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Aids and maternity in India

Patrice Cohen
Suniti Solomon


Françoise Barré-Sinoussi

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1As a former member of the Indo-French Forum for Initiatives, from 1998 to 2001, it is a great pleasure for me to preface these proceedings. Indeed, one of the first priorities recommended by the Indo-French Forum, in 1998, was to promote and facilitate cooperation and exchanges between the two countries on HIV/AIDS research. At that time, the HIV/AIDS epidemic in India was already alarming, with an estimated 5 million individuals affected by HIV. According to the national sentinel surveillance in India, the figures were probably lower, with 3.86 million people estimated to have HIV at the end of 2000, with a clear prevalence of HIV infection among risk groups and pregnant women as well.

2In 1998, mother-to-child transmission (MTCT) was immediately selected among the topics for Indo-French collaboration, in particular research that would provide information to decision-makers on measures to be taken for improving the prevention of mother-to-child transmission of HIV. Soon thereafter, the Indo-French Forum strongly encouraged initiatives for collaboration in the social sciences designed in concert with HIV/AIDS and STD medical research. To my knowledge, this book is the result of the first Indo-French multidisciplinary collaboration on MTCT, which has considered both epidemiological and biomedical aspects and issues in the social sciences with respect to the improvement of the prevention of MTCT in India.

3Over the past twenty years, a huge amount of research effort has resulted in remarkable progress in the diagnosis and monitoring of MTCT, as well as in knowledge of risk factors. One of the greatest successes was the evidence that ARV prophylaxis, including short-course ARV regimens, significantly reduces HIV-1 MTCT, providing a catalyst for action worldwide. However, despite the development of national MTCT prevention programmes, many countries with severe HIV/AIDS epidemics are experiencing difficulties in increasing access to MTCT prevention services, including ARV prophylaxis. In addition, the prevention of postnatal transmission through breastfeeding remains among the urgent questions to be resolved in MTCT.

4Although global access to ARV therapy remains the primary goal in reducing MTCT, considerable efforts are still needed to improve the organization of MTCT prevention services with regard to a better knowledge of all the obstacles and gaps related to the prevention of MTCT (PMTCT) and to the care of HIV-infected mothers and infants. Indeed, a joint interdisciplinary effort, integrating social and cultural aspects, public health and health-care issues as well as biomedical sciences, is urgently needed to make the PMTCT more understandable, acceptable and efficient for the concerned people.

5The approach of the scientific editors of this book is part of this effort to link epidemiological, clinical and biological issues to analyse perspectives in the social sciences so as to improve the understanding and prevention of MTCT in India.

6The context of MTCT and of its prevention in India is now undergoing considerable change. A new government policy plans to provide in 2004 free ARV treatment to HIV/AIDS-positive mothers and children, and a new policy for the prevention of MTCT was launched in 2002. While these improvements represent a very huge step in the struggle against the epidemic, the contextual aspects of the epidemic in India, specificities of MTCT and conditions of this mass prevention remain a critical issue for the management and monitoring of the HIV/AIDS epidemic, as in most countries.

7This book show different aspects of the Indian situation regarding the HIV/AIDS epidemic. Political and scientific choices have been made to launch Indian investigations on the efficiency of ARV prevention in MTCT, and to develop procedures for counselling and prevention. These efforts should also integrate specificities of the Indian population and of all the areas related to MTCT, such as maternity status and practices, women’s identity, the place of the women in Indian society, the social vulnerability of populations at risk of infection, including women and children. In addition, specificities of the Indian health and prevention systems should not be neglected.

8This publication, in providing official information, data and analyses of all these conditions and factors, constitutes a valuable input to the subject. The social sciences are presented here to help understand the psychological, social and cultural contexts of the three routes of MTCT and the context of its prevention. It is a remarkable contribution to all experts in biology and medicine, as well as to prevention-providers.

9 Let me express the wish that this first effort to integrate different disciplines will be followed by others and that further investigations to complement the understanding of the Indian context and to help health-care providers and policy makers to adapt their actions will follow these perspectives in the social sciences.


Director of the Retrovirus Biology Unit, Institut Pasteur, Paris

© Institut Français de Pondichéry, 2004

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