Preventing mother to child transmission

Representatives of ministries of health, national AIDS committees and civil society organizations from 19 countries in western and central Africa gathered in Dakar, Senegal, from 16 to 18 November to take stock of progress, challenges and opportunities for the prevention of mother-to-child transmission and paediatric care of HIV.

Together with experts from international organizations, they called for action to Fast-Track the AIDS response and achieve the 90–90–90 treatment target by 2020. To reach the target in the context of mother-to-child transmission of HIV and paediatric care of HIV, it is critical to scale up HIV testing and antiretroviral therapy for pregnant women and children living with HIV.

The participants agreed on key elements of a regional strategy to accelerate the identification and effective management of pregnant women and children living with HIV. They also called on national and international actors to mobilize and cooperate so that children are no longer born with HIV or die of AIDS-related causes in western and central Africa.

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.

During a visit to South Africa, UNAIDS Executive Director Michel Sidibé met with President Jacob Zuma and First Lady Tobeka Zuma to discuss the country’s response to HIV.

During their meeting, President Zuma and Mr Sidibé applauded the contribution made by community health workers in reducing mother-to-child transmission of HIV. They discussed a successful service delivery model in KwaZulu-Natal that puts community health workers at the centre. This model has helped to drive down the number of new HIV infections among children in the province. If replicated across the country, the model could put South Africa firmly on track to eliminate new HIV infections among children.

In his meeting with Ms Zuma, discussions focused on the health of young women and adolescent girls, who are at particular risk of HIV infection.

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.

If the newly adopted Sustainable Development Goals (SDGs) are to be achieved the needs of women, children and adolescents must be at the heart of the development agenda, said United Nations Secretary-General Ban Ki-moon as he launched a bold initiative at the 70th session of the UN General Assembly.

The updated Global Strategy for Women’s, Children’s and Adolescents’ Health is intended to ensure that the SDG commitment to accelerate progress in reducing newborn, child and maternal mortality becomes a reality for women, children and young people around the globe.

Launched on 26 September during the UN Sustainable Development Summit, the initiative builds on the Global Strategy for Women’s and Children’s Health, spearheaded by the Secretary-General in 2010, that blossomed into the Every Woman Every Child global movement. This movement has seen the galvanizing of political commitment, multi-stakeholder partnerships and action that has led to significant progress in reducing maternal and infant mortality. However, Ban Ki-moon told the gathering that efforts now need to step up a gear.

To ensure that the necessary resources are available, a major section of the high-level two-hour event involved the announcement of key strategic commitments from world leaders, multilateral organizations, CEOs from the private sector and other partners.

Young people also played a vital role, taking the floor to tell the gathering what they want and need over the next 15 years and what they commit to do to improve the health of their generation. Young people representing The PACT, a coalition of youth organisations supported by UNAIDS, as well as Restless Development and Y-PEER shared commitments to the updated Global Strategy to end all preventable maternal, child and adolescent deaths by 2030 and the end of the AIDS epidemic by 2030.

Introduced by UNAIDS Executive Director Michel Sidibé, Ishita Chaudhry spoke about the importance of governments committing to adolescents and to support young people to be agents of change to help ensure that mothers, children and adolescents everywhere survive and lead healthy lives.

UNAIDS has been awarded first prize in the Popular Medicine category of the British Medical Association (BMA) Book Awards for its book The Bravest Boy I Know.

The prestigious awards were announced at a ceremony on 3 September at BMA House in London. An annual event, the awards aim to encourage and reward excellence in medical publishing, with prizes given out in categories and an overall BMA Medical Book of the Year award made from the category winners.

The Bravest Boy I Know is about two friends, Kendi and Kayla. Kendi is living with HIV. The story is set in Africa and is a heart-warming tale of how the two friends deal with HIV in a positive way. The book conveys the important message that by taking medicine, children living with HIV can live active and healthy lives, while also explaining that the medicines can make children feel unwell and tired.

The judges noted that the book, “Is a unique offering … and is well-presented and engaging. If used appropriately it could be an important public health tool.”

UNAIDS Director of Communications and Global Advocacy Annemarie Hou, accepting the award on behalf of UNAIDS, said, “This is a tremendous honour and recognition that children everywhere need access to high-quality health information.”

