PMTCT

Credit: UNAIDS/D.Kwande

A mid-term review on the implementation of the Global Plan Towards the Elimination of New HIV infections among Children by 2015 and Keeping their Mothers Alive took place in Nairobi, Kenya from 6-7 December. The two-day workshop discussed the way forward in overcoming three key bottlenecks to achieve the Global Plan targets, including early infant diagnosis, human resources for health and supply chain management.

In June 2011, UNAIDS and the President’s Emergency Plan for AIDS Relief (PEPFAR) unveiled the Global Plan with two main targets for 2015: a 90% reduction in the number of children newly infected with HIV and a 50% reduction in the number of AIDS-related maternal deaths. The Global Plan focuses on 22 priority countries with the highest estimated numbers of pregnant women living with HIV.

Opening the meeting, US Deputy Global AIDS Coordinator Deborah Von Zinkernagel noted the momentum that has been gained in the 18 months since the launch of the Global Plan. “Strong political leadership, progressive policy change, and accelerated programmatic scale up at various levels are helping to significantly reduce new HIV infections among children and AIDS-related deaths among mothers,” said Ms Von Zinkernagel. “While the job is far from done, the intensified efforts of many partners under the Global Plan are advancing our progress towards the goal of achieving an AIDS-Free Generation”, she added.

Speaking about the challenges, participants highlighted that immediate confirmation of HIV infection in children is urgent to ensure timely initiation of antiretroviral therapy, as half of the children infected with the virus die before the age of two years. UNAIDS estimates that in 2010, among 65 reporting countries, only 28% of infants born to mothers living with HIV received an HIV test within the first two months of life. In 2011, 230 000 children died from HIV-related causes worldwide and only 28% of children eligible for treatment were receiving it, compared to 54% of adults.

Participants also stressed that, despite progress made in the provision of services to prevent mother-to-child transmission of HIV, access to appropriate diagnostics and/or treatment for pregnant women still remained inadequately low. According to UNAIDS, the percentage of treatment-eligible pregnant women living with HIV who were receiving antiretroviral therapy for their own health in 2011 was an estimated 30%.

In countries like the Democratic Republic of Congo, Chad, and Nigeria, less than 20% of pregnant women received HIV testing and counselling in 2010. Participants noted that, in some cases, the lack of access to these services is caused by uninformed or misguided government policies that do not prioritise the provision of this life-saving treatment.

Overall supply chain challenges, and in particular, the cost of commodities have overarching implications. Participants agreed that without an effective supply chain, the goals of the Global Plan are impossible to meet. Strategies such as pooling and integrating procurement, strengthening and harmonizing regulatory systems, systems transparency, and improving the accuracy of commodity forecasting to reduce stock wastage are critical to maximize  supply chain efficiency. The meeting also discussed the importance of predictable funding and skilled personnel to enable efficient logistics management while lowering costs.

A shortage of human resources for health, including doctors, nurses and midwives was discussed as a major bottleneck in rapidly expanding HIV prevention, treatment and support services for mothers and children. Many of the participating countries are experimenting with task-shifting and task-sharing, as well as working with community and lay health workers in order to stretch the reach of health care services. Strategies that can accelerate the recruitment, retention and retraining of health care providers were shared, such as formalizing the role of community health workers, the development of a formal professional management cadre to oversee health facilities, and accelerated pre-service training schemes.

Participants agreed that eliminating new HIV infections among children and keeping their mothers alive is not, and should not be, just about pills. It is first and foremost about protecting the health, dignity and security of mothers living with HIV and their children. They heard reports of human rights violations of women living with HIV such as mandatory HIV testing, forced sterilizations, as well as stigma and discrimination especially in the health care setting. Networks of women living with HIV demonstrated how they have been overcoming these challenges including sensitizing communities on their rights, demanding action and accountability from governments and other stakeholders, and playing a central role within their country programs to end vertical transmission. During the workshop, participants agreed on key actions required for progress to be made against the targets of the Global Plan in these areas. Participants also discussed the global financing architecture, and how to maximize towards available resources such as Global Fund and PEPFAR, but beginning with their own domestic funding.   

