PMTCT

A general view of the panel during the Symposium held at the University of KwaZulu Natal School of Medicine in Durban, South Africa. Credit: UNAIDS/A.Debiky

When doctors from the University of Mississippi medical centre announced on 2 March 2013 that a baby had been ‘functionally cured’ of HIV, the world hailed the news as a historical medical breakthrough.

The baby—famously known as the ‘Mississippi baby’—was born with HIV and treated with aggressive antiretroviral drugs 30 hours after birth. Now, more than two years old, doctors confirm that the baby has not taken any medication since the age of 18 months and tests show no sign of re-active HIV (detectable viral load).

From the time that this extraordinary news was announced scientists and researchers have been busy trying to understand how the ‘Mississippi baby’ case could advance future research in preventing mother-to-child transmission of HIV.

More than 20 scientists, researchers, public health practitioners, donors, government authorities, representatives of non-government organisations and civil society came together for a two-day symposium on 3-4 June under the theme Scientific advances from ‘Mississippi baby’: Implications for public health programmes on mother-to-child transmission of HIV.

“This meeting is about giving people hope,” said UNAIDS Executive Director, Michel Sidibé. “The Mississippi miracle has to become a Durban miracle, a Bamako miracle, a miracle for all children irrespective of where they are born.”

Organised by UNAIDS and the Centre for the AIDS Programme of Research in South Africa (CAPRISA), the symposium focused on 1) whether programmes to stop new HIV infections among children need to be reformulated to promote early identification and treatment of babies at risk of HIV infection and 2) challenges associated with stopping new HIV infections among children and paediatric antiretroviral treatment.

Despite the 24% drop in new HIV infections in children since 2009, some 330 000 children around the globe were born with HIV in 2011. Most children born with HIV (more than 90%) are in sub-Saharan Africa.

Many African countries have made remarkable progress in preventing mother-to-child transmission of HIV by increasing access and integrating HIV prevention, treatment and cares services to mothers and their new-borns. AIDS-related deaths among children in the 22* priority countries of the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive also reduced from 243 000 in 2009 to 203 000 in 2011

However, progress in expanding access of antiretroviral therapy to children has been minimal. The percentage of children living with HIV  eligible for treatment and who were receiving it in 2011 largely falls below 50% in at least 15 of the 22 priority countries—8% in Chad, 19% in Ethiopia and 29% in Malawi.

“Paediatric treatment and care lags behind; there seems to be a disconnect between investments in programmes to stop new HIV infections in children and for children in need of treatment. Even when the infants are identified they are not successfully linked to care,” said Dr Chewe Luo, UNICEF Senior Advisor on AIDS. 

The ‘Mississippi baby’ case was discussed at great length highlighting the need for early infant diagnosis and initiation of treatment. “The relevance of the ‘Mississippi baby’ to the general population remains unclear and more research, including for safe and appropriate neonatal drugs needs to be done before we push for widespread change in policy,” said Dr Hanna Gay, Associate Professor at University of Mississippi, who treated the ‘Mississippi baby’. “But one thing we can be certain of is that early diagnosis and treatment saves lives.”

At the end of the two-day discussions, participants made several recommendations, including the need for early infant diagnosis, better research and improved medicines for children as well as more efficient funding mechanisms to strengthen mother and child AIDS programmes.

“What we do know is that early diagnosis of HIV and early treatment of infants and children does lead to better outcomes – regardless of the issue of a cure. We should be concerned that we are not diagnosing and treating children early enough. In South Africa only 65% of children who are in need to treatment are on treatment,” said Dr Aaron Motsoaledi, Minister of Health of South Africa.

UNAIDS Executive Director Michel Sidibé and Dr Sibongiseni Dhlomo, Member of the Executive Committee for Health in KwaZulu Natal met on 3 June on the side-lines of the UNAIDS/CAPRISA Symposium: Scientific advances from the ‘Mississippi baby’: Implications for public health programmes on mother to child transmission of HIV taking place in Durban, South Africa.

Mr Sidibé applauded the bold leadership that transformed the province from being the HIV epicentre in South Africa to an innovator in turning the epidemic around.

In recent years, KwaZulu Natal, through strong political commitment and effective HIV programmes, managed to ensure that more than 600 000 people in need of antiretroviral treatment had access in 2012, compared to just over 36 000 in 2005. The rate of mother-to-child transmission of HIV at six weeks declined to 2.1% in 2012 compared to 22% in 2005. The life expectancy in KwaZulu Natal has increased from 56.4 years in 2009 to 60 years in 2011, which is highly attributed to a decrease in AIDS-related deaths.

