Entrevues auprès d’enfants qui dévoilent une agression sexuelle : examen du processus d’enquête et du parcours judiciaire des dossiers

Cette étude a été rendue possible grâce aux bourses doctorales accordées à la première auteure par les organismes suivants : le Conseil de recherche en sciences humaines (CRSH), la Chaire interuniversitaire Marie-Vincent sur les agressions sexuelles envers les enfants (CIMV), l’Équipe violence sexuelle et santé (ÉVISSA) et le Centre de recherche interdisciplinaire sur les problèmes conjugaux et les agressions sexuelles (CRIPCAS). Cette étude a également été soutenue par une subvention de recherche accordée par le Bureau d’aide aux victimes d’actes criminelle (BAVAC) du ministère de la justice du Québec accordée à Mireille Cyr.

Abusabilidad : Potencialidad de resultar víctima de abuso sexual intrafamiliar

Este estudio se centra en los llamados casos de abusos sexuales intrafamiliares (ASI), donde niños y adolescentes, o aun personas que ya han superado tales etapas vitales, se encuentran condicionadas en su integridad sexual por miembros de su entorno familiar con trato cotidiano, prolongado en el tiempo y con secuelas graves respecto a su estructuración subjetiva y a su vinculación social. En esta producción se intenta conceptualizar dentro de la problemática e abuso sexual, un fenómeno, que si bien no es nuevo, permanece oscurecido por otros que lo anteceden o del que derivan pero sin reconocerlo. Para ello se parte de la experiencia acumulada y del análisis de los textos más importantes sobre el tema. Además de la vinculación con otros profesionales que lo investigan. Esto promovió el deseo de profundizar en un campo, que si bien actualmente es rico en producciones teóricas, se visualiza como abierto, por su complejidad y demanda en aumento, a nuevas propuestas. Por otro lado el abuso sexual, en la actualidad, está reconocido como un hecho que convoca y requiere del compromiso de los profesionales de la salud, para realizar aportes que permitan un abordaje especializado y pertinente de la problemática. Este trabajo quiere brindar un primer punto fundamental para comprender, evaluar y tratar el abuso sexual, propone pensar una inscripción psíquica que funciona como potencialidad, es decir la construcción de atributos particulares que condicionan la concreción de la acción por parte del agresor y concomitantemente, la conversión de un sujeto en víctima de un abuso sexual, en especial cuando es intrafamiliar y prolongado. A tales condicionamientos se los llamará, aquí - Abusabilidad-. El enfoque supone la construcción de una característica particular en un sujeto que favorece que sea abusado, esta característica incluye componentes intrapsíquicos y vinculares, en un entramado complejo. El mismo requiere de una visión transdisciplinaria que permita captar el juego en el que se incluye tanto al abusador como al abusado y a todo el grupo primario al que pertenecen. La participación en este juego es lo que induce al abuso y lo sostiene en el tiempo. De él forma parte todo su grupo familiar y/o de crianza, por acción u omisión, en una característica que se llamará en este trabajo -ceguera y/o parálisis vincular- , y que presenta tanto la víctima directa como sus hermanos, madre u otros familiares. La víctima presenta, simultáneamente, la imposibilidad de defenderse y de pedir ayuda, y es inducida por el abusador y por el contexto en el que se da el abuso, al mantenimiento de un pacto de silencio. En el presente trabajo se intentará revertir el consenso establecido de que todo sujeto es igualmente pasible de resultar victimizado. La reversión surge, por un lado, de obviedades y experiencias (no hay dos sujetos iguales ni contextos idénticos); y, por otro, de lecturas que han orientado la reflexión hacia una dimensión crítica cuestionadora de lo instituido