Closing the meeting, the Director of the Department of Evidence, Innovation and Policy at UNAIDS Dr Bernhard Schwartlander, commended countries for their rapid momentum. “The call for elimination of new HIV infections among children by 2015 and keeping their mothers alive has been widely heard”, he said, “and countries are now making important and sustained investments for their populations. It is now time to notch up our efforts as we enter the second phase of the Global Plan, and be better accountable to our governments and the people we serve.”

The meeting was attended by government representatives from 16 of the 22 priority countries under the Global Plan, as well as representatives from PEPFAR, the UN, and several global implementing agencies.  Others present included Women Fighting AIDS in Kenya (WOFAK), The International Community of Women with HIV/AIDS (ICW), and the Inter-Agency Task Team on the Prevention and Treatment of HIV among Pregnant Women, Mothers and Children.

In a new report, entitled Women out loud, UNAIDS explores the impact of HIV on women and the instrumental role women living with the virus are playing to end AIDS. It includes the latest data and commentary from some of the leading advocates on women and HIV.

The report includes the voices of some 30 women living with HIV who have given their personal insights into how the epidemic is affecting women and on how women are actively working to reduce the spread and impact of AIDS.

HIV is continuing to have a disproportionate effect on the lives of women. It is still the leading cause of death for women of reproductive age, and gender inequalities and women’s rights violations are persistent in rendering women and girls more vulnerable to HIV and preventing them from accessing essential HIV services.

“Achieving zero new HIV infections, zero discrimination and zero-AIDS related deaths will require accelerated action for women and girls,” said Michel Sidibé, Executive Director of UNAIDS. “Women must have access to education and knowledge as well as being empowered to protect themselves from HIV. We must listen to their needs, their voices and transform their words into action.”

Every minute, one young woman is infected by HIV

The infection rates among young women aged 15-24 are twice as high as in young men, highlighting the impact HIV is having on young women’s lives. The disparity is most pronounced in sub-Saharan Africa, where 3% of young women are living with HIV.

Comprehensive sexuality education is critical for all young people to ensure that they can protect themselves from HIV, especially young women. However the percentage of young women who can correctly identify ways of preventing HIV is still very low in many countries with high HIV prevalence.

“Today around 60% of adults living with HIV in the most affected regions are women––we need to take urgent action,” said the Executive Director UN Women Michelle Bachelet. “To make our response more effective, we need more women in decision-making, more access to information and services for sexual and reproductive health, and more focus on promoting and protecting the rights of women and girls.”

Gender inequalities critically influence the risk of HIV infection

Much progress is needed is in ensuring gender equality and respect for women’s sexual and reproductive health and rights, especially those of women living with HIV. Harmful gender norms and a lack of economic empowerment are rendering women more vulnerable to acquiring HIV through sexual transmission.

“Improving women’s social and economic status and enhancing their decision making power reduces the risk of HIV infection,” said Jennifer Gatsi, Executive Director of the Namibian Women’s Health Network.

Marginalised women remain the most impacted by HIV

Sex workers and people who use drugs are particularly vulnerable to HIV. When sex is exchanged for money or drugs, women often exert little influence over a partner’s condom use. Female sex workers are 13.5 times more likely to be living with HIV than other women. Some countries reported an HIV prevalence rate of more than 20% among female sex workers in capital cities. Studies conducted in nine European Union countries have indicated on average a 50% higher prevalence of HIV among women who inject drugs than in men who inject drugs.

End new infections among children and keep their mothers alive

Since UNAIDS launched the Global Plan to stop new HIV infections in children and keep their mothers alive, new infections in children in sub-Saharan Africa have fallen by nearly 25% (2009 to 2011). This represents a huge step towards achieving zero new HIV infections in children by 2015.

However, stigma and discrimination or the threat of stigma and discrimination are still preventing many women from accessing prenatal care services. Almost two of every three pregnant women in low- and middle- income countries do not know their HIV status.

It is critical to protect the sexual and reproductive health and rights of all women living with HIV. This includes their right to access voluntary and confidential HIV testing and counselling, accurate and non-judgemental information, quality treatment and services, and to bear children in a safe environment, free of stigma, discrimination and violence.

Laws and policies to protect the rights of women living with HIV

Laws and policies should protect women and girls, however there are many that exist that actually punish, stigmatize and discriminate against women living with HIV, creating a significant barrier to women accessing both harm-reduction and HIV-related services. The report highlights the need for changes in laws, policies, programmes and practices, and calls for women to be an integral part of policy-making and programming.

