' C AIDS Fund. The Zam bian Anglican Council and the Livingstone Anglican Children's Project- Episcopal Relief and Development's on-the-ground partners-are im plementing th e proj ect in the regions of Ngwena, Maramba, Namatam a, Libuya, and nearby compounds around Livingstone. An estimated 40 percen t of pregnant women in this area are HIV-posit ive-one of the highest rates in the coun try.

Nancy Mahon, Vice President, M •A' C Cosmetics and Execut ive Director, M •A· C AIDS Fund, has great hope fo r the project. "Evidence fro m North America and Europe shows that provid ing a mother with a fu ll range of PMTCT ser vices can reduce the risk of tra nsm ission to less than 2 percent. Despite the current stat ist ics in Zambia, by partnering with Episcopal Relief and Developme nt and supporti ng its work, we are hoping to reduce mother-to-child tr ansmission in the region to zero:'

The need to prevent mother-to-ehild transmission in Zambia is cri t ical:

• Zambia has a very high fert ili ty rate: on average, women bear 5.3 children during their lifetimes.

• Young women ages 15-19 are contracting HIV at six times the rate of men in their same age group.

• Women of childbearing age account for 57 percent of the

I -p sit ive popu ati on.

• The majority of women do not know their HIV status-it's estimated only 9.4 percent have been tested. Many fear testi ng will lead to st igma and discriminat ion.

Saving Lives by Preventing Mother-to-Child Transmission (PMTCT) Episcopal Relief and Development's program focuses on the proven components of effective Preventing Mother-to-Ch ild Transmission efforts.

Building comm unity awareness

With the support of leaders and key stakeholders, community sensit izat ion activities are held to

il awarenes n n l U i a e key facts. Trained volunteer motivators from the com munity perfor m dramatic presentations, conduct focus group discussions and door-to-door visits to explain how HIVj AIDS is transmitted from pregnant women to infants.

Because involving men is a proven factor in ensuring positive outcomes in preventing Mother-to­Child Transmission, these sessio ns Include both women and their male partners. Motivators convey the importance of HIV prevention

815 Second Avenue New York , NY 1001 7 1.800.334.7626, ext. 5129 www.er-d.org

;&sion in Zambia methods during sexual contact and the critical need for pregn ant women to kn ow their HIV status. Pregnant women are encouraged to utilize prenatal services and deliver their babies at health centers so they can receive nevirapine, an antiretroviral drug that reduces HIV transmission between mothe rs and infants. Traditional birth attendants are trained to promote testing and clinic deliveries for HIV-positive mothers.

PlOf OUf'fg voluntary counseli, and -

testing to determine HIV status

Volunteer motivators stress th e need for both men and wom en to be tested, and provid e preli mi nar y counseling to address fears and enco urage test ing. They iden t ify and refer pregnant women at risk to th e local health centers, where trained psychosoci al counselors conduct tests and provide fo llow­up counseling for wom en, th eir partners and fami lies.

Through this program, prenatal clinics and health centers are sto cked with HIV tes t kits, and m idwives are trained to conduct on­the-spot tests for women in labor whose HIV status is unknown.

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Preventing Mothe~to-Child Transmission: Making a Difference in Zambia

Total Population in Target Area

Community Members Sensitized to PMTCT

Women Who Received Pre-Test Counseling

Pregnant Women Tested

Pregnant Women Who Tested Positive

7 -=_ ......;;;.:'"---= ----J

the best start in life. Doctors also recognize that breastfeedlng has the potential to t ransm it the virus to th e infant. However, a mixed diet can result in cereal or bread scratching the baby's delicate digest ive system allowing th e virus present in the milk to pass into the blood stream. To ensure the risk is eliminated, exclusive breastfeeding mu st be maintained for the first six months. Once the infant is six mo nths old, they are fully weaned.

"Prevent ing Mother-to-Child Transmission is not complicat ed­and it has profound impact;' says Robert W. Radtke, Episcopal Relief and Development's President.

197,000

37.263

6 .962

300

60

Mothers and Infants Who Received Nevirapine During Delivery 57

Mothe rs Put on ARVs Following Delivery 23

Infants Put on ARVs After Birth ,-==-==--==-= =----=-_ =----=--== Providing antiretroviral treatment and follow-up care to mothers and infants

A single dose of Nevirapine has been shown to reduce th e transmission of HIV f rom mother to newborn by up to 50%. Midwives at local health centers are trained to adm inister the drug to women during labor, and give the baby a pediatric dose af te r delivery. Mothers and newborns who require ongoing ARV therapy are monitored by home-based caregivers who treat opport unisti c infect ions and ensure proper nutrition for mothers and babies.

