Roni, thanks for your clarifications, we have antenatal sentinel
surveillance testing here too where the mother's blood is tested but she is
not told the results - close to 40% of the women test positive.

Regarding testing the baby after delivery you wrote, "There are newer tests
that can be done to determine if the baby is HIV
positive within a very short period of time, I think one to two weeks."  I
have seen this information too, that PCR testing can identify the infected
baby within 0 - 14 days.  However in the WHO/UNICEF/UNAIDS guidelines it
also says that babies of HIV+ mothers *not exposed to breastmilk* have
tested positive up to 90 days after birth. I find this intriguing.  And if
this *is* the case, then how much mother-to-child transmission which appears
to have been attributed to breastfeeding in many of these large statistical
studies, may have actually occurred during delivery?

To clarify the query Naomi made about lower rates of transmission during
C/Sec, my understanding is that it is exposure of the baby's skin, mouth,
eyes and mucous membranes to vaginal secretions which is thought to account
for transmission during delivery and, as you rightly point out, maternal and
fetal circulations do not mix in utero.

Hoping we can brainstorm some more about this.

Pamela Morrison IBCLC, Zimbabwe
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