Women out loud provides an in depth insight into the many challenges faced by women and particularly women living with HIV. It also offers a snapshot of how women are shaping the response to HIV and the importance of their active involvement in decision making and programming.

The foreword of Women out loud is signed by Michel Sidibé, Executive Director of UNAIDS, Michelle Bachelet, Executive Director of UN Women and Jennifer Gatsi, Co-founder and Executive Director of the Namibian Women’s Health Network. The report was formally launched at the Polish mission in Geneva on Tuesday 11 December 2012 by the Under Secretary of State, Ministry of Health of Poland and Chair of the 31st PCB, Igor Radziewicz-Winnicki and His Excellency Remigiusz A. Henczel, Ambassador Extraordinary and Plenipotentiary, Permanent Representative of the Republic of Poland to the United Nations Office and other international organizations in Geneva.

Mrs Rai Bachchan toured the facilities of the Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai where she had the opportunity to speak to pregnant women living with HIV.

On World AIDS Day, UNAIDS International Goodwill Ambassador Aishwarya Rai Bachchan visited local hospital facilities in her hometown of Mumbai, India to learn more about the services provided to HIV positive pregnant women.

Mrs Rai Bachchan toured the facilities of the Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai where she had the opportunity to speak to pregnant women living with HIV benefitting from HIV services. “I am very impressed with what I have been seeing. The women I spoke with will all have healthy babies because they have access to the needed medicines,” said Mrs Rai Bachchan.

Mrs Rai Bachchan emphasised the importance of all pregnant women to go for an HIV test and to know their status. Accessing HIV services on time will contribute to stopping new HIV infections among children and keeping the mothers healthy. “I commit to work towards the elimination of new HIV infections among children not only in India, but globally,” she said.

During the visit to the hospital, Mrs Rai Bachchan also met with Aradhana Johri, Additional Secretary of the National AIDS Control Programme. Ms Johri stressed that the HIV prevalence in the country had declined to 0.27% as of 2011, new HIV infections had been reduced by more than half and HIV related deaths had also come down. "We are proud to be associated with what has been recognised as a global success,” said Ms Johri. “We are balancing a prevention approach with treatment and lastly, we are working to ensure that every person who is infected lives a life of dignity."

Haiti President Michel Martelly (left) and UNAIDS Executive Director Michel Sidibé at the Ministry of Planning in Port-au-Prince.
Credit: UNAIDS

The President of Haiti ushered in World AIDS Day 2012 commemorations with a note of hope. “It would be a very beautiful success story if we could pull off an HIV-free generation,” declared President Michel Martelly, in a meeting on 30 November with UNAIDS Executive Director Michel Sidibé.

In 2011, an estimated 77% of pregnant women living with HIV in Haiti had access to services that prevent mother-to-child transmission (PMTCT) of HIV. Between 2009 and 2011 the country secured a 25% decrease in the number of children born with HIV.

“Getting to zero HIV infections in children should be the legacy of this administration,” said Mr Sidibé. “It would be a very powerful accomplishment. Two children are born with HIV in Haiti each day. Think of what it would mean if we could leave behind a generation that was born HIV-free,” he added.

President Martelly noted the moral and economic imperatives of preventing HIV in children, saying that while it costs only US $150 to prevent a child being born with HIV, it would cost hundreds of thousands of dollars to treat a person living with the virus over the course of their lives. “If you can save a mother,” he added, “you prevent a child from becoming an orphan.”

In separate meetings with Haiti’s First Lady, Sophia Martelly, and the Minister of Health, Florence Guillaume Duperval, Mr Sidibé stressed that Haiti has the potential to eliminate HIV in children and dramatically reduce AIDS-related deaths in mothers. The First Lady pointed to national efforts geared toward achieving these twin goals, including a campaign to ensure that more pregnant women—particularly those living in rural areas—access HIV testing and treatment services.

Haiti First Lady Sophia Martelly (left) and UNAIDS Executive Director Michel Sidibé at Haiti's National Palace in Port-au-Prince.
Credit: UNAIDS

The Caribbean has the highest PMTCT coverage of any developing region. Many smaller Caribbean countries are already close to eliminating new HIV infections among children. Further scale-up of PMTCT services in Haiti—one of the region’s most populous countries—will help the entire Caribbean reach closer to the goal of eliminating new HIV infections among children, a key target of the 2011 Political Declaration on HIV/AIDS.

