Eastern and Southern Africa, 18 March 2011: UN agencies and partners agree on framework to eliminate transmission of HIV from mothers to their babies
NAIROBI, 18 March 2011 – Key partners working in the area of HIV and AIDS have agreed on a way forward to boost the elimination of mother-to-child-transmission of HIV in Eastern and Southern Africa. The new regional framework was endorsed on Thursday at the end of a three-day consultation in Nairobi, Kenya by participants from UNICEF, the World Health Organization (WHO), the UN Population Fund (UNFPA), UNAIDS, and their partners. Government representatives from 15 high-burden countries , civil society organizations and donors attended the meeting.
“In 2009, still some 370,000 young children were newly infected with HIV, half of them in the 15 most affected countries in our region. We now have the leadership at all levels to bring this number down. We know what works and we have more funding than ever before. Now is the time to act and make a difference. An AIDS-free generation by 2015 is possible,” said Elhadj As Sy, UNICEF Regional Director for Eastern and Southern Africa.
Participants endorsed the UNAIDS call for the “elimination of mother-to-child transmission of HIV by 2015”, which aims to ensure that less than 5 percent of children born to women with HIV are themselves positive. This will mean to a reduction of new infections among young children by 90 percent compared to 2009.
Four key components
Participants stressed the need to thoroughly and simultaneously pursue all four components of the internationally agreed PMTCT strategy to achieve such a dramatic reduction in mother-to-child-transmission. These include in the first place the prevention of HIV among women of childbearing age as well as the prevention of unintended pregnancies among women living with HIV. All HIV-positive pregnant women need access to the most efficacious antiretroviral prophylaxis to prevent the transmission. Once the child is born, both the mother and the infant as well as their families need to receive appropriate treatment, care and support.
“PMTCT is closely linked to child and maternal health. If we are successful in scaling up PMTCT services in Eastern and Southern Africa, we will be able to achieve significant progress towards the Millennium Development Goals on the reduction of child and maternal mortality,” said Mr. Sy. In Southern Africa, HIV contributes to up to half of all cases of child and maternal mortality.
To achieve the 2015 elimination of transmission goal throughout the region, participants will support country-specific approaches building on the current level of coverage of PMTCT services and interventions for the four components of PMTCT.
Participants also agreed on the need to integrate PMTCT services into routine antenatal and reproductive health services and to make paediatric HIV care a routine part of child health services. Furthermore, countries agreed to work on ensuring that all pregnant women and their partners are counseled and tested during the first antenatal care visit.
Important progress, but not enough
In recent years, countries have made great strides to strengthen HIV-prevention efforts. In 2009, in Southern Africa, some 130,000 infants were newly infected, a reduction by 32 percent compared to 2004, largely as a result of scaled up PMTCT interventions. WHO estimates that in 2010 some 100,000 new infections were averted globally thanks to the existing programmes.
However, many pregnant women, particularly in rural areas in Eastern and Southern Africa, still do not have access to health centres offering these services. Among those who attended antenatal care in 2009, on average only 50 percent received an HIV test. Of those testing positive, 68 percent received ARV to prevent the transmission of the virus to their babies, up from only 19 percent in 2005.
This regional average, however, masks huge disparities. Botswana, Namibia, South Africa and Swaziland for example already achieved coverage rates of more than 85 percent, while in Angola, Burundi and Ethiopia less than 20 percent of HIV-positive pregnant women were enrolled in PMTCT programmes. And in countries such as Malawi and Zimbabwe more than 80% of women received single-dose nevirapine in 2009 rather than a more efficacious ARV regimen.
“If countries continue rapid scale up of quality, comprehensive PMTCT service access, the goal of elimination of HIV transmission from mother to infants by 2015 can be achieved,” said Helen Jackson, Senior HIV Prevention Advisor for UNAIDS in Eastern and Southern Africa. “We have joined forces to make sure this happens.”
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“Towards Universal Access" on HIV/AIDS (2010)