HIV/AIDS and children
In The Gambia, the first case of Human Immuno-deficiency Virus (HIV) was diagnosed in May 1986. Since then, there has been on-going efforts to combat the spread of HIV infection. The HIV epidemic includes both HIV-1 and HIV-2, although the former appears to be increasing while the latter is decreasing.
The prevalence of HIV in the Gambia is estimated using results from the National Sentinel Surveillance (NSS) conducted among antenatal women. HIV prevalence in adults, while still relatively low, has increased from 0.6 per cent in 1995 to 2.8 per cent in 2008. The main route of transmission is through heterosexual contact. According to the 2011 NSS study conducted among 6120 antenatal women in 12 health facilities (3 hospitals and 9 health centres), the prevalence of HIV-1 is estimated at 1.65 per cent and HIV-2 at 0.07 per cent. Over the past 12 years, the prevalence of HIV-1 among antenatal women has been inconsistent, soaring to 2.8 per cent in 2006 from 1.4 per cent in 2002, but showing a sustained decline in 2007, 2008 and 2011. The prevalence of HIV-1 is higher in older women, aged 25-49 years compared to younger women of 15-24 years.
The main mode of transmission of HIV to children is from mother to child during pregnancy, delivery and through breastfeeding. The rate of mother to child transmission (MTCT) is 9.1 per cent (PMTCT Strategic Plan 2010). The country launched and implemented a six year Prevention of Mother to Child Transmission Strategic Plan (2010- 2015) that aims to accelerate the expansion of PMTCT sites and improve the quality of services. In a related move to sustain and increase the momentum achieved in the strategic plan, the country has developed a three-year Costed National Strategic plan for the elimination of Mother to Child Transmission (eMTCT) of HIV (2013 - 2015). This is in line with global plans to eliminate MTCT of HIV by the year 2015. This eMTCT HIV Strategic Plan (2013 – 2015) has been developed based on a bottleneck analysis that identified gaps such as low coverage of PMTCT services in Reproductive and Child Health facilities, absence of early infant diagnosis (EID), low HIV testing and CD4 testing among pregnant women, stock-out of essential commodities, and poor demand of Maternal and Neonatal Child Health (MNCH) services, including family planning.
UNICEF is a key member of the Country Coordinating Mechanism of the Global Fund on Malaria, TB and HIV and was instrumental in the development of the PMTCT Policy and Strategic Plan (2007 – 2012).
Provision of quality integrated services in all PMTCT sites (Health centres and hospitals as well as private health facilities) will be prioritized by ensuring the availability of trained staff, ARV and commodities, continuum of care with strong linkage between community and peer support groups, and effective integration and referral systems. Regular supportive supervision and mentoring sessions will also be strengthened. UNICEF will support the area of community involvement initiatives and linkage mechanisms to health facilities aiming to create demand and increasing service utilization for Maternal New-born and Child Health and eMTCT of HIV. The strategies to be used will be:
The demand for Maternal New-born and Child Health services will be created thereby increasing the uptake of PMTCT services. The linkages between the health facilities and communities will be strengthened and evidence based interventions to accelerate eMTCT put in place for the successful achievement of eMTCT.