In addition to PMTCT scale-up, Haiti has progressed in other areas of its national HIV response.  Between 2001 and 2011, for example, new HIV infections in the country declined by 54%. Haiti also attained a 47% decline in AIDS-related deaths from 2005 to 2011.

Dr Francis Kimani, Director of Medical Services, Maya Harper, UNAIDS Country Coordinator, Robert Godec, United States Ambassador to Kenya and Hon Beth Mugo, Minister for Public Health and Sanitation of Kenya.

A national campaign to stop new HIV infections among children by 2015 and keep their mothers alive was announced on 16 November by the Kenyan Minister for Public Health and Sanitation Beth Mugo. The new initiative is part of a commitment made by Kenya at the 2011 United Nations General Assembly High Level Meeting on AIDS in New York, and marks an important milestone in the national AIDS programme in Kenya.

HIV is the leading cause of all deaths in the country and contributes to 20% of maternal deaths and 7% of all deaths in children aged five years or less. An estimated 13 000 children became newly infected with HIV in 2011. Kenya is one of the 22 countries listed as riorities under the Global Plan—which provides the foundation for country-led movements towards the elimination of new HIV infections among children and keeping their mothers alive.

The new campaign aims to mobilize citizens, especially women of reproductive age, to access HIV prevention services. The Government of Kenya has committed to improve the quality of HIV services available by providing all HIV-positive pregnant women with life-long antiretroviral therapy (ART) even after delivery (a strategy known as Option B+).

Ms Mugo acknowledged the multiple benefits of providing HIV-positive pregnant women with life-long ART, which include preventing HIV transmission to their children and improving the overall health of HIV-positive mothers. Ms Mugo noted, however, that the implementation of this approach will be gradual and will require a strengthened health system. “Let us not focus solely on HIV services, but adopt an integrated service and multi-sectoral approach to keep our mothers and children alive,” she said.

Placing women at the centre

Women living with HIV have been central to the campaign through the Kenya Mentor Mothers programme, through which HIV-positive mothers provide advice and encourage other pregnant women to access HIV services.

Mercy, an HIV-positive mother of three, works as a mentor mother in the new programme. She herself benefited from accessing HIV services to prevent HIV transmission to her children and stressed that stigma initially made it difficult for her to access HIV prevention, treatment and care services. She highlighted that stigma and discrimination are continuous barriers to HIV services and must be addressed in order for the campaign to be successful.

“I was lucky to have had access to health services. My baby is negative because of the information, services and support I received from the health facility,” said Mercy. “Today I serve my community as a mentor mother where I support HIV positive pregnant women and encourage them to adhere to treatment and exclusive breastfeeding.”

The role of men is also taken into account in the new campaign. “Maternal and Child health has been complicated and slowed by HIV. Worse still, maternal and child health is affected by the poor male involvement,” said the Director of Medical Services, Dr Francis Kimani. He called on men to fully participate in ensuring that their children and their children's mothers are healthy, and encouraged men to find out their HIV status and to always accompany their partners to visits to antenatal clinics.

UNAIDS Country Coordinator Maya Harper noted that services for the prevention of mother to child transmission of HIV are a key entry point to providing HIV services to the entire family. “This campaign is an excellent opportunity to catalyze a new movement for family planning, reproductive health and rights in the country,” she said.

The event also saw the launch of the National Strategic Framework to guide the implementation of the campaign for the year 2012 – 2015 in addition to the National Communication Strategy for the elimination of new HIV infections among children and the National Guidelines for peer education to prevent mother-to-child HIV transmission.

Myanmar’s Minister of Health Professor Dr Pe Thet Khin and UNAIDS Executive Director Michel Sidibé.

Myanmar’s Minister of Health, Professor Dr. Pe Thet Khin, says his ministry is committed to working towards the elimination of new HIV infections among children by 2015 and keeping their mothers healthy to raise them. Minister Pe Thet Khin jointly announced this commitment with UNAIDS Executive Director Michel Sidibé in a meeting on 27 October in Mandalay.

