Geraldine Dunne Clinical Nurse Consultant Paediatric Immunology and Infectious Disease, Sydney Children’s Hospital NSW.
Acknowledgment to Karen Blyth (first edition)
Summary
- Introduction and global overview
- Pre-conception
- Pre-natal period
- Emotional care and support during pregnancy
- Birth
- Mode of feeding
- Care of the infant in the first 18 months of life
- PEP for the infant.
- Infant testing
- Multidisciplinary care
- Education and stigma reduction
- Resources
Throughout this document, reference is made to ‘women’ based on the literature; however, where relevant, the information may apply to any pregnant person. Specific professional advice and support should be sought for all PLHIV who are pregnant regardless of their gender assigned at birth.
Introduction and global overview
Pregnancy and the post-natal period have been long recognised as potentially vulnerable times in a woman’s life. When a woman is living with HIV (LWHIV), the potential for vulnerability is even greater.
Globally, approximately 1.3 million young women and girls LWHIV become pregnant each year. In the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, birthing, and breast or chest feeding ranges from 15% to 45% (1).
In Australia, universal HIV testing is recommended for all pregnant women in the antenatal period (2). This has been the case for approximately one decade and, as a result, perinatal HIV transmission has declined considerably. Throughout 2017 – 2021 inclusive, there have been 4 perinatal transmissions in Australia. This compares to 23 transmissions in the period from 2007-2011. (3).
In terms of prevention of transmission strategies for WLWHIV, the most significant factors are knowing a woman’s HIV status and the provision of ART. Effective ART suppresses the viral load (VL), significantly reducing the risk of perinatal transmission. (4) Duration of VL suppression is also a factor in reducing transmission, therefore early HIV detection and provision of ARVs is important (5).
Nursing support, education, and care, in terms of access to, adherence to and provision of medication are important components of comprehensive care.