At the recently concluded International AIDS conference in Vienna, Austria, there was an emotional call to eradicate Mother to Child Transmission (MTCT) of HIV. Participants were particularly charged when Austria, which hosted the conference, presented their progress, noting that MTCT has been virtually eliminated, recording about two to three cases a year. It's the same scenario in developed countries like the US, UK and Canada. There was also progress reported in a few African countries like Botswana.

However, when the World Health Organization (WHO) announced its new recommendations on treatment, prevention and infant feeding in the context of HIV, participants were skeptical about implementing them back home; many argued it would reverse past gains.

In 2006, WHO recommended that all patients start ART [antiretroviral therapy] when their CD4 count (a measure of immune system strength) falls to 200 or lower, at which point they typically show symptoms of HIV. It also said that ARVs be provided to HIV-positive pregnant women in the third trimester (beginning at 28 weeks) to prevent mother-to-child transmission of HIV.

Now, the global health body promotes the use of ARVs earlier in pregnancy, starting at 14 weeks and continuing through the end of the breastfeeding period. It also recommends that breastfeeding continue until the infant is 12 months, provided the HIV-positive mother and baby are taking ARVs during that period. This is premised on the fact that treatment will significantly lower the mother's viral load, minimizing risk of transmission and improve the infant's chance of survival.

Nevertheless, critics urged poor countries to "guard against killing what is working for new thinking". Perhaps their arguments are justified, especially in countries like Uganda where preventing MTCT coverage in the whole country is still limited, with just half of all HIV positive women accessing treatment. And that's not the only issue. A 2005 survey showed that only 4% of women and 3.8% men aged 15-49 had received an HIV test and knew their results in the 12 months. Besides, there are challenges with frequent ARV stockouts and health infrastructural challenges; many women live far away from health centres.

Still, the changing position of the global health watchdog shows how much HIV is an evolving epidemic that calls for continuous innovations, subsequent awareness and education. Unfortunately, many scientific based interventions are never adopted nationally. Even when adopted, the public is never educated on the new developments.

That's why progress has been made in reducing infections during pregnancy and childbirth, but breastfeeding for HIV positive mothers remains the most challenging because communities have not been educated well.

The new guidelines have already left many confused and without the much needed education, pessimists could be right, we shall just reverse our past gains.

In Uganda, an estimated 1.1m people are infected, with about 130,000 children under 15 living with HIV. MTCT contributes 22% of these infections, majority of which occur through breastfeeding.

For the last decade, the policy in Uganda has been to advise HIV-positive mothers to exclusively breastfeed for six months. With the new guidelines, information may turn out conflicting, as one HIV positive mother remarks.

"I'm now confused and scared. You used to tell us 'don't breastfeed, now you are saying 'you can breastfeed'."

No mother would wish to infect her young. The majority are desperate to protect them and education would be their biggest weapon in the absence of a vaccine against pediatric HIV infections.

Since WHO encourages national health authorities to identify the most appropriate infant feeding practices (either breastfeeding with ARVs or the use of infant formula) for their communities, policy makers should move fast to promote their choice with vigorous advocacy.

In fact, it's pertinent to note that it could turn out an uphill task convincing many mothers to continue breastfeeding but with an aggressive sensitisation and education campaign for health workers and the communities, the new guidelines can reduce MTCT to less than 5%. No child should be infected.

The writer is a CDC/MUSPH Fellow working with UNAIDS