Every day, 1900 children acquire HIV-1 infection from their mother in Africa. The 25-45% risk of mother-to-child transmission can be reduced in several ways: prevention of sexual transmission for women of child-bearing age, access to HIV-1 testing, reduction of unwanted pregnancies by education of HIV-1-infected women, and antiretroviral-based prevention. All antiretroviral regimens of proven efficacy can be used in a minimum package of care for HIV-1-infected pregnant women. At present, programmes in 13 countries reach less than 3% of HIV-1-infected African women. 35-59% of African children infected with HIV-1 die by their second birthday. Infectious complications are preventable by primary prophylaxis with co-trimoxazole. A rapid scaling-up and comprehensive continuum of care is needed for all members of affected families, including access to antiretroviral treatment and community-based responses to the increasing number of orphans. Prevention of mother-to-child transmission should become a universal standard of care in Africa, and research should continue to reduce the transmission risk to well below 5%.