Situation analisys on HIV vertical transmission Dr Zhanna Trumova Republican HIV/AIDS center The Republic of Kazakhstan

Number of HIV-infected people detected in Kazakhstan (per year)

Spread of HIV/AIDS in Kazakstan (as of 01.09.03) 59 сл. 58 сл. 705 сл. 196 сл. 56сл. 137 cл. 110 сл. 12 сл. 73 сл. 1210 сл. 38 сл. 19 сл. 7 сл. 62 сл. 185сл. 368 сл. 3788 HIV-cases are registered in Kazakhstan

Ways and factors of HIV transmission

Prevalence of HIV - infected women by age groups

Growth rates of HIV-positive women

Number of pregnant women tested for HIV (per year)

Number of detected HIV-infected pregnant women

Prevalence of HIV-infected pregnant women by region Total - 205

Risk factors for HIV-infected pregnant women

Co-factors for HIV-infected pregnant women

Pregnancy outcomes

Spread of children by region n=75

Health status of children born to HIV-infected mothers

Antiretroviral therapy of newborn, begun in 2002

Feeding of newborn , n=81

Proposed preventive treatment schemes Scheme 1 – ZDV (Protocol 076: from 14th week of pregnancy to delivery (II and III trimesters of pregnancy) 600 mg/pd; from the beginning of labour to delivery 2 mg/kg, then 1 mg/kg intravenous per hour; to the child – suspension ZDV 2 mg/kg every 6 hours in the course of 6 weeks) Scheme 2 – short-term treatment ZDV from 36th week Scheme 3 –Nevirapin: the pregnant – 200 mg once in delivery, the child – nevirapin suspension 2 mg/kg once within 72 hours (HIVNET 012, Uganda)

Current activities A Government Dicree # 1207 «Programme on AIDS prevention in Kazakhstan from 2001 till 2005» dated from 14 september 2001 was developed and aproved in Kazakhstan. Preventive Programmes aare being intriduced with the assistance of international organizations. Access to counselling and HIV voluntary testing Pregnant women and children are provided with antiviral medicine and child nutrition free of charge from public funds Quality medical care and preventive interventions are provided to HIV- infected women during pregnancy and deliveries

Challenges Lack of information and educational materials on «HIV and pregnancy» Difficulties related to timely detection, registration, examination of people from risk-groups (drug addicts, RKS, etc) including pregnant women Weak VCT services network in health care, including PHC, obs -genecologi , in particular lack of professional training for health workers in HIV/AIDS consultation Lack of financing for equipment, test-systems, antiviral medications

Possible solutions Primary prevention among pregnant women, access to HIV/AIDS info, promotion of safe sex, prevetion of unwanted pregnancy, availability of contraceptives, STIs treatment Introduction of voluntary consultation and testing for target-groups (IDU, CSW, married couples, youth) as a supplement to ongoing prevention programmes Prevention of mother-to-child HIV transmisstion in antenatal, intranatal and postnatal periods Access to antiretroviral medications Artificial feeding Care and support of HIV-infected women, their children and family members