“The Ministry of Health believes that by 2015 children in Myanmar can be born free of HIV and their mothers can remain healthy to raise them,” said Minister Pe Thet Khin. “This plan is realistic, achievable and supported by evidence. Preventing new HIV infections among children is a smart investment that saves lives and helps to give children a healthy start in life. This will be achieved through scaling up testing services and providing drugs that are simple and safe to all pregnant women who need them.”

With treatment from early in pregnancy through the breastfeeding period, the risk of transmitting HIV from a mother living with HIV to her child can be less than 5%. Myanmar’s National AIDS Programme has been gradually scaling up its HIV prevention services for pregnant women. In 2011, 84% of the estimated 3700 pregnant women living with HIV received antiretroviral prophylaxis to prevent transmission of HIV to their babies. However, less than a third of pregnant women are currently tested for HIV. Myanmar health authorities plan to decentralize HIV testing services to reach more pregnant women.

“I congratulate Myanmar on its commitment to reach an AIDS-free generation by 2015,” said UNAIDS Executive Director Michel Sidibé. “I am sure if resources are made available to Myanmar, the country will reach its ambitious goal and I call on donors to support the Ministry of Health.”

Mr Sidibé and Minister Pe Thet Khin called on international donors and other partners to work with Myanmar’s Ministry of Health to maintain the achievements made so far and to expand HIV prevention and treatment services for key affected populations.

The two leaders also spoke about country ownership and sustainability of health programs. The health system in Myanmar is undergoing reform. Mr Sidibé suggested applying the “three ones” principle for health: one costed national health plan; one national health sector coordination mechanism; and one national monitoring and evaluation system that all development partners follow.

On 14 October, the First Lady of DRC (pictured here) toured the Ngaliema Clinic in Kinshasa, together with medical personnel.

On the sidelines of the 14^th Summit of the Francophonie, the First Lady of the Democratic Republic of the Congo (DRC), Marie Olive Lembé Kabila, launched the initiative “Rolling back malaria and eliminating mother-to-child transmission of HIV.”

Speaking at the campaign launch, the First Lady called for improved reproductive health in DRC, including the integration of HIV into family planning services.  She highlighted the importance of male partner involvement in programmes to prevent new HIV infections among children and of youth mobilization in HIV prevention activities.  While stressing that abstinence and fidelity are a means of HIV prevention, the First Lady reminded her audience of another effective tool at their disposal: the condom.

The First Lady emphasized the importance of increasing domestic resources for the national HIV response: "Before relying on others, we must first rely on ourselves,” she said, echoing the UNAIDS concept of shared responsibility.

The Minister of Health, Félix Kabange Numbi—who spoke alongside the First Lady at the launch event—underscored that 89% of maternity hospitals in DRC do not offer services to prevent mother-to-child transmission (PMTCT) of HIV.  “Even though national HIV programmes have officially been in place for 10 years, the situation is not stellar,” he said.  The Minister outlined the national plan to eliminate new HIV infections among children which aims, by 2017, to:

• Reduce new HIV infections among children under the age of 15 by 90%
• Reduce AIDS-related maternal deaths and infant mortality by 50%
• Provide access to antiretroviral therapy for more than 87 000 HIV-positive women and more than 87 000 children born with HIV.

Affirming the commitment of DRC President Joseph Kabila towards the goal of eliminating HIV transmission from mother to child, Minister Numbi noted the need for: an increase in the number of maternity hospitals offering PMTCT services, the provision of a regular supply of drugs and tests, and community involvement.

Dr Leodegal Bazira, World Health Organization representative in DRC, reaffirmed that international organizations remain committed to supporting the country in its efforts to eliminate mother-to-child transmission of HIV by 2015 and keep mothers alive.  Country partners congratulated the First Lady on the campaign and said that they hoped it would serve as a springboard for action in the national AIDS response.

Following the launch event, the First Lady toured the Ngaliema Clinic, together with Dr Pascal Tshamala, its Medical Director. During the tour, she visited the antenatal clinic, biology laboratory, delivery rooms and paediatric ward. The First Lady used the opportunity of her visit to make a donation of mosquito nets and diagnostic tests for malaria and HIV to the clinic.

Actress and UNAIDS Goodwill Ambassador Naomi Watts talked about her work in support of UNAIDS’ efforts towards an AIDS free generation while in Mozambique.

