PMTCT

Over the past five years, there has been a rapid scale-up of services to prevent mother-to-child transmission of HIV. This has reduced the annual number of new infections among children by 50% worldwide since 2010. Globally, an estimated 77% of pregnant or breastfeeding women living with HIV were receiving antiretroviral medicines to prevent transmission of HIV to their children in 2015, up from 50% in 2010.

Antiretroviral medicines have averted 1.6 million new infections among children since 2000. There has also been a dramatic reduction in AIDS-related paediatric deaths. In the 21 priority countries that were the focus of the Global Plan towards the elimination of new HIV infections among children and keeping their mothers alive (Global Plan), AIDS-related mortality among children under 15 years of age dropped by  53% between 2009 and 2015. In countries such as Botswana, Burundi, Namibia, South Africa and Swaziland, even greater reductions, above 65%, were achieved.

However, this welcome news is tempered by some complex remaining challenges. In 2015, there were 1.8 million children under 15 years of age living with HIV worldwide. An additional 150 000 children acquired HIV globally in 2015 (2800 a week), and 110 000 children died of AIDS-related causes (300 a day). In some high-burden countries, such as Angola, Chad and Nigeria, less than half the pregnant or breastfeeding women living with HIV are receiving antiretroviral medicines.

Programmes to help women avoid HIV infection remain underdeveloped and fragile, leading to 900 000 new HIV infections among women over the age of 15 years in 2015. They joined the 17.8 million women already living with HIV, and when they decide to have children they will need services to prevent transmission to their children and maintain their own health. Programmes to help women living with HIV avoid unintended pregnancies also remain inadequate: a recent study in Kenya found that despite improvements in coverage of family planning, women living with HIV were more likely to have experienced an unintended pregnancy than other women.

The World Health Organization (WHO) now recommends treating everyone living with HIV, but it is also essential to maintain good adherence to antiretroviral medicines in order to ensure their efficacy. Good adherence suppresses viral load to undetectable levels, greatly reducing onward transmission to the baby while restoring the mother’s immune system for better health. However, many women gradually stop taking the medicines after the baby is born, increasing the risk of transmission during breastfeeding and placing their own health in jeopardy. In Malawi, a study showed that a third of 7500 pregnant or breastfeeding women did not adhere to antiretroviral therapy adequately, compromising the benefits of treatment and increasing their risk of developing drug resistance.

Access to diagnosis and treatment among children has improved, but much remains to be done. Among the 21 Global Plan priority countries, only half the children exposed to HIV received virological testing within two months of birth, as recommended by WHO. Since mortality among untreated infants is highest in the first three months of life, prompt diagnosis and linkage to treatment are crucial. Yet only half the children under 15 living with HIV in those countries were accessing treatment, compared to 80% of pregnant women living with the infection. This signals service delivery failure for children.

In order to address the unfinished agenda of the Global Plan, UNAIDS and the United States President’s Emergency Plan for AIDS Relief have launched a follow-up initiative known as Start Free, Stay Free, AIDS Free. With the goal of ending paediatric AIDS, this framework embraces the aspiration that every child should be born and remain HIV-free (start free), every adolescent and young woman should be able to protect themselves from HIV (stay free) and every child and adolescent living with HIV should have access to quality HIV treatment, care and support (AIDS-free).

Start Free, Stay Free, AIDS Free includes the targets endorsed in the 2016 United Nations Political Declaration on Ending AIDS of 95% of pregnant and breastfeeding women accessing antiretroviral medicines, reducing new HIV infections among children to 40 000 and 1.8 million children living with HIV accessing HIV treatment by 2018. It also aims to reduce new HIV infections among adolescents to under 100 000 and for 1.5 million adolescents to be on HIV treatment by 2020.

Start Free, Stay Free, AIDS Free promotes concerted and coordinated country-led action designed to close the remaining HIV prevention and treatment gap for children, adolescent women and expectant mothers. Its success will depend on tailor-made acceleration and implementation plans to respond to the country context, building on successful strategies to strengthen systems where necessary and identifying critical opportunities and actions to expand access to life-saving HIV treatment and prevention services. To support implementation, the framework also calls on industry, civil society and international partners to focus on investing in efficient and cost-effective solutions that maximize programme outcomes.

Like the Global Plan, Start Free, Stay Free, AIDS Free places women living with HIV at the centre of the response.

Ahead of the United Nations High-Level Meeting on AIDS, which will take place in New York in June, the Organisation of African First Ladies against HIV/AIDS (OAFLA) has called for the response against the epidemic to be stepped up.   

