Image copyright Marc-Grégor Photography Image caption Pregnant women who are HIV positive risk passing on the virus to their babies during pregnancy, labour, delivery or breast-feeding

Inside a foil sachet, which looks more at home in a fast-food restaurant, an exact dose of antiretroviral medicine is helping to protect newborn babies against the threat of infection from their HIV-positive mothers.

Rosa's family considers her dead after they found out she lives with HIV.

"They even built a tomb in a cemetery here in Guayaquil (in Ecuador) and take flowers to it every month," she says.

Rosa, however, is happy, because her one-year-old baby is about to be declared free of HIV.

"I don't care if my career as a teacher was ruined by this illness. Today I am happy to see my children healthy and studying."

Rosa is one of many HIV-positive women who gave birth at South America's biggest maternity hospital, the Enrique Sotomayor Hospital in Guayaquil.

I don't care if my career as a teacher was ruined by this illness. Today I am happy to see my children healthy and studying. Rosa, HIV positive mother

Their babies must be given antiretroviral (ARV) medication within 24 hours of birth, otherwise the risk of the infection being passed from mother to child during pregnancy, labour, delivery or during breast-feeding is around 45%.

According to the UN, mother-to-child transmission in the developing world creates 260,000 new infections in children every year.

Thanks to a programme involving the hospital, the Ecuadorian government, the VIHDA foundation in Guayaquil and Duke University in North Carolina, at least 1,000 babies have been born without the infection from HIV-positive mothers.

The programme is enabling newborn babies to take their medicines efficiently - via a pouch that looks just like the small ketchup sachets you get at fast food restaurants.

Only in this case, they are filled with antiretroviral drugs, which protect against HIV.

Image copyright Marc-Grégor Photography Image caption An HIV positive mother in Moshi, Tanzania, giving her baby antiretroviral medicine from the sachet

Image copyright Marc-Grégor Photography Image caption Mothers simply tear open the pouches and put the contents into their babies' mouths

'Ketchup pack'

Rosa's baby was born in one of the hundreds of rooms in the hospital - just like 20% of Ecuadorian children.

She has received free psychological and medical support since she tested positive for HIV three years ago.

Rosa has been able to try different methods of giving the antiretroviral medicine to babies, who have to take them during their first four weeks of life.

"We used to get a small bottle with a dropper, but that spilled and it was difficult to measure the dose", she tells the BBC.

The same thing happened with syringes and spoons, she says.

"But now with the pouch it is easy to put all the liquid in the baby's mouth without spilling or spoiling it."

As well as giving the exact dose, the pouch avoids contact with the air, enabling the medicine inside to be preserved for up to a year without degrading.

Patient and activist

The pouch was researched and designed by a group of students, most of them from Ecuador, at the Pratt School of Engineering at Duke University.

But it only reached the wards of the hospital thanks to Humberto Mata, who was born there 47 years ago.

A car parts seller and former politician of the Guayas State, Mata created the VIDHA foundation with his husband to prevent children from getting HIV.

The Harvard graduate says he is part of the 1980s generation, when thousands of young Americans died of AIDS.

"I buried many of my friends", he says.

After that experience, Mata did some research and found out that babies with HIV were not being treated as well as adults with HIV.

"So we became the bridge between the public sector, which pays for the drugs, and the hospital, where a huge number of cases are gathered in the same building," Mata says.

Home birth model

Image copyright Marc-Grégor Photography

The Pratt pouch is now also being used in African countries such as Tanzania, Zambia and, soon, Uganda to prevent children being infected by their HIV-positive mothers.

In these countries, many women give birth at home so the pouches have to be handed out at ante-natal appointments and stored at home until the baby is born, rather than provided in hospital at the time of delivery.

Most mothers who know they are HIV positive will be on medication already so the emphasis is on protecting newborns from the virus during birth and the time they are breastfed, particularly the first six to eight weeks.

Dr Robert Malkin, from Duke University, who led the design of the pouch and the research into its use in Ecuador, says some countries are better equipped than others to make use of it.

"In Yemen there are a huge number of mothers who never make an ante-natal visit. And there is no HIV testing, so they don't know if they are HIV positive or not. There is no point in the pouch being used there."

Dr Malkin says there are currently 30,000 medicine pouches in circulation at clinics around the world.

Early detection

At the hospital we have a 0% chance of infection in mothers if we get to them in their early months of pregnancy. Mercedes Ortiz, chief of infections control, Enrique Sotomayor Hospital

Like many other countries in Latin America, Ecuador has a high rate of young pregnancy. There's a big sexual industry and, according to Mata, a complicated problem of education.

"Could you believe that 40% of Ecuadorians believe HIV is transmitted by mosquitoes?" he asks rhetorically, citing recent polls.

HIV can be transmitted through sexual relations and blood transfusions.

But mothers who live with HIV can also infect their children with a 50% chance in birth, 30% during pregnancy and 20% through breastfeeding.

"At the hospital we have a 0% chance of infection in mothers if we get to them in their early months of pregnancy," says Mercedes Ortiz, chief of the Infections Control Committee at the hospital.

"But the problem is that 53% of HIV-positive mothers get here days or even hours before giving birth, something that complicates our job preventing the infection".

All HIV-positive mothers take antiretroviral during pregnancy, have a caesarean birth and are told not to breastfeed.

But despite these measures, and using technologies like the pouch, there are still a small number of cases of HIV-positive babies at the hospital.

Cuba was recently declared by the World Health organization as the first country with 0% HIV infection between mother and child.

To match this, Ortiz says Ecuador needs an ambitious sexual education programme.

"Because HIV doesn't fly - it's transmitted through chiqui-chiqui (sex)".