The acquired immunodeficiency syndrome (AIDS) was first recognised among homosexual men in the United States in 1981. It has since then spread like wildfire, becoming one of the worst epidemics of the twentieth century, affecting all populations.

Global HIV burden is estimated at 37 million individuals, and women account for more than half of them. In the most affected countries in the world, such as in sub-Saharan Africa, 20–40 per cent of pregnant women are HIV-infected and one-third of their babies become infected.

These children are vulnerable to HIV transmission in utero, at birth, or through breastmilk.

Mother-to-child transmission (MTCT) accounts for 90 per cent of HIV infections among children worldwide.

The management of HIV in pregnancy has evolved over the last few decades due to an improved understanding of prevention of perinatal transmission of HIV and development of better drugs to control the infection. The successful prevention efforts can be attributed to universal testing and screening of pregnant women for HIV infection, the use of caesarean delivery (when appropriate), new and effective antiretroviral medications and avoidance of breastfeeding, when feasible. This chapter focuses on understanding the effects of HIV in pregnancy, MTCT and the intervention control strategies.

In developed countries, the introduction of antiretroviral drugs has resulted in a significant reduction in AIDS-related mortality and improved survival.