Meeting in Addis Ababa, Ethiopia, OAFLA First Ladies recognized the huge progress already made in reducing the impact of HIV, but warned against complacency, calling on stakeholders to increase investment in the response. The First Ladies said more resources were required to prevent new HIV infections among children and keep their mothers healthy and alive and to broaden access to testing services. They also said that increased resources were necessary in order to ensure that people access treatment immediately if need be, to allow young people, particularly young women and girls, to access combination prevention services, and to end gender-based violence, which increases the risk of HIV exposure.

Addressing the OAFLA General Assembly, UNAIDS Executive Director Michel Sidibé congratulated the First Ladies for playing a transformative role by championing social justice and keeping the issue of HIV high on the political agenda. He added that achieving zero mother-to-child transmission of the virus, reaching universal health access for children and ending the AIDS epidemic by 2030 were possible if the right decisions were made now.

Geneva, 11 December 2015—UNAIDS and the International Planned Parenthood Federation (IPPF) have signed a memorandum of understanding to Fast-Track access to HIV services by 2020. Under the partnership, UNAIDS and IPPF will support the delivery of high-impact HIV advocacy, prevention and treatment services, particularly in sub-Saharan Africa.

The partnership will boost collaboration in four specific areas: integrating HIV and sexual and reproductive health services and ensuring that people can realize their sexual and reproductive rights; stopping new HIV infections among children and keeping mothers alive; expanding HIV services for young people; and ensuring key populations—gay men and other men who have sex with men, transgender people, sex workers and people who inject drugs—are reached with life-saving HIV prevention, treatment, care and support. In each of these areas UNAIDS and IPPF will work jointly to ensure that there is prompt and concrete joint action on the ground.

“This partnership is about turning targets to results so that no one is left behind,” said Michel Sidibé, Executive Director of UNAIDS. “Many young people, women and key populations are still out of reach and in need of access to sexual and reproductive health and HIV services.”

UNAIDS and IPPF will aim to ensure that young people have the knowledge, agency and means to protect themselves from HIV and that all women have access to sexual and reproductive health and rights, including HIV, services. Ensuring that all people live in equality and dignity, free from discrimination and violence, will also be a goal. Progress on the objectives of the partnership will be reviewed annually.

“We are delighted that we are entering this partnership with UNAIDS,” said IPPF’s Director-General, Tewodros Melesse. “It isn’t about making a difference in London or Geneva. It’s about making a real difference on the ground, so we are able to work together to provide more integrated HIV prevention, testing and treatment services, especially for the most marginalized and underserved in society.”

The partnership will advance the UNAIDS Fast-Track Strategy to end the AIDS epidemic as a public health threat by 2030. To do this will require front-loading investments over the next five years, reaching the UNAIDS 90–90–90 treatment target, expanding access to HIV prevention and ensuring zero discrimination.

The memorandum of understanding was signed at UNAIDS headquarters in Geneva during an event on the rights, roles and responsibilities of men in Fast-Tracking the end of AIDS, organized by UNAIDS, IPPF and Sonke Gender Justice. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP,  UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely  with global and national partners to end the AIDS epidemic by 2030 as part of the Sustainable  Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter and Instagram.

IPPF

International Planned Parenthood Federation (IPPF) is the world’s largest sexual and reproductive health and rights provider. Since 1958, IPPF has served the poorest and most vulnerable, delivering health services that empower women and girls, including 149.3 million services to 61.8 million people in 2014.

In 2011, global leaders committed to working towards ending new HIV infections among children and reducing AIDS-related maternal mortality. They launched the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan). The Global Plan prioritized 22 countries with the highest number of pregnant women living with HIV in need of services, encompassing more than 90% of all women in need of services to prevent mother-to-child transmission of HIV.

At the 18th International Conference on AIDS and STIs in Africa, which is taking place in Harare, Zimbabwe, UNAIDS hosted a discussion on how to maximize the role of communities in preventing mother-to-child transmission of HIV. The panel included prominent specialists and activists from Côte d’Ivoire, Kenya, Nigeria and Zimbabwe, who explored promising and innovative ways to accelerate progress towards the elimination of new HIV infections among children and the improvement of maternal health.

The Global Plan calls for broader thinking and action both within and outside the formal health-care delivery system. An important feature of country programmes since the beginning has been their emphasis on communities. Community-based programmes have increased demand for health services and commodities and strengthened their quality.

In addition, community organizations are building their capacity to advocate for better access to appropriate services in line with international guidelines, and are empowering themselves to ensure continuity of care for mothers and children within a family-based approach.