Abusabilidad : Potencialidad de resultar víctima de abuso sexual intrafamiliar

Este estudio se centra en los llamados casos de abusos sexuales intrafamiliares (ASI), donde niños y adolescentes, o aun personas que ya han superado tales etapas vitales, se encuentran condicionadas en su integridad sexual por miembros de su entorno familiar con trato cotidiano, prolongado en el tiempo y con secuelas graves respecto a su estructuración subjetiva y a su vinculación social. En esta producción se intenta conceptualizar dentro de la problemática e abuso sexual, un fenómeno, que si bien no es nuevo, permanece oscurecido por otros que lo anteceden o del que derivan pero sin reconocerlo. Para ello se parte de la experiencia acumulada y del análisis de los textos más importantes sobre el tema. Además de la vinculación con otros profesionales que lo investigan. Esto promovió el deseo de profundizar en un campo, que si bien actualmente es rico en producciones teóricas, se visualiza como abierto, por su complejidad y demanda en aumento, a nuevas propuestas. Por otro lado el abuso sexual, en la actualidad, está reconocido como un hecho que convoca y requiere del compromiso de los profesionales de la salud, para realizar aportes que permitan un abordaje especializado y pertinente de la problemática. Este trabajo quiere brindar un primer punto fundamental para comprender, evaluar y tratar el abuso sexual, propone pensar una inscripción psíquica que funciona como potencialidad, es decir la construcción de atributos particulares que condicionan la concreción de la acción por parte del agresor y concomitantemente, la conversión de un sujeto en víctima de un abuso sexual, en especial cuando es intrafamiliar y prolongado. A tales condicionamientos se los llamará, aquí - Abusabilidad-. El enfoque supone la construcción de una característica particular en un sujeto que favorece que sea abusado, esta característica incluye componentes intrapsíquicos y vinculares, en un entramado complejo. El mismo requiere de una visión transdisciplinaria que permita captar el juego en el que se incluye tanto al abusador como al abusado y a todo el grupo primario al que pertenecen. La participación en este juego es lo que induce al abuso y lo sostiene en el tiempo. De él forma parte todo su grupo familiar y/o de crianza, por acción u omisión, en una característica que se llamará en este trabajo -ceguera y/o parálisis vincular- , y que presenta tanto la víctima directa como sus hermanos, madre u otros familiares. La víctima presenta, simultáneamente, la imposibilidad de defenderse y de pedir ayuda, y es inducida por el abusador y por el contexto en el que se da el abuso, al mantenimiento de un pacto de silencio. En el presente trabajo se intentará revertir el consenso establecido de que todo sujeto es igualmente pasible de resultar victimizado. La reversión surge, por un lado, de obviedades y experiencias (no hay dos sujetos iguales ni contextos idénticos); y, por otro, de lecturas que han orientado la reflexión hacia una dimensión crítica cuestionadora de lo instituido

Abusabilidad : Potencialidad de resultar víctima de abuso sexual intrafamiliar

Este estudio se centra en los llamados casos de abusos sexuales intrafamiliares (ASI), donde niños y adolescentes, o aun personas que ya han superado tales etapas vitales, se encuentran condicionadas en su integridad sexual por miembros de su entorno familiar con trato cotidiano, prolongado en el tiempo y con secuelas graves respecto a su estructuración subjetiva y a su vinculación social. En esta producción se intenta conceptualizar dentro de la problemática e abuso sexual, un fenómeno, que si bien no es nuevo, permanece oscurecido por otros que lo anteceden o del que derivan pero sin reconocerlo. Para ello se parte de la experiencia acumulada y del análisis de los textos más importantes sobre el tema. Además de la vinculación con otros profesionales que lo investigan. Esto promovió el deseo de profundizar en un campo, que si bien actualmente es rico en producciones teóricas, se visualiza como abierto, por su complejidad y demanda en aumento, a nuevas propuestas. Por otro lado el abuso sexual, en la actualidad, está reconocido como un hecho que convoca y requiere del compromiso de los profesionales de la salud, para realizar aportes que permitan un abordaje especializado y pertinente de la problemática. Este trabajo quiere brindar un primer punto fundamental para comprender, evaluar y tratar el abuso sexual, propone pensar una inscripción psíquica que funciona como potencialidad, es decir la construcción de atributos particulares que condicionan la concreción de la acción por parte del agresor y concomitantemente, la conversión de un sujeto en víctima de un abuso sexual, en especial cuando es intrafamiliar y prolongado. A tales condicionamientos se los llamará, aquí - Abusabilidad-. El enfoque supone la construcción de una característica particular en un sujeto que favorece que sea abusado, esta característica incluye componentes intrapsíquicos y vinculares, en un entramado complejo. El mismo requiere de una visión transdisciplinaria que permita captar el juego en el que se incluye tanto al abusador como al abusado y a todo el grupo primario al que pertenecen. La participación en este juego es lo que induce al abuso y lo sostiene en el tiempo. De él forma parte todo su grupo familiar y/o de crianza, por acción u omisión, en una característica que se llamará en este trabajo -ceguera y/o parálisis vincular- , y que presenta tanto la víctima directa como sus hermanos, madre u otros familiares. La víctima presenta, simultáneamente, la imposibilidad de defenderse y de pedir ayuda, y es inducida por el abusador y por el contexto en el que se da el abuso, al mantenimiento de un pacto de silencio. En el presente trabajo se intentará revertir el consenso establecido de que todo sujeto es igualmente pasible de resultar victimizado. La reversión surge, por un lado, de obviedades y experiencias (no hay dos sujetos iguales ni contextos idénticos); y, por otro, de lecturas que han orientado la reflexión hacia una dimensión crítica cuestionadora de lo instituido

