The meeting was attended by participants from Djibouti, Egypt, Islamic Republic of Iran, Iraq, Jordan, Lebanon, Libyan Arab Jamahiriya, Morocco, Pakistan, Sudan, Syrian Arab Republic and Republic of Yemen as well as by staff, consultants and temporary advisers from WHO, UNFPA and the World Bank. Dr Nahed Azzazy of Egypt was elected as chair of the meeting and Dr Mustafa El Nakib of Lebanon as rapporteur.

In his message to the meeting, Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, referred to the present situation of HIV/AIDS in general and perinatal transmission in particular. He informed the participants of the low prevalence of HIV in the Region owing to high religious and moral values. He highlighted various interventions to prevent perinatal transmission and stressed that prevention of sexual transmission should be the primary aim. He referred to the efficacy of zidovudine treatment in combination with avoidance of breastfeeding in preventing perinatal transmission.

Dr Gezairy drew the attention of the participants to various implications of the strategies for prevention of perinatal transmission including the high cost of zidovudine, ethical issues and other resource implications. He emphasized that interventions for prevention of perinatal transmission should be integrated into national maternal and child health services. He called upon the participants to discuss and identify appropriate regional strategies to be subsequently adapted in the individual countries.

After deliberations for three days, the participants of the meeting made the following recommendations for the countries of the region:

1. High-level commitment including provision of adequate financial and human resources should be made for prevention of perinatal transmission which is also called mother-to-child transmission (MTCT).

2. As effective interventions are becoming available for prevention of MTCT, countries should consider implementing interventions for preventing MTCT. In some cases such programmes may consider initiating pilot projects focusing on safety and feasibility, particularly in areas where HIV prevalence is relatively high.

3 . MTCT pilot prevention programmes should consist of voluntary counseling and testing (VCT), antiretroviral treatment and advice on replacement feeding. Other interventions may be added if they are proved to be effective by well conducted studies.

4 . As the cost of VCT is very high in low-prevalence countries, VCT should focus on women who are at increased risk of HIV infection, and informed consent should be obtained.

5. Short-course zidovudine treatment is recommended in resource-constrained countries because of lower cost, easier administration and better likelihood of completion of treatment. Zidovudine should be available, accessible and affordable. Infected pregnant women as well as their husbands and families should be educated and counseled about the treatment.

6. As replacement feeding by HIV-positive women may increase the risk of childhood illnesses in resource- constrained countries, care should be given to appropriate alternatives which may include proper preparation of formula feeding and training of women. Promotion of breastfeeding for HIV-negative women and for women of unknown HIV status should be continued and further strengthened.

7. Continued efforts including education, advocacy and other appropriate measures should be made to deal with ethical, social, cultural and legal issues in order to avoid stigmatization and discrimination of infected women or their children.

8. MTCT prevention programme should be integrated into reproductive health/family planning services and should be developed in a phased manner, in collaboration with national AIDS programmes and nutrition departments and with the involvement of medical and nursing schools, professional associations, nongovernmental organizations and other advocacy groups.

9. Efforts for prevention of sexual transmission of HIV should be continued and strengthened, targeting both women and men.

10. Primary health care/reproductive health programmes should be strengthened to accommodate MTCT interventions which include prevention of HIV infection through the expansion and strengthening of family planning and STD/ HIV information and services, especially dual protection approaches; an essential package of antiretroviral treatment including nutritional support; safe labour and delivery care, including skilled attendants and minimizing invasive obstetric practices; and integrating prevention and treatment of STD into antenatal services.

The meeting also called upon WHO and other UN organizations to provide technical and financial support to the countries in order to facilitate the implementation of MTCT prevention programme and to continue negotiations with manufacturers in order to reduce the prices of antiretroviral drugs and breastmilk substitutes.