Dr Dhlomo said he was humbled by the recognition and support his province has been gaining for the successful outcomes in the AIDS response. He acknowledged that the government would need to invest more on HIV prevention services including behaviour and social change programmes. In 2012, the province spent 73% of HIV funds on treatment and care services and only 5% on preventing sexual transmission of HIV.

Austrian Federal President Dr Heinz Fischer, UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures, UNAIDS Goodwill Ambassador Aishwarya Rai Bachchan.
Credit: AIDS Life

The Life Ball 2013, Europe’s biggest AIDS charity event, brought to the Austrian city of Vienna on 25 May celebrities and influential leaders in the global AIDS response to celebrate the 21st edition of one of the largest AIDS fundraising events worldwide. Organised by Gery Keszler in his capacity as chairman of the NGO AIDS LIFE, this year’s Life Ball was held under the theme “1001 nights”. All proceeds from this year’s event will go towards reaching the international goal of eliminating new HIV infections in children and keeping their mothers alive.  

During the star-studded evening high-profile guests included former United States President   Bill Clinton, UNAIDS Goodwill Ambassador Aishwarya Rai Bachchan, Sir Elton John, singer Fergie representing amfAR, the Foundation for AIDS Research, Editor-in-chief of the Italian Vogue, Franca Sozzani, former Chairman and CEO of MTV Networks International, Bill Roedy, and fashion designer Roberto Cavalli who hosted this year’s Life Ball fashion show.  

The role of UNAIDS in achieving the global success against AIDS was highlighted by celebrities and global leaders at the gala dinner. "We can celebrate tonight the work of UNAIDS. A lot of the success and work achieved so far has been championed by UNAIDS, the Global Fund, the Elton John foundation and other partners,” said President Clinton

At the international press conference before the grand opening UNAIDS Goodwill Ambassador Aishwarya Rai Bachchan stressed the need to join efforts to stop new HIV infections among children. "It is every mother's wish to have a healthy child and it is every woman's right to live a life with dignity and access to health services,” said Ms Bachchan. “It is everybody's responsibility. In my role as UNAIDS International Goodwill Ambassador I will do my best but the media can play a huge role and I ask you to help me spread the message," added Ms Bachchan.

For the third year in a row UNAIDS co-hosted the AIDS Solidarity Gala, a dinner at the Hofburg Palace which directly preceded the ball. The patron of the gala was the Austrian Federal President Dr Heinz Fischer, which provided the event with political backing at the highest level.

"The AIDS response in the future will be led, shaped, and defined by young people. If we fail to build our AIDS response that is inclusive of young girls and young men who have sex with men we cannot achieve the goal of ending the AIDS epidemic,” said UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures. “Following Sir Elton John's words: we are going to the end of AIDS but we need to make sure we leave no one behind,” he added.

The Life Ball itself began with the opening ceremony spectacle of tens of thousands of people thronging City Hall Square for a two-hour show staged on a gigantic red ribbon.

L to R: UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures, Sir Elton John and former Chairman and CEO of MTV Networks International, Bill Roedy.

This year’s Crystal of Hope Award—a 100 000 euro award given to individuals who are making a difference in the AIDS response—was presented by actor and producer Hilary Swank  to representatives of the transnational project ‘The Girl Effect’, an initiative that supports young women to fight poverty and keep themselves safe from HIV. They were: Lisa T.D. Nguyen from Cambodia, Patricia Suriel from the Dominican Republic, Sulaiman Turay from Cameroon and Sadie St. Denis from Uganda.

Following the opening ceremony some 4 000 invited guests entered City Hall for an all-night event involving international performers.  

Thousands of children and their mothers are expected to benefit from the several million dollars following Life Ball 2013. Organisers hope that this year’s event will not only help to stop children becoming infected, but also further strengthen solidarity, understanding, and tolerance towards those living with and affected by HIV.

L to R: Minister of Health of Burundi, Dr Sabine Ntakarutimana, UNAIDS Executive Director Michel Sidibé and United States Ambassador to Burundi, Dawn Liberi.

Burundi marked its National AIDS Day on 8 May and committed to stopping new HIV infections among children and keeping their mothers alive. The Minister of Health of Burundi, Dr Sabine Ntakarutimana who opened the event at the Kamenge health centre in Bujumbura said, “I am committed to bringing Burundi to zero new HIV infections, zero discrimination and zero AIDS-related deaths.”

