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Of the 40 million people living with HIV/AIDS worldwide at the end of 2003, 2.5 million were children under 15 years old. Most of these infections (90%) occurred in sub-Saharan Africa. The most significant source of HIV infection in children and infants is transmission of HIV from mother-to-child during pregnancy, labour and delivery, or breastfeeding. According to UNICEF, in the absence of preventive measures, the risk of a baby acquiring the virus from an infected mother ranges from 15-25 per cent in industrialised countries and 25-35 per cent or higher in developing countries. Infants in Eastern and Southern Africa are particularly at risk as a consequence of high fertility rates and high infection rates among women of childbearing age. Some five per cent of HIV-exposed children are infected during pregnancy; about 15 per cent are infected at delivery; and approximately 10 per cent are infected through breastfeeding.
The sources of infection include maternal blood, placenta, amniotic fluid, cervicovaginal secretions, and breast-milk. The routes of entry vary from umbilical circulation, skin, and mucous membranes including gastrointestinal tract and respiratory tract, transplacental infection, microtransfusion, ascending infection through the vagina, or direct contact by the infant.
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