Keeping children HIV-free and keeping their mothers alive

By Msgr. Robert Vitillo, Caritas Internationalis Special Advisor on HIV/AIDS, and Ms. Aurorita Mendoza, Caritas Internationalis Volunteer in Geneva

One year following the launch of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, two-thirds of the 22 focus countries are showing good progress towards meeting their targets.

Father Pius Perumana chats with children at a shelter for HIV-positive mothers and children near Kathmandu, Nepal. Caritas is working to prevent mother-child transmission of the virus. Photo: Laura Sheahen/Caritas

UNAIDS timed its Progress Report on the Global Plan to coincide with the International AIDS Conference, held in Washington, DC, between 22-27 July 2012. UNAIDS reported an optimistic trend in the implementation of this comprehensive strategy to benefit pregnant women and children living with or affected by HIV and AIDS. The Plan was launched in June 2011, and aims to reduce the number of children infected by HIV by 90% by 2015 and to reduce pregnancy-related deaths among women with HIV by 50%.

Of the 22 countries, eight – Ethiopia, Ghana, Kenya, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe – are showing a rapid (30%) decline of infections among pregnant women and are projected to reach their targets by 2015.  Seven other countries are reporting a moderate decline of between 20-30% and will need to accelerate programme implementation.  On the other hand, seven countries, where less than 20% decline in HIV among pregnant women is seen, are at risk of not reaching their targets.

The Global Plan builds on the success of high-income countries in reducing HIV transmission from mothers to their newborns (PMTCT).  This ambitious initiative focusing on 22 countries with the largest numbers of women living with HIV is expected to see not only increased number of women and children with HIV on antiretroviral treatments, but also better linkages between maternal and child health and HIV facilities resulting in improved health outcomes for mothers and their children.

The UNAIDS Report highlights some critical challenges in sustaining this progress trajectory.    To achieve the Global Plan targets, we will need to reach out with diagnosis and treatment to HIV-positive women during pregnancy, delivery, and breastfeeding and to use antiretroviral medicines both efficiently and effectively.  Among the 21 priority countries in sub-Saharan Africa, 61% of HIV-positive women receive antiretroviral medicines during pregnancy, but that number  drops down to 29% during breastfeeding.  Consequently, transmission rates during breastfeeding remain high.  In addition, switching to preferable and more effective medication regimens involve longer treatment periods for both pregnant mother and infant and require tremendous amounts of financial resources..  A further challenge is increasing coverage of ART for children, currently estimated at 22%, far lower than the adult coverage of 57%.

What will change in the way focus countries will meet these challenges?  UNAIDS and PEPFAR, which are at the helm of the Global Plan, stress the essential role of communities, who can drive demand for health care among women as well as provide key health services.  In sub-Saharan Africa, faith-based organizations provide 30-70% of health services.  For example, the HIV programmes implemented by Caritas members and other Catholic organizations in the Global Plan focus countries prioritize Prevention of Mother-to-Child Transmssion (PMTCT) services, including counseling and testing, ARV treatment, nutritional support, and early infant diagnosis.  The Report concludes that the effective engagement of communities must be resourced with financial investment, technical support, and a commitment to the involvement of women and mothers living with HIV.

By launching its HAART for Children Campaign in 2009, Caritas Internationalis articulated the goal of ending mother-to-child transmission of HIV by calling for early testing and treatment of HIV+ pregnant women. The Campaign also calls for development of “child-friendly” medicines for HIV+ children since, without such treatment, 50% of children living with HIV die before their second birthday and one-third die before their first birthday.



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