The book, which is beautifully illustrated by celebrated artist Sujean Rim, was launched in May 2014 by UNAIDS and the United Nations World Tourism Organization’s Sustainable Tourism for Eliminating Poverty (ST-EP) Foundation at an event attended by the United Nations Secretary-General Ban Ki-moon and Ambassador Dho Young-shim, Chairperson of the ST-EP Foundation. The book is dedicated to Mr Ban for his work in prioritizing education through the Global Education First Initiative, which aims to put every child in school, improve the quality of learning and foster global citizenship.

Speaking at the launch in 2014, Mr Ban said that, “This book, which will be delivered to schools across Africa through ST-EP’s Small Libraries project, will help everyone understand that young people can live normal and fulfilling lives with HIV.”

Ambassador Dho said at the launch in 2014, “As the UN MDGs Advocate for Education, I firmly believe in the power of education to accelerate the achievement of all UN MDGs by 2015, and particularly Goal 6—aimed at HIV. This meaningful collaboration with UNAIDS is creating synergies that will have a powerful impact on the education and the health of children.”

In addition to winning first prize in the Popular Medicine category, UNAIDS was also Highly Commended for The Gap Report in the Public Health category and for The Cities Report in the Health and Social Care category.

WASHINGTON DC/GENEVA, 30 June 2015—Cuba today became the first country in the world to receive validation from the World Health Organization that it has eliminated mother-to-child transmission of HIV and syphilis.

“Eliminating transmission of a virus is one of the greatest public health achievements possible,” said Dr Margaret Chan, WHO Director-General. “This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation” said Dr Margaret Chan, WHO Director-General.

Michel Sidibé, Executive Director of UNAIDS, added: “This is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”

The challenge

Every year, globally, an estimated 1.4 million women living with HIV become pregnant. Untreated, they have a 15-45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding.  However, that risk drops to just over 1% if antiretroviral medicines are given to both mothers and children throughout the stages when infection can occur. The number of children born annually with HIV has almost halved since 2009 - down from 400 000 in 2009 to 240 000 in 2013. But intensified efforts will be required to reach the global target of less than 40 000 new child infections per year by 2015.

Nearly 1 million pregnant women worldwide are infected with syphilis annually. This can result in early foetal loss and stillbirth, neonatal death, low-birth-weight infants and serious neonatal infections. However, simple, cost-effective screening and treatment options during pregnancy, such as penicillin, can eliminate most of these complications.

Cuba’s achievement

PAHO/WHO have been working with partners in Cuba and other countries in the Americas since 2010 to implement a regional initiative to eliminate mother-to-child transmission of HIV and syphilis.

As part of the initiative, the country has worked to ensure early access to prenatal care, HIV and syphilis testing for both pregnant women and their partners, treatment for women who test positive and their babies, caesarean deliveries and substitution of breastfeeding. These services are provided as part of an equitable, accessible and universal health system in which maternal and child health programs are integrated with programs for HIV and sexually transmitted infections.

“Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV,” said PAHO Director, Dr Carissa F. Etienne. “Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis”.

Global efforts to stop mother-to-child transmission of HIV and syphilis

There have been major efforts in recent years to ensure that women get the treatment they need to keep themselves well and their children free from HIV and syphilis and a number of countries are now poised to eliminate mother-to-child transmission of both diseases.

In 2007, WHO launched the Global elimination of congenital syphilis: rationale and strategy for action. The strategy aims to increase global access to syphilis testing and treatment for pregnant women. By 2014, more than 40 countries were testing 95% or more of pregnant women in prenatal care for syphilis. But although progress has been made, many countries have still to prioritize preventing and treating mother-to-child transmission of syphilis. In 2012, syphilis affected 360 000 pregnancies through stillbirths, neonatal deaths, prematurity, and infected babies.

In 2011, UNAIDS with WHO and other partners launched the Global Plan towards the elimination of new HIV infections among children by 2015, and keeping their mothers alive. This global movement has galvanized political leadership, innovation and engagement of communities to ensure that children remain free from HIV and that their mothers stay alive and well.

Between 2009 and 2013, the proportion of pregnant women living with HIV in low- and middle-income countries receiving effective antiretroviral medicines to prevent transmission of the virus to their children doubled. This means that globally, 7 out of 10 pregnant women living with HIV in low- and middle-income countries receive effective antiretroviral medicines to prevent transmission of the virus to their children. Among the 22 countries which account for 90% of new HIV infections, 8 have already reduced new HIV infections among children by over 50% since 2009, based on 2013 data, and another four are close to this mark.