A Safe Vaccine (DV-STM-07) against Salmonella Infection Prevents Abortion and Confers Protective Immunity to the Pregnant and New Born Mice

Pregnancy is a transient immuno-compromised condition which has evolved to avoid the immune rejection of the fetus by the maternal immune system. The altered immune response of the pregnant female leads to increased susceptibility to invading pathogens, resulting in abortion and congenital defects of the fetus and a subnormal response to vaccination. Active vaccination during pregnancy may lead to abortion induced by heightened cell mediated immune response. In this study, we have administered the highly attenuated vaccine strain delta pmrG-HM-D (DV-STM-07) in female mice before the onset of pregnancy and followed the immune reaction against challenge with virulent S. Typhimurium in pregnant mice. Here we demonstrate that DV-STM-07 vaccine gives protection against Salmonella in pregnant mice and also prevents Salmonella induced abortion. This protection is conferred by directing the immune response towards Th2 activation and Th1 suppression. The low Th1 response prevents abortion. The use of live attenuated vaccine just before pregnancy carries the risk of transmission to the fetus. We have shown that this vaccine is safe as the vaccine strain is quickly eliminated from the mother and is not transmitted to the fetus. This vaccine also confers immunity to the new born mice of vaccinated mothers. Since there is no evidence of the vaccine candidate reaching the new born mice, we hypothesize that it may be due to trans-colostral transfer of protective anti-Salmonella antibodies. These results suggest that our vaccine DV-STM-07 can be very useful in preventing abortion in the pregnant individuals and confer immunity to the new born. Since there are no such vaccine candidates which can be given to the new born and to the pregnant women, this vaccine holds a very bright future to combat Salmonella induced pregnancy loss.

Mother-Infant Antibodies to Pneumococcal Polysaccharides and Proteins : Transfer and Persistence of Maternal Antibodies and Development of Vaccine-Induced and Naturally Acquired Antibodies in Infants

Symptomless nasopharyngeal carriage of Streptococcus pneumoniae (pneumococcus) is very common in young children. Occasionally the carriage proceeds into mild mucosal diseases, such as sinusitis or acute otitis media, or into serious life-threatening diseases, such as pneumonia, sepsis or meningitis. Each year, up to one million children less than five years of age worldwide die of invasive pneumococcal diseases (IPD). Especially in the low-income countries IPD is a leading health problem in infants; 75% of all IPD cases occur before one year of age. This stresses the need of increased protection against pneumococcus in infancy. Anti-pneumococcal antibodies form an important component in the defence against pneumococcal infection. Maternal immunisation and early infant immunisation are two possible ways by which potentially protective antibody concentrations against pneumococci could be achieved in early infancy. The aim of this thesis is to increase the knowledge of antibody mediated protection against pneumococcal disease in infants and young children. We investigated the transfer of maternal anti-pneumococcal antibodies from Filipino mothers to their infants, the persistence of the transferred antibodies in the infants, the immunogenicity of the 23-valent pneumococcal polysaccharide vaccine (PPV) in infants and the response of the children to a second dose of PPV at three years of age. We also investigated the development of antibodies to pneumococcal protein antigens in relation to culture-confirmed pneumococcal carriage in infants. Serum samples were collected from the mothers, the umbilical cords and from the infants at young age as well as at three years of age. The samples were used to determine the antibody concentrations to pneumococcal serotypes 1, 5, 6B, 14, 18C and 19F, as well as to the pneumococcal proteins PspA, PsaA, Ply, PspC, PhtD, PhtDC and LytC by the enzyme immunoassay. The findings of the present study confirm previously obtained results and add to the global knowledge of responses to PPV in young children. Immunising pregnant women with PPV provides the infants with increased concentrations of pneumococcal polysaccharide antibodies. Of the six serotypes examined, serotypes 1 and 5 were immunogenic already in infants. At three years of age, the children responded well to the second dose of PPV suggesting that maternal and early infant immunisations might not induce hyporesponsiveness to polysaccharide antigens after subsequent immunisations. The anti-protein antibody findings provide useful information for the development of pneumococcal protein vaccines. All six proteins studied were immunogenic in infancy and the development of anti-protein antibodies started early in life in relation to pneumococcal carriage.