Burundi’s health authorities report HIV prevalence in the country was 1.4% in 2010 with more than 98,000 people living with HIV in 2011. The country is struggling with a low HIV treatment coverage with only 49% of people eligible for antiretroviral therapy accessing it. Almost 2000 babies were born with HIV in 2011. The government has promised to improve treatment coverage especially for pregnant women living with HIV and recently Burundi’s President Pierre Nkurunziza adopted a decree which aims to significantly scale-up services to prevent new HIV infections among children.

“AIDS is a strategic entry point for advancing Burundi’s social agenda at several levels: protecting women, children and human rights,” said UNAIDS Executive Director Michel Sidibé at the event.

The country will be receiving support for scaling-up services from the United States of America according to its Ambassador to the country, Dawn Liberi. “We will double our financial contribution to cover eight of the 17 provinces in Burundi with services to prevent new HIV infections among children,” she said.

Burundi’s Second Vice-President, Gervais Rufyikiri (left) and UNAIDS Executive Director Michel Sidibé.

In 2011, UNAIDS and partners launched the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Burundi is one of the 22 countries that the Global Plan focuses on, where 90% of new HIV infections among children occur.

Mr Sidibé also visited the centre of health and family welfare (ABUBEF). The centre provides medical and care and support services to people living with HIV, as well as conducting HIV prevention programmes.  

As part of his official visit to Burundi, Mr Sidibé met with the Second Vice-President, Gervais Rufyikiri, who has championed the country’s drive to stop new HIV infections in children. In 2005, Burundi emerged from a long civil war and the Vice-President asked UNAIDS to support the country’s efforts towards greater development. He said, “I am asking the international community to pay more attention to Burundi. We are in the process of rebuilding our country and we need your support.”

The UNAIDS Executive Director continues his official mission on 9 May with a meeting with the country’s president.

The First Lady of Ghana, Lordina Mahama, has agreed to become UNAIDS premiere ambassador for the implementation of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.

First Lady Mahama has committed to lead Ghana's push towards reaching an AIDS-free generation. In her new role, she will encourage political dialogue in the country ensuring that AIDS remains high on the political agenda. She will work towards empowering women and girls, challenging stigma, and helping national and community leaders understand that the AIDS response cannot be separated from the work to improve the health of mothers and children.

UNAIDS Executive Director Michel Sidibé visting the Issaka-Gazobi maternity clinic, which handles many complicated pregnancies and two years ago began providing services to pregnant women living with HIV. Niamey, Niger. Credit: UNAIDS

It is 10 am in the morning and the hot sun is already high in the sky above Niamey, Niger. Inside the Issaka-Gazobi maternity clinic a group of women are waiting expectantly for a meeting very few imagined they would ever have. The First Lady of Niger, Aïssata Issoufou Mahamadou and UNAIDS Executive Director, Michel Sidibé met the women during their visit recently to the maternity clinic, which is a model for the rest of the country.

The facility provided services to more than 20 000 patients and had nearly 6000 births last year. It handles many complicated pregnancies and two years ago began providing services to pregnant women living with HIV. The First Lady came to the clinic to officially donate food and medical supplies to the staff and she said, “This maternity is a model in the prevention of mother to child transmission services in Niger.”

Niger struggles with an extremely high infant mortality rate, which in 2012 the government estimated at 51 deaths per 1000 live births. Like many other maternity wards, Issaka-Gazobi struggles with providing quality care in a resource-poor setting. However, the big challenges facing the facility spurred the staff to become innovative and adapt a concept that has been used elsewhere to the local situation.

The maternity lacks enough incubators to keep alive all the premature babies in its care. So the staff developed a pouch, which can hold a new-born snug next to his or her mother’s body, benefitting from a natural human incubator. While, the so called “kangaroo care” concept has been used in a number of other countries, the Issaka-Gazobi is the first place to promote it in Niger. The device is novel in a country where most mothers carry their babies on their backs.

After seeing the innovative human incubator, Mr Sidibé said, “Kangaroo care is a wonderful concept. I am really impressed by how the maternity has adapted the idea to give life-saving warmth to premature babies and enable mothers to keep their infants alive.”

The Issaka-Gazobi provides antiretroviral therapy for free to mothers living with HIV to prevent transmission of the virus to their children and almost all patients living with HIV give birth to healthy babies. However in much of the country this is not the case. In 2011 Niger estimates less than 65% of pregnant women received an HIV test and less than 30% of pregnant women living with HIV had access to ARVs to prevent transmitting HIV to their children. The rate of HIV infection among children was nearly 22% in 2011.

