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A prospective study at the University Teaching Hospital of 306 women with their infants, who were enrolled at delivery, was conducted in 1997. The primary aim was to define the magnitude and effects of maternal human immuno-deficiency virus (HIV) infection on obstetric problems and infant outcome. Women were mainly over 19 years (87.3%), literate (73.7%) and married (91.4%), with no formal income (75.7%). 48.2% and 46.7% had antenatal or post-partum anaemia (PPA) and of these 1.8% and 6.2% were severely anaemic. Low post-partum (PP) serum retinol «0.7f.lmoI/L) and CD4 counts «400 cells/mm3 ) occurred in 12.8% and 16.2% of the women. The commonest obstetric problems were previous child death (32.4%), malaria treatment during pregnancy (32.6%), previous abortion (16.4%) and hypertension (13.7%). Post-partum, 30.1% of the women were HIV infected, 14.9% rapid plasma reagin (RPR) positive and 4.5% hepatitis B surface antigen (HBsAg) positive. Factors independently associated with HIV infection were: alcohol intake during pregnancy (RR 5.67); ante-partum haemorrhage (RR 5.85); PP HBsAg positivity (RR 27.45); low PP CD4 cell count (RR 10.63) and PPA (RR 3.99). Primigravidae had a lower risk ofHIV infection (RR OJ). For PPA independent risk factors were: caesarean section (RR 9.95); HIV infection (RR 2.81) and low PP mean corpuscular haemoglobin concentration (MCHC) (RR 8.33); mean corpuscular volume (MCV) (RR 2.39) and serum retinol (RR 3.03). Alcohol intake during pregnancy (RR 0.22) and low PP maternal weight (RR 0.10) were associated with reduced risk ofPPA. The prevalence of low birth weight (LBW; weight <2.5kg), pre-term delivery «37 weeks gestation) and intra-uterine growth retardation (IUGR; weight < lOth centile for gestational age) were 18.9%, 23.8% and 25.9%. These showed no association with maternal HIV infection although the mean birth weight was significantly lower in children born of HIV infected mothers (P=0.006). In HN non-infected women, antenatal anaemia was independently associated with increased risk pre-term delivery (RR 5.l2) and low birth weight (RR 5.08). Low PP serum retinol increased the risk of IUGR (RR 3.10). In HN infected women, lack of paternal income was associated with pre-term delivery (RR 11.7), IUGR with LBW (RR 3.59) and antibiotic treatment in pregnancy with IUGR (RR 5.85). The cumulative rate of HN mother to child transmission (MTCT) at 1 year of age was 31 %, with 10.3%, 1O.l% and 9.l% of infants DNA polymerase chain reaction (PCR) positive at birth, 1 month and 4 to 12 months respectively. On multivariate analysis, PP maternal viral load (>50,OOOcopies Iml) was the only risk factor associated with early infant HN acquisition (birth and 1 month) (P = 0.005) and cumulative infections at one year (P=O.OOI). At a year of age, HIV infected children were severely undernourished (weight for age median Z-score -3.46) and stunted (height for age median Z-score -4.44). Stunting was the main form of malnutrition in uninfected infants regardless of maternal HN status. Reported morbidity in infancy was unaffected by HN status. The infant mortality rate was 136 per 1000 live births, 85 per 1000 in HN uninfected children of uninfected mothers, 272 per 1000 in infants of infected mothers and 424 per 1000 in infected infants. After correcting for confounders, maternal HN infection (HR 0.28) and primigravidae (HR 0.20) were significant risk factors for infant survival. The population attributable risk percentage of infant mortality was 41.3% for maternal HN infection and 24.9% when the infant was HN infected as well.

"Although the number of new infections has dramatically decreased during the last ten years, portraying this country [Uganda] as the 'AIDS miracle', the number of people already infected and progressing to AIDS is increasing. Acces to anti-retroviral (ARV) drugs, as well as to medicines for treatment of opportunistic infections (TOI), is essential for people living with HIV/AIDS (PLWHA) to enjoy their right to life and health. Although access to these essentail medicines forms part of the core content of the right to health, which states should be able to provide irrespective of their available resources, slightly more than half of the people in need in Uganda were accessing them in June 2005. Of 63,896 PLWHA accessing ARVs, still 83.5 percent are paying the medicines out of their pockets. This is despite the fact that Uganda receives funds from various sources, among which Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) and the US President's Emergency Plan for AIDS Relief (PEPFAR). Although the cost of ARV treatment in Uganda has dramatically decreased since 1997, the price of treatment remains still unaffordable for most Ugandans. ... This study comprises five chapters. The present chapter exposes the problem, the objectives of the study and the research questions, reviews the literature available on the subject, outlines the study's structure, proposes a methodology and points out the study's limitations and relevance. Chapter two sets out the international legal framework of the study. It oulines the scope of the right of PLWHA to access to essential treatment under different international instruments of relevance for Uganda and its connection with other human rights. The chapter also assesses the implications of this right for state and non-state actors. Chapter three sets out the national legal, policy and judicial framework. It explores the action taken by the various branches of the government in addressing the international obligations with regard to access essential treatment. This chapter will also look at the role played by other relevant stakeholders in the realisation of this right in Uganda. Chapter four analyses the various obstacles that impede the realisation of this right at national level, taking into account the globalisation process, the political situation of Uganda, as well as other socio-economic factors. Chapter five provides the final conclusions and recommends legal, judicial and administrative channels towards the realisation of the right to access essential treatment for OLWHA in Uganda." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2005. / [Prepared under the supervision of] Dr. Ben Kiromba Twinomugisha, Makerere University / http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html / Centre for Human Rights / LLM