An estimated 15.8 million people are now on HIV treatment, a doubling from five years ago, as countries adopt the UNAIDS Fast-Track Strategy using data to fine-tune delivery of HIV prevention and treatment services to reach people being left behind

GENEVA, 24 November 2015—Ahead of World AIDS Day 2015, UNAIDS has released a new report showing that countries are getting on the Fast-Track to end AIDS by 2030 as part of the Sustainable Development Goals. By adapting to a changing global environment and maximizing innovations, countries are seeing greater efficiencies and better results.

Progress in responding to HIV over the past 15 years has been extraordinary. By June 2015, UNAIDS estimates that 15.8 million people were accessing antiretroviral therapy, compared to 7.5 million people in 2010 and 2.2 million people in 2005. At the end of 2014, UNAIDS estimates that new HIV infections had fallen by 35% since the peak in 2000 and AIDS-related deaths have fallen by 42% since the 2004 peak.

“Every five years we have more than doubled the number of people on life-saving treatment,” said Michel Sidibé, Executive Director of UNAIDS. “We need to do it just one more time to break the AIDS epidemic and keep it from rebounding.”

The life-changing benefits of antiretroviral therapy mean that people living with HIV are living longer, healthier lives, which has contributed to an increase in the global number of people living with HIV. At the end of 2014, UNAIDS estimates that 36.9 million people were living with HIV. Once diagnosed, people need immediate access to antiretroviral therapy.

Countries are gearing up to double the number of people accessing HIV treatment by 2020. This Fast-Track approach will be instrumental in achieving the UNAIDS 90–90–90 treatment target of ensuring that 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are on treatment and 90% of people on treatment have suppressed viral loads.

“Today, we have more HIV prevention options than ever before. And with better data, we can become better matchmakers, finding the right prevention options for the right people,” said Mr Sidibé.

To end AIDS as a public health threat, an accelerated and more focused response is needed using better data to map and reach people in the places where the most new HIV infections occur. To support countries with this approach, UNAIDS has released a new report, Focus on location and population: on the Fast-Track to end AIDS by 2030, which gives examples of more than 50 communities, cities and countries that are using innovative approaches to reach more people with comprehensive HIV prevention and treatment services.

Through the responsible use of detailed national data sets, countries are able to focus at a more granular level, mapping where new HIV infections occur and where people need services most.  The report demonstrates how countries can redistribute resources to improve access to HIV prevention and treatment services. With the Fast-Track approach and front-loaded investments, gaps are closed faster and resources go further and from 2020 annual resource needs will begin to fall.

The report highlights how high-impact HIV prevention and treatment programmes, such as pre-exposure prophylaxis, voluntary medical male circumcision and sexual and reproductive health services, are being successfully implemented in various locations and for different populations, including adolescent girls and young women and their partners, pregnant women living with HIV, sex workers, transgender people, gay men and other men who have sex with men and people who inject drugs.

Examples of high-impact programmes are:

• A nationwide mapping in Kenya has helped to reach more female sex workers with a comprehensive package of HIV services and reduce the number new HIV infections among sex workers. Most dramatic has been the reduction in the incidence of sexually transmitted infections, from 27% among people screened in 2013 to just 3% in 2015.
• In Botswana, a policy change increased access to secondary school. Each additional year of secondary education was shown to reduce the cumulative risk of acquiring HIV by 8.1 percentage points.
• In the Islamic Republic of Iran in 2002–2003 only one prison provided methadone for just 100 prisoners dependent on opioids. By 2009, however, 142 prisons across all 30 provinces offered this vital harm reduction service, reaching 25 000 prisoners.
• A quarter of El Salvador’s transgender people live in the capital, San Salvador. In 2014, community centres were established in the country’s three largest cities to provide a comprehensive package of HIV prevention and health-care services tailored to the specific needs of this highly marginalized population. Within the first six months of 2015, these specialist services had reached a quarter of San Salvador’s transgender population.

These innovative programmes use national and subnational data and local knowledge from populations at higher risk of HIV to direct tailored HIV and related services to reach the people currently being left behind, resulting in greater impact at lower cost.