WHO validation process

In 2014, WHO and key partners published Guidance on global processes and criteria for validation of elimination of mother-to-child transmission of HIV and syphilis, which outlines the validation process and the different indicators countries need to meet.

As treatment for prevention of mother-to-child-transmission is not 100% effective, elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.

An international expert mission convened by PAHO/WHO visited Cuba in March 2015 to validate the progress toward the elimination of mother-to-child transmission of HIV and syphilis. During a five-day visit, members visited health centres, laboratories, and government offices throughout the island, interviewing health officials and other key actors. The mission included experts from Argentina, the Bahamas, Brazil, Colombia, Italy, Japan, Nicaragua, Suriname, the United States of America and Zambia.   

The validation process paid particular attention to the upholding of human rights, in order to ensure that services were provided free of coercion and in accordance with human rights principles.

Note to editors:

Required validation indicators include:

HIV

Impact Indicators – must be met for at least 1 year

• New paediatric HIV infections due to mother-to-child transmission of HIV are less than 50 cases per 100 000 live births; and
• Mother-to-child transmission rate of HIV is less than 5% in breastfeeding populations or less than 2% in non-breastfeeding populations

Process Indicators – must be met for at least 2 years

• More than 95% of pregnant women, both who know and do not know their HIV status, received at least one antenatal visit
• More than 95% of pregnant women know their HIV status
• More than 95% of HIV-positive pregnant women receive antiretroviral drugs

Syphilis

Impact Indicators – must be met for at least 1 year

• Rate of mother-to-child transmission of syphilis are less than 50 cases per 100 000 live births

Process Indicators – must be met for at least 2 years

• More than 95% of pregnant women received at least one antenatal visit
• More than 95% of pregnant women are tested for syphilis
• More than 95% of pregnant women with syphilis receive treatment.

The term “validation” is used to attest that a country has successfully met criteria (internationally set targets for validation) for eliminating mother to child transmission of HIV and/or syphilis at a specific point in time, but countries are required to maintain ongoing programmes.

In 2013, only two babies were born with HIV in Cuba, and only 5 babies were born with congenital syphilis.

WHO

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends and improving global health security.

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 need for a holistic approach to HIV prevention among young women and girls was the focus of the 15th Ordinary Assembly of the Organization of African First Ladies, (OAFLA). The meeting was held on the side lines of the 25th African Union Summit, held on 15 June in Johannesburg, South Africa. 

The African First Ladies stressed that addressing the needs of young women and adolescent girls must be a priority at all levels of society—from the highest political leadership to schools, families and community leaders. They called for an integrated approach to HIV prevention, treatment and care that addresses all socio-economic and structural drivers which place young women and adolescent girls at a higher risk of HIV infection, including poverty, gender inequality and harmful cultural practices.

Lordina Mahama, First Lady of Ghana and newly-elected President of OAFLA, encouraged all African First Ladies to ensure that the UNAIDS and UNICEF All In! campaign, which focuses on ending adolescent AIDS, is rolled out in their countries.

The President of Malawi, Arthur Peter Mutharika, met with UNAIDS Executive Director, Michel Sidibé, on 13 June 2015, on the side lines of the 25th African Union Summit, in Johannesburg, South Africa.

Mr Sidibé congratulated President Mutharika on the breakthrough results that Malawi has achieved in its AIDS response in recent years. Malawi was the first country in the world to implement the World Health Organization’s Option B+ for HIV-positive pregnant women (access to lifelong antiretroviral treatment), which has resulted in a dramatic 67% decline in mother-to-child transmission since 2009. The President expressed his commitment to continue to invest in prevention of mother-to-child transmission of HIV to meet the target of bring new HIV infections down to below 5% as outlined in the Global Plan to eliminate new HIV infections among children and keeping their mothers alive.

Earlier in the day, Mr Sidibé met with the African Union Commissioner for Social Affairs, Mustapha Kaloko, who also expressed his desire to see an AIDS-free generation by 2030. Mr Sidibé affirmed UNAIDS’ commitment to continue to work on the Fast-Track approach to ending the AIDS epidemic as a public health threat by 2030, taking advantage of the next five years to leverage country ownership and global solidarity.