Mozambique is one of the settings of a new film about the life of Diana, Princess of Wales. It’s also where UNAIDS.org caught up with actress and UNAIDS Goodwill Ambassador Naomi Watts. She talked about her work in support of UNAIDS efforts towards an AIDS free generation—ensuring no new HIV infections among children by 2015 and keeping their mothers alive.

“In the United States and Europe there are virtually no new HIV infections in children and many African countries are moving steadily in that direction,” said Ms Watts. “We at UNAIDS call that ‘getting to zero’—zero babies born with HIV and zero mothers dying of AIDS-related causes. And for us, getting to zero is not a dream or a slogan but a doable reality,” she added. 

The country she is filming in has one of the highest rates of HIV in sub-Saharan Africa—11.5% of the adult population is living with the virus. But is also one of the 22 countries that is making a concerted effort to stop new HIV infections among children as part of a Global Plan championed by UNAIDS and partners.

In 2011, 98 000 pregnant women living with HIV were in need of antiretroviral medicine to prevent transmission of HIV to their children in Mozambique—the third highest number after South Africa (241 000 women) and Nigeria (229 000 women).

The nationwide programme to stop new HIV infections among children and keep their mothers alive has grown rapidly since its inception in 2002. The number of sites offering HIV services to prevent new HIV infections in children has increased across the country from 356 in 2009 to more than a thousand in 2010. As a result, the number of pregnant women receiving HIV counselling and testing also increased from 12% in 2005 to 87% in 2010—one of the highest rates in the region. And since 2009, the percentage of pregnant women living with HIV in Mozambique receiving antiretroviral treatment to prevent transmission of HIV to their children rose from 38% to 51%.

However, much more needs to be done when nearly half the pregnant women living with HIV in Mozambique do not yet receive the medicines to prevent transmission to their children.

“I wish I could spend more time here in this beautiful country of Mozambique. I would encourage all the partners in the AIDS response to redouble their efforts here and in the other 21 highly affected countries,” said Ms Watts. “Women need access to quality, life-saving HIV prevention and treatment services for themselves and their children and I know that together we can make this a reality.”

In her role as a UNAIDS Goodwill Ambassador, Ms Watts joined former President Bill Clinton and United Nations Secretary-General Ban Ki-Moon to launch the Global Plan in June 2011 at the United Nations in New York. She has visited AIDS and maternal and child health programmes from Lusaka, Zambia to Dehli, India advocating tirelessly to ensure all countries put in place the necessary efforts to achieve a generation born free of HIV. Last week in New York, Ms Watts urged the Women Leaders Forum, which included prominent CEOs and a number of African Firs Ladies, to combine their efforts to get to zero.

Her Royal Highness Crown Princess Mette-Marit of Norway presents the Red Ribbon Award for Stopping new HIV infections in children and keeping mothers alive, women's health to the Giramatsiko Post Test Club. XIX International AIDS Conference (AIDS 2012), Washington D.C. Credit: IAS/Ryan Rayburn

Justine, a 38-year-old Ugandan woman, tested positive for HIV during an antenatal visit at the local health centre when she was pregnant with her fourth child. After disclosing her HIV status to her husband, he left home and never came back.

She did not go through the pregnancy alone though. Justine had the support from her peers at Giramatsiko Post Test Club, a grassroots organization established in 2002 in Kabwohe, Uganda.

The organization was set up by seven women living with HIV with the aim to empower and educate their peers about HIV prevention, treatment, care and support. In addition to focusing on their health and physical well-being, Giramatisko also empowers women to understand their rights to health services.

“Finding out you are HIV-positive brings physical and spiritual distress and the accompanying shame and discrimination have prevented many individuals from seeking treatment and leading a productive life,” notes Fara Twinamatsiko, a founder and chairperson of Giramatsiko.

A peer educator from Giramatsiko referred Justine to a health facility during her pregnancy where she received antiretroviral drugs to prevent HIV transmission to her child. The drugs helped ensure that Justine gave birth to a healthy, HIV-negative baby.

With a small staff and dozens of volunteers, the Giramatsiko Post Test Club currently reaches out to women in 19 centres in the Sheema district of western Uganda where they provide emotional and psychological support, HIV testing and counselling as well as referring women to health centres to access antiretroviral medicines, antenatal care and other services.

