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Fri Oct 18, 2013

Get rid of the demonizing term "Mother-to-Child Transmission"

by Paula Donovan

This week, the BBC produced a video news story it called, Helping Stop Mothers Giving Their Babies HIV.  Finally, there’s concrete evidence that the toxic phrase 'mother-to-child transmission' puts the blame on mothers when their children contract HIV.

Women have been trying to get rid of that odious terminology since the late 1990s. We’ve pleaded with UNICEF, the World Health Organization, and UNAIDS to use 'vertical transmission' instead, but to no avail.

Now a BBC video provides vivid proof of the mighty power of poisonous words, repeated over and over again for more than a decade, to mislead and stigmatize. We learn from the well-informed Kenyan woman featured in the piece that her infant has benefitted from an antiretroviral regimen she has followed since before his birth and continues while safely breastfeeding. But in the words of the award-winning journalist, “when her first child…was born 10 years ago, she did not have the knowledge she has today to prevent HIV transmission. But he’s taking medication to suppress the virus in his body and boost his immunity. He will have to take them for the rest of his life.”  That enormous burden, it’s clearly implied, was a direct result of his mother’s ignorance.

In fact, ten years ago, knowledge was of little use to pregnant women living with HIV in Kenya. I lived in Nairobi then, and can well remember the anger and despair on the faces of mothers when they learned that the preventive drugs and services available to pregnant women in Western countries were already blocking about 98% of vertical transmissions. But for women across Africa, the UN and governments recommended a cheap, one-time dose of nevirapine that reduced the chance of transmission during labor and delivery by half (but did nothing to make breastfeeding safe, nothing for the health of mothers, put women and babies at risk, and was finally discontinued a few years ago.) Back then, even single-dose nevirapine was available to very small numbers of women---just 3,432 women in 2002, compared with 637,032 in 2006.[1] 

Today, things are vastly improved for Kenyan mothers like the woman videotaped by the BBC, who have access to drugs and services that come close to what was available in the Western world ten years ago–-in theory. But in practice, it’s simply not true that knowledge is now the only thing standing between a pregnant African woman living with HIV and the assurance that her baby won’t contract the virus.

The latest data from the UN show antiretroviral drug coverage levels of just 26% for pregnant and breastfeeding women in low- and middle-income countries. This isn’t the fault of mothers. But by stubbornly hanging onto the misogynist term 'mother-to-child transmission,' the UN sustains the myth that we’d be moving pell-mell toward “zero new infections” in newborns if mothers just cared enough, if they were just smart enough.

The UN has stopped using a host of HIV-related terms because they risk violating people’s dignity, offending, confusing, or misleading.  In fact, UNAIDS has published and revised “Terminology Guidelines” with “DON’T USE” next to terms such as ‘AIDS victim,’ ‘homosexual’ (use 'men who have sex with men' instead, to include those who have relations with men but don’t want to be identified as gay) and even ‘pandemic.'  

When a respected news outlet like the BBC cluelessly names a news story Helping Stop Mothers Giving Their Babies HIV in 2013, do we need any more proof that it’s long past time to retire the offensive, confusing, misleading term 'mother-to-child transmission of HIV'? Wouldn’t it be worth the tiny effort it would take to replace ‘mother-to-child’ with ‘vertical’ transmission, and break the Victorian-era habit of portraying women as the evil vectors of sexually transmitted infections?

[1] Ayisi R.  Overview of PMTCT Nationally and Regionally. Kenya National PMTCT Consultative Forum. Nairobi Kenya 14 August 2007.