• Since July 2014 the community organization Colectivo Amigos contra el SIDA (CAS) has provided comprehensive HIV services in Guatemala City that are promoted on popular social networking websites and gay dating apps. The services are then provided through outreach activities in popular meeting places, such as parks, pedestrian walkways, saunas and nightclubs. These efforts have increased the reach of HIV prevention services by 61%, and the number of people tested increased by 32%. However, the map shows that coverage of services is still very low in many parts of the city.
• In the Blantyre district of Malawi, self-test kits were provided to 16 000 residents. Some 76% of residents self-tested and shared their results with a volunteer counsellor within one year.
• In 2012 and 2013, health facilities in Guangxi, China, began offering immediate initiation of antiretroviral therapy following diagnosis of HIV. As a result, the average time between diagnosis of HIV and initiation of treatment plummeted from 53 days to five days. Mortality also fell by approximately two thirds, from 27% to 10% during that same time period.
• Rwanda has integrated programmes to prevent mother-to-child transmission of HIV into maternal, neonatal and child health services and by 2014 had reduced new HIV infections among children by 88% compared to 2009.   

In the report UNAIDS identifies 35 Fast-Track countries that account for 90% of new HIV infections. Focusing on location and population and programmes that deliver the greatest impact will reap huge benefits by 2030: 21 million AIDS-related deaths averted; 28 million new HIV infections averted; and 5.9 million new infections among children averted.

“Everyone has the right to a long and healthy life,” said Mr Sidibé. “We must take HIV services to the people who are most affected, and ensure that these services are delivered in a safe, respectful environment with dignity and free from discrimination.”

The report shows that areas with fewer numbers of people living with HIV and lower HIV prevalence are more likely to have discriminatory attitudes than areas that have more cases of HIV. This seemingly contradictory result is explained by education and understanding about HIV usually being higher in countries where HIV is more prevalent and where more people are receiving treatment. However, these discriminatory attitudes make it more difficult for people in low-prevalence areas to come forward to seek HIV services for fear of stigma and reprisals.   

Adopting the UNAIDS Fast-Track approach through strong leadership and investment within the communities, cities and countries most affected, the AIDS epidemic can be ended by 2030 as part of the Sustainable Development Goals. 

Read the publication on ISSUU

• Part 1 (Foreword - Conclusions)
• Part 2a (Where services are needed - Lesotho)
• Part 2b (Malawi - References)

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The First Lady of Djibouti, Kadra Mahamoud Haid, and the Executive Director of UNAIDS, Michel Sidibé, have taken part in an event to announce a further acceleration of the country’s campaign to eliminate mother-to-child transmission of HIV.

At the event, the Djibouti Minister of Health, Kassim Issak Osman, said that projects to prevent mother-to child-transmission of HIV had shown clear benefits and would be expanded to allow more pregnant women and new mothers to access them.           

At the end of 2014, about one in five pregnant women living with HIV in Djibouti were accessing antiretroviral medicines to keep them healthy and prevent them from transmitting the virus to their children.

At a high-level event in New York on 28 September, the Organization of African First Ladies Against HIV/AIDS (OAFLA) endorsed the newly adopted Sustainable Development Goals (SDGs) and pledged to redouble their efforts to help ensure a safe and healthy future for women, children and young people. 

The event, Building on MDGs to invest in the Post-2015 Development Agenda, took place during the 70th session of the UN General Assembly and was led by Gertrude Mutharika, the First Lady of Malawi and Vice-Chair of OAFLA. The meeting brought together First Ladies from across the continent, as well as heads of UN agencies and major international donors, to explore how the SDGs will tackle the ‘unfinished business’ of the Millennium Development Goals. In addition, Lorena Castillo de Varela, First Lady of Panama, and UNAIDS Goodwill Ambassador Victoria Beckham attended the meeting as special guests.

They were joined by representatives of the Fashion 4 Development (F4D) initiative which aims to harness the influence of the fashion world to create positive social change. F4D co-hosted the meeting with OAFLA, with support from UNAIDS, the UN Population Fund (UNFPA), the International Planned Parenthood Federation (IPPF) and the Global Fund.

OAFLA reviewed its own role in helping attain the SDGs, linking its Strategic Plan 2014-2018 with global efforts to reach the new goals. It also took the opportunity to increase its profile at the global gathering with the aim of developing new partnerships and platforms through which to share its messages, programmes and activities.  

After introductory presentations, including one given by UNAIDS Executive Director Michel Sidibé, the meeting broke up into two roundtable discussion groups to examine HIV treatment and prevention for young people; and investing in women’s and adolescents’ health in the post-2015 development framework.

The First Ladies reaffirmed their commitment to eliminate mother-to-child transmission of HIV and keeping mothers alive by championing the end of early marriage and adolescent pregnancy, improving access to HIV services and ensuring that all children diagnosed with HIV receive treatment.

OAFLA members also committed to end new HIV infections among young women and adolescent girls and ensure AIDS is no longer the leading cause of death among adolescents. These commitments are expected to be key priority areas of implementation for 2015 and 2016 by OAFLA member states and their partners.