The Activity of Breast Milk and Monoclonal HIV-specific Antibodies in Mother-to-Child Transmission

Mother-to-child transmission of HIV is a unique setting that allows us to explore both the correlates of protective immunity and the characteristics of transmitted variants. This thesis first describes the levels and functional capacity of breast milk HIV-specific antibodies in 19 women with high plasma viral loads. Neutralizing antibodies (Nabs) were detected in breast milk supernatant (BMS) of 4 of 19 women examined, were of low potency and were not associated with infant infection. The low NAb activity in BMS was reflected in binding antibody levels with HIV envelope specific IgG titers being 2.2 log10 lower in BMS versus plasma. In contrast, non- neutralizing antibodies (nNAbs) capable of antibody dependent cell-mediated cytotoxicity (ADCC) were detected in the BMS from all 19 women. BMS ADCC activity was associated with envelope-specific IgG titers (p = 0.014) and was inversely associated with infant infection risk (p = 0.039). Our data indicate that BMS has limited HIV neutralizing activity, however, BMS ADCC activity is a correlate of transmission that may impact infant infection risk. In the second part of this thesis the neutralization sensitivity of 111 variants of diverse subtypes obtained from mothers and infants was determined against 7 HIVspecific broadly neutralizing monoclonal antibodies (mAbs) (NIH45-46w, VRC01, PGT128, PGT121, PG9 PGT145 and b12). Maternal and infant variants did not differ in their neutralization sensitivity to these mAbs and neither did variants from transmitting versus those from non-transmitting women. However, subtype A viruses were iii significantly more sensitive to neutralization by NIH45-46w and VRC01 (p= 0.0001 in both cases) and PGT145 (p=0.03) compared to non-subtype A viruses. Together, NIH45- 46w and PGT128 neutralization profiles resulted in 100% coverage of the variants tested. These data suggest that the epitopes targeted by these mAbs are present and accessible in both circulating and transmitted variants and that a combination of antibodies would provide maximum coverage against diverse subtypes commonly found in HIV endemic regions. Overall, this data suggest that an antibody based HIV vaccine capable of eliciting antibodies of multiple specificities that can mediate ADCC and/or neutralizing activity can provide protection and conquer the genetic diversity displayed by HIV.

Determinants of mother-baby relationship evaluated during pregnancy

ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

Risk and protective factors associated with depression among racial and ethnic mothers of adolescents