Countering stigma and discrimination

Though stories like Justine’s are not uncommon in Uganda—and in many other parts of the world—there are signs of hope as individuals and communities take action to counter HIV related stigma, discrimination and harmful social norms.

The Giramatsiko founders have confronted discrimination head-on by disclosing their own HIV status. In doing so, they have helped hundreds of other men and women in Uganda, young and old, openly discuss their experiences. They are breaking taboos and challenging the stigma associated with HIV.

“We have a very conservative attitude towards HIV in our community, but no social problem can be solved without open discussion and education,” says Tumushabe Sedrida, Coordinator at Giramatsiko.

According to the 2011 Uganda AIDS Indicator Survey, HIV prevalence in Uganda increased from 6.4% in 2004-5 to 6.7% in 2011. To-date, the HIV prevalence among women in the age group of 15-49 is 7.7% while that of men is 5.6%. Regarding pregnant women living with HIV, an estimated 53% receive services to prevent new HIV infections in their children and just 17% receive treatment for their own health. These gaps in access to HIV services emphasize the need for organizations like Giramatsiko.

Red Ribbon Award

Ten years on, Giramatsiko continues to prove that a small group of individuals can make a big difference in the lives of an entire community.

In recognition of its efforts to reduce new HIV infections in children, keep mothers alive and change community perceptions about people living with HIV, Giramatsiko received the  UNAIDS Red Ribbon Award at the XIX International AIDS Conference in July 2012. The award recognized ten organizations worldwide that have undertaken innovative and outstanding community work in the response to HIV.

Despite recent accolades, Giramatsiko’s work is far from complete. “Our aspiration is to touch many and save more lives,” notes Ms Sedrida.

Mr and Mrs Chikonyora with their twins who have both tested negative for HIV.
Credit: UNAIDS

Madziva- Anoziva and Anotida Chikonyora are one-year old identical twins, born to a discordant couple (in which one person is HIV positive and the other is not) in Centenary, about 120 kilometres north of the capital of Harare. Smiling in the comforting hands of their parents, the twins have both tested negative for HIV - thanks to the government supported elimination of new HIV infections among children.

“We are grateful for the support that our community is receiving to prevent mother-to-child transmission. I also believe people should not be made dependent on long-term donations and subsistence, they should be empowered to establish their own projects,” said Innocent Chikonyora the father of the twins.

Elizabeth Tafira a friend of the Chikonyora family has a similar story. Their friendship dates back to the early 1990s when she was diagnosed with HIV and joined a support group for people living with HIV. According to Tafira much has changed since those days.

She said, “In the 1990s when I discovered my status there was little hope, treatment was very inaccessible, there was a lot of stigma and discrimination and delivering a baby was not an option for me.” She reckons lack of information as well as professional and community support stops women living with HIV from accessing services. “I was a little hesitant in the past to consider the options that became available for delivering babies without transmitting HIV,” confessed Elizabeth.

Elizabeth recently had a baby girl, Anashe, and is anxiously waiting for the results of the HIV test for her child. She enrolled in the government’s prevention of mother- to-child transmission of HIV (PMTCT) programme and is confident that the test will be negative and after the results she intends to visit the nearby health institution to speak to the some of medical staff who advised her against having a baby. “I want to show them that an HIV positive women can indeed have HIV negative babies.”

Zimbabwe’s government through the Ministry of Health and Child Welfare (MoHCW) and the National AIDS Council (NAC) is working with various partners at the community level to provide a broad range of HIV services.

The Zimbabwe National AIDS Strategic Plan II (2011-2015) prioritises PMTCT and aims to reduce the rate of mother to child transmission from 14% in 2010 to 7% in 2013 and less than 5% by 2015.

Chief Chiveso of Mashonaland Central Province in Zimbabwe says, despite the encouraging results, government authorities, communities and development partners should accelerate their efforts to reach more mothers with quality services.

“My people are no longer afraid of being tested. What we do not yet have are adequate services for HIV testing and counselling, CD4 count, TB screening and testing,” highlighted Chief Chiveso.

Information, education and behaviour change communication are also key elements of this effort, stressed the chief who added, “Home deliveries remain a challenge in addressing new infections in children.”