HIV-posit ive mothers are strongly encouraged to breastfeed. This provides infants with th e nutrition for

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How HIV/ AIDS Is Transmitte f om other to Child During Pregnancy

• In most cases, HIV does not cross the placenta from mother to fetus

• If the mother has a high viral load due to advanced HIV, the risk of transmission is much greater

At De livery

• High risk of transmission if the infant is exposed to infected blood and fluids

• Through breastfeed ing • Breastfeeding by an HIV-posit ive mother increases tile risk of transmiss ion

from 10 percent to 20 percent

• Risk is reduced when mothers exclusively breastfeed their babies until they are six months old and then switch to infant formula

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we are saving children 's lives."

"There is such affirmation for th e women in this program ;' reports Janette O'Neill , Senior Director for Afri ca Programs for Episcopal Reli ef and Development. "These are mothers finding a way to live with HIV. They are determined to give thei r new babi es the best possible start in life:'

Please consider how you can help Episcopal Relief and Development ensure an AIDS-free life for newborn babies.

What Your Parish Can Do World AIDS Day is December 1 , 2007. This year 's theme-"Leadership"-celebrates people around the world who have led the fight against HIVj AIDS.

Effect ive leadership has been a proven factor in the success of HIVj AIDS init iat ives and efforts. Leaders are not just those at the highest level of inf luence in the internat ional sphere, though such individuals are vitally needed. To stop AIDS, leaders must step forth from all levels: in families, communities, fa ith institutions and countries around the world.

The World AIDS Day Campaign suggests that:

"Leaders are distinguished by their action, innovation and vision; their personal example and engagement of others; and their perseverance in the fac e of obsta cles and challenges ."

We agree. Episcopal Relief and Developm ent has been privileged to support and nurt ure such individuals and groups in comm unit ies around the world. We have seen firsthand how effective grassroots leadership and compassionate action transforms lives . Our new Preventing Mother-to-Child Transmission program in Zam bia is a wonderful exam ple.

Here are some ways your parish can take the lead in your sphere of infl uence:

• On World AIDS Day, remember th ose who are lea ding HIVjAIDS programs, both locally and around the world.

• Pray for pregnant HIV-positive women and their newborns.

• Spread awareness about the impact of Preventing Mother-to-Child Transmission and how sup por t ing Episcopal Relief and Develop ment's program will save chi ldren's lives.

• Take a special offering for Episcopal Relief and Development's HIVj AIDS programs.

For more informat ion about Episcopal Relief and Development's programs, visit our Web site: www.er-d.org.

Episcopal Relief and Development 's HIVj AIDS Programs: Working to Achieve Millennium Development Goals The Millennium Development Goals call for combating preventable diseases including HIVjAIDS and malaria (MDG #6) and reducing by two-thirds the number of children who die before their fifth birthday (MDG #4) from these and other illnesses.

Preventing Mother-to-Child Transmission is a key weapon in Episcopal Relief and Development's fight against HIVjAIDS and child mortality.

Episcopal Relief and Development's comprehensive HIVjAIDS programs use a three­pronged approach to stop the spread of the disease and care for those affected:

• Prevention education-such as Preventing Mother-to-Child Transmission programs­that increase awareness and use of prevention methods.

• Church-and community-based care and treatment for people suffering from the disease.

• Support-including food , education, counseling, jo b training and micro-enterprise opportunities-for HIV-posit ive women , children orphaned by AIDS, extended families and communities affected by the disease.

Episcopal Relief and Development works in partnership with the worldwide church and ecumenical organizations to go "t he last mile"-reaching the most vulnerable people and communities whom others have forgot en.

Your gift to Episcopal Relief and Development's HIVjAIDS programs will help us protect and save lives.

TO MAKE A LlFE-5AVING DONATION, make your checks

payable to EpIscopal Relief and Development · c/o EN07-5

Malt your donatIon to Episcopal Relief and Development,

PO Box 7058, Merrifield, VA 22116-7058.

IF YOU WOULD LIKE TO MAKE A CREDIT CARD DONATION,

call 1.800.334.7626, ext. 5129, or vIsit www.er-d.org.

81 5 Second Avenue New York, NY 10017 1.800.334.7626, ext. 5129 www.er-ti.org 60-{)711