The central paradigm linking disadvantaged social status and mental health has been the social stress model (Horwitz, 1999), the assumption being that individuals residing in lower social status groups are subjected to greater levels of stress not experienced by individuals from higher status groups. A further assumption is that such individuals have fewer resources to cope with stress, in turn leading to higher levels of psychological disorder, including depression (Pearlin, 1989). Despite these key assumptions, there is a dearth of literature comparing the social patterning of stress exposure (Hatch & Dohrenwend, 2007; Meyer, Schwartz, & Frost, 2008; Kessler, Mickelson, & Williams, 1999; Turner & Avison, 2003; Turner & Lloyd, 1999; Turner, Wheaton, & Lloyd, 1995), and the distribution and contribution of protective factors, posited to play a role in the low rates of depression found among African- and Latino-Americans (Alegria et al., 2007; Breslau, Aguilar-Gaxiola, Kendler, Su, Williams, & Kessler, 2006; Breslau, Borges, Hagar, Tancredi, Gilman, 2009; Gavin, Walton, Chae, Alegria, Jackson, & Takeuchi, 2010; Williams, & Neighbors, 2006). Thus, this study sought to describe both the distribution and contribution of risk and protective factors in relation to depression among a sample of African-, European-, and Latina-American mothers of adolescents, including testing a hypothesized mechanism through which social support, an important protective factor specific to women and depression, operates. ^ Despite the finding that the levels of depression were not statistically different across all three groups of women, surprising results were found in describing the distribution of both risk and protective factors, in that results reported among all women who were mothers when analyzed masked differences within each ethnic group when SES was assessed, a point made explicit by Williams (2002) regarding racial and ethnic variations in women's health. In the final analysis, while perceived social support was found to partially mediate the effect of social isolation on depression, among African-Americans, the direct effect of social isolation and depression was lower among this group of women, as was the indirect effect of social isolation and perceived social support when compared to European- and Latina-American mothers. Or, put differently, higher levels of social isolation were not found to be as associated with more depression or lower social support among African-American mothers when compared to their European- and Latina-American counterparts. ^ Women in American society occupy a number of roles, i.e., that of being female, married or single, mother, homemaker or employee. In addition, to these roles, ethnicity and SES also come into play, such that the intersection of all these roles and the social contexts that they occupy are equally important and must be taken into consideration when making predictions drawn from the social stress model. Based on these findings, it appears that the assumptions of the social stress model need to be revisited to include the variety of roles that intersect among individuals from differing social groups. More specifically, among women who are mothers and occupy a myriad of other roles, i.e., that of being female, married or single, African- or Latina-American, mother, homemaker or employee, the intersection of all the roles and the social contexts that women occupy are equally important and must be taken into consideration when looking at both the types and distribution of stressors across women. Predictions based on simple, mutually exclusive categories of social groups may lead to erroneous assumptions and misleading results.^

Association of HIV-1 Envelope-Specific Breast Milk IgA Responses with Reduced Risk of Postnatal Mother-to-Child Transmission of HIV-1.

UNLABELLED: Infants born to HIV-1-infected mothers in resource-limited areas where replacement feeding is unsafe and impractical are repeatedly exposed to HIV-1 throughout breastfeeding. Despite this, the majority of infants do not contract HIV-1 postnatally, even in the absence of maternal antiretroviral therapy. This suggests that immune factors in breast milk of HIV-1-infected mothers help to limit vertical transmission. We compared the HIV-1 envelope-specific breast milk and plasma antibody responses of clade C HIV-1-infected postnatally transmitting and nontransmitting mothers in the control arm of the Malawi-based Breastfeeding Antiretrovirals and Nutrition Study using multivariable logistic regression modeling. We found no association between milk or plasma neutralization activity, antibody-dependent cell-mediated cytotoxicity, or HIV-1 envelope-specific IgG responses and postnatal transmission risk. While the envelope-specific breast milk and plasma IgA responses also did not reach significance in predicting postnatal transmission risk in the primary model after correction for multiple comparisons, subsequent exploratory analysis using two distinct assay methodologies demonstrated that the magnitudes of breast milk total and secretory IgA responses against a consensus HIV-1 envelope gp140 (B.con env03) were associated with reduced postnatal transmission risk. These results suggest a protective role for mucosal HIV-1 envelope-specific IgA responses in the context of postnatal virus transmission. This finding supports further investigations into the mechanisms by which mucosal IgA reduces risk of HIV-1 transmission via breast milk and into immune interventions aimed at enhancing this response. IMPORTANCE: Infants born to HIV-1-infected mothers are repeatedly exposed to the virus in breast milk. Remarkably, the transmission rate is low, suggesting that immune factors in the breast milk of HIV-1-infected mothers help to limit transmission. We compared the antibody responses in plasma and breast milk of HIV-1-transmitting and -nontransmitting mothers to identify responses that correlated with reduced risk of postnatal HIV-1 transmission. We found that neither plasma nor breast milk IgG antibody responses were associated with risk of HIV-1 transmission. In contrast, the magnitudes of the breast milk IgA and secretory IgA responses against HIV-1 envelope proteins were associated with reduced risk of postnatal HIV-1 transmission. The results of this study support further investigations of the mechanisms by which mucosal IgA may reduce the risk of HIV-1 transmission via breastfeeding and the development of strategies to enhance milk envelope-specific IgA responses to reduce mother-to-child HIV transmission and promote an HIV-free generation.