Niger faces many challenges to preventing new HIV infections in children. While the majority of pregnant women receive a prenatal consultation, only around 30% of women give birth with the help of a trained health worker. This is primarily because while prenatal visits are free, receiving professional assistance at birth costs money. Many pregnant women, who test positive for HIV are lost to follow up and do not receive the treatment they need.

The government of Niger is striving to expand its services for preventing mother to child HIV transmission (PMTCT) and increased the funds it allocated to PMTCT from 2.6% of the total budget in 2010 to 15.9% in 2011. However, the country still faces a huge gap of around $US1.17 million this year for PMTCT services.

Mr Sidibé commended the country for the efforts it is making to improve health services for mothers and urged the country keep pushing towards stopping new HIV infections in children by 2015 and keeping their mothers healthy.

L to R: Dr Simon Zwane, Director of Health Services of Swaziland, Michel Sidibé, UNAIDS Executive Director, Benedict Xaba, Minister of Health Swaziland. Credit: UNAIDS/J.Matas

UNAIDS Executive Director Michel Sidibé joined Swaziland’s Minster of Health, Benedict Xaba to launch a new National Framework to stop new HIV infections among children by 2015 and keep their mothers alive.

Swaziland has dramatically scaled up services to prevent new HIV infections among children in the country reaching more than 90% coverage in 2012.

"The framework will allow us to continue strengthening national programmes to realize our goal of eliminating new HIV infections among children,” said Mr Xaba. “An HIV-free generation is doable in Swaziland,” he added.

The Framework—developed with technical support from UNAIDS, UNICEF, UNFPA and WHO— is divided into four programme areas including HIV prevention, integration of family planning services, improvement of labour and delivery care, and provision of comprehensive antiretroviral treatment.

Health centers providing services to prevent new HIV infections among children expanded from only three in 2003 to more than 150 in 2010. The percentage of pregnant women living with HIV receiving antiretroviral treatment (ART) rose from 57% in 2009 to 86% in 2011, according to government data.

“Our science and political will have reached a point where countries no longer allow children to be born with HIV in Africa,” said UNAIDS Executive Director Michel Sidibé. “With the launch of this new, bold framework, I am confident that Swaziland will reach an AIDS free Generation by 2015.”

The new Swaziland Framework also identifies crucial socio-cultural and economic factors that increase the vulnerability of women to HIV. It proposes scaling-up of various activities, including the increase of male involvement; integration of HIV testing with antenatal care; improving the quality of services provided to HIV positive women and their exposed infants; and social and behaviour change communication to create a supportive community environment.

Launch of the new National Framework to stop new HIV infections among children by 2015 and keep their mothers alive. Ezulwini, Swaziland. 22 March 2013. Credit: UNAIDS/J.Matas

“Today is a day for both celebration and commitment,” said Ambassador Makila James, United States Ambassador to Swaziland. “We should celebrate the effort that went into developing this strategic document, but we must also commit ourselves to fully implementing the critical, life-saving interventions of the framework.”

Despite encouraging progress, 67% of maternal deaths in Swaziland are still attributed to HIV—the leading contributor of maternal and child mortality in the country. The country also has one of the highest levels of HIV among pregnant women.

Swaziland is one of the 22 priority countries highlighted in the Global Plan towards the elimination of new HIV infection among children by 2015 and keeping their mothers alive that was launched in June 2011. The Global Plan calls for urgent strategic and programmatic scale-up to achieve the target of reducing the rate of mother-to-child transmission of HIV to less than 2% by 2015.

On 7 March, the eve of International Women's Day, Sierra Leone’s First Lady Alice Sia Nyama Koroma hosted a dinner in Freetown, where efforts to improve health services for women and children were showcased. The First Lady recently launched a campaign towards eliminating new HIV infections among children in partnership with UNAIDS, Voice of Women and the National AIDS Control Programme.

Michel Sidibé, UNAIDS Executive Director, joined the high level delegation along with Cherie Blair, head of the Cherie Blair Foundation for Women and  Dr Kandeh Yumkella, UNIDO Director General.

The First Lady presented her project “the Women’s Initiative for Safer Health” (WISH), which aims to reduce child and maternal mortality by improving access to health facilities and training health workers. A documentary was also screened on the efforts to eliminate new HIV infections in children and keeping mothers healthy.

UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures and President of Niger H.E. Mahamadou Issoufou.

The annual congress of the African Society of Gynaecologists and Obstetricians (Société Africaine des Gynécologues et Obstétriciens – SAGO) took place in Niger from 21-23 January 2013 under the theme “Mortality Costs and Maternal and Neonatal Morbidity in Africa”. The meeting was attended by the Prime Minister of Niger, and first ladies of Niger, Burkina Faso and Mali. The UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures also participated in the congress as part of his official visit to the country.

Launched in 1988 by African ob-gyns to strengthen scientific discourse and eliminate barriers between African scientists, SAGO members comprise countries mostly from west and central Africa. Focussing on the Millennium Development Goals (MDG) 4 and 5 to reduce child and maternal mortality rates by 2015, SAGO aims to define standards of practice for gynaecologists and obstetricians.

First Lady of Niger Malika Issoufou Mahamadou with UNAIDS Deputy Executive Director, Programme, Dr Luiz Loures.

The Prime Minister of Niger, His Excellency Brigi Rafin said that the Congress was held at a time where surveys show weak progress in reducing maternal and neonatal morbidity and mortality in Sub-Saharan countries. "Every day 24 women die giving birth and 72 newborn children die in my country," he said.

Niger has made considerable progress in maternal and child health because of its policies, resources and strategies, outstripping other countries in the region. Government scale up of high-impact child health services, including eliminating user fees for pregnant women and children and strengthening child nutrition, has brought down annual mortality rate by 5.1%.

Dr Loures pegged these achievements to the country’s transformative and visionary political commitment, backed by judicious budgetary decisions and a focus on high impact strategies for maternal and child health.

A joint agreement of cooperation was signed UNAIDS and SAGO to accelerate the implementation of the Global Plan to eliminate new HIV infections among children and keeping their mothers alive. “The promotion of maternal and child health is the basis for the achievement of the Global Plan,” said Dr Loures.

Annual congress of the African Society of Gynaecologists and Obstetricians, Niger, 21-23 January 2013.

According to Dr Loures, professional organisations such as SAGO are uniquely placed to advocate for the rights of their patients and clients, particularly women living with HIV. These organizations can ensure that women are not stigmatized, their confidentiality is not violated, or that they are not forced and coerced into accepting services. They can serve as a collective workforce towards achieving the health MDGs and also provide a forum to expand knowledge, exchange information and legitimise and amplify the contribution of the members.

First Lady of Sierra Leone, Madam Sia Nyama Koroma.

The First Lady of Sierra Leone, Madam Sia Nyama Koroma has launched a national campaign to prevent new HIV infections among children called “Bon Pikin Wae Nor Get HIV” (Give Birth to Life without HIV).

The new initiative was developed by the First Lady’s Office in collaboration with UNAIDS, the Network of Women Living with HIV (Voice of Women), the National AIDS Control Programme and the National AIDS Secretariat. The campaign, led by the network of women living with HIV aims to raise awareness about HIV prevention among women of reproductive age in order to accelerate the uptake of HIV services to prevent new HIV infections among children.

The availability of services to prevent mother-to-child transmission of HIV has increased substantially in recent years, however, coverage is not uniform across the country. This campaign will try to address the existing gap mainly in rural areas where the service demand is still low.

Besides increasing demand for antenatal services, it is expected that the campaign will help promote the sexual and reproductive health and rights of women; improve access to antiretroviral prophylaxis amongst HIV positive women and strengthen the capacities and participation of women living with HIV in the promotion of the national agenda to stop HIV infections among children in Sierra Leone.

During the launch, the First Lady called on Sierra Leonean women and the general public to visit hospitals and health clinics to test for HIV. She emphasised the need for male participation in prenatal care services. “If we are to win the war against AIDS, we will need caring men and women to join us in the campaign,” she said.

Madam Kadija Sam Sumana, wife of the Vice-President of Sierra Leone, stressed the lack of education and information as the major cause in the spread of HIV in young girls. She encouraged parents to ensure that girls receive education and also to discourage teenage pregnancy and early marriages.

The UNAIDS Country Coordinator Dr Job Sagbohan welcomed the First Lady’s efforts in promoting maternal and child health and empowering women and girls for their social economic development. He assured UNAIDS continued commitment and support in the response to AIDS and in achieving the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths by 2015. “Progress is possible when we come together for a common cause—with vision, clear objectives and strong and sustained effort,” he said.