Résumé
For more than 10 years, pediatric AIDS has been virtually eradicated from Northern developed countries. In Africa, despite technical means and apparent political will, the percentage of pregnant women involved in preventing mother-to-child transmission (PMTCT) interventions is not increasing as fast as public health authorities would expect. There has been real progress during the last years, but these changes are still limited to Southern and East Africa. Eradication of pediatric AIDS in Africa seems a difficult objective to reach in 2015 as UNAIDS targeted it. This chapter is based on the combination of a literature review, an analysis of databases and empirical evidence collected during 15 years of PMTCT implementation, childcare research, and treatment programs in West Africa. One way to progress is to analyze why in some countries, PMTCT programs do not work properly and how in some others it works well. It seems important to analyze the process of PMTCT programs at several levels (site, regional, and national), step-by-step through literature, databases, and qualitative studies. It should be the better way to understand the successes and failures of the programs and how to “scale up” PMTCT programs, where there are gaps or obstacles and how to try to go through these obstacles. It includes analyses of the health system, of health workers expectations and limitations, of mothers’ expectations, and of relationships between mothers and the care system.
Perinatal intervention itself changes with new recommendations of the World Health Organization (WHO). Women can, however, give up or vanish at any time during the whole process. With new recommendations of WHO on breastfeeding and antiretroviral drugs, we can expect a dramatic decrease of postnatal transmission of HIV, but new problems arise, such as difficulties in getting formula milk, when HIV-infected mothers make that choice. This additional step gives many problems as women and exposed children have to be followed longer, and the final diagnosis cannot be given before the end of breastfeeding.