First decade – PMTCT and paediatric AIDS

Second decade – Preventing HIV infection among adolescents

Across both decades – Protection and care for children affected by AIDS

Policy briefs


First decade – PMTCT and paediatric AIDS

© UNICEF/NYHQ2005-2234/Bannon
A Kenyan girl runs inside her home. Her mother is living with HIV and is receiving antiretroviral medication.

Ensuring no baby is born with HIV is an essential step towards achieving an AIDS-free generation. Over the past two decades, programmes such as prevention of mother-to-child transmission of HIV, or PMTCT, have received immense attention from national governments, development partners and donor communities around the world, resulting in an increasing number of pregnant women in need having access to antiretroviral treatment, and fewer babies being born with HIV.  

In Eastern and Southern Africa, efforts to eliminate mother-to-child transmission have intensified dramatically. In 2011, 72 per cent of pregnant women in need of such services were reached with effective drug regimens, which can reduce the risk of mother-to-child transmission to less than 5 per cent. However, with 960,000 pregnant women living with HIV in 2011 – that’s more than any other region of the world – the need continues to be immense. More than 90 per cent of them resided in just nine countries - South Africa, Mozambique, Uganda, Tanzania, Kenya, Zambia, Zimbabwe, Malawi and Ethiopia.

Without effective treatment, more than half of all babies born with HIV will die before their second birthday. Yet, in 2011, only 33 per cent of children in need of treatment received antiretroviral therapy. In high-burden countries in Southern Africa, HIV contributes to 10 - 28 per cent of all deaths among children under five years of age. HIV also contributes to high levels of maternal deaths in ESA, especially in Southern Africa, ranging from 27 per cent in Mozambique to 67 per cent in Swaziland.

UNICEF in action

With years of investment, achieving an HIV-free generation is finally within reach. The work towards a world free of HIV for UNICEF and our international, national and civil society partners is guided by the Global Plan to Eliminate New Infections among Children by 2015. The Global Plan aims to keep HIV infection rate for children born to women living with HIV below 5 per cent, and reduce the number of new infections among young children by 90 per cent compared to 2009. To this end, UNICEF has set two goals in its strategic plan for Eastern and Southern Africa:

  • enduring 80 per cent of all pregnant women living with HIV are reached with triple ARV regimens by 2015; and

  • ensuring 80 per cent of children living with HIV are reached with ART by 2015, from the baseline of 32 per cent in 2009.

Whether HIV-infected or not, children born to women living with HIV have increased risk of morbidity and mortality.  Poverty, isolation and distance from health care facilities can further place them beyond the reach of life-saving care. By making things as simple as possible, UNICEF works to reach more women and children, especially in rural areas where health services are scarce. Offering HIV testing that gives results in just a few minutes as part of routine antenatal care for pregnant women is a first step, and providing treatment of “one pill, once per day” as early as possible for those who are tested HIV-positive is a second. Such treatment not only protects the health of the mother living with HIV, but also prevents transmission to her child – in utero, during delivery or during the breastfeeding period.

© UNICEF/NYHQ2006-2226/Pirozzi
A health worker introduces her hospital's PMTCT programme to a group of pregnant women, and counsels them to be tested for HIV in Mozambique.

Another key area for UNICEF is the integration of HIV care, treatment and support with antenatal, postnatal and child health services. Prevention of HIV infection among women of child-bearing age, for example, as well as prevention of unintended pregnancies among women living with HIV can be achieved only if PMTCT services are integrated with maternal, newborn and child health, as well as family planning services. Recent research indicates that antiretroviral treatment reduces the risk of HIV transmission within couples by 96 per cent [1]. Therefore, finding innovative ways to engage sexual partners of pregnant women through routine health services, and linking these partners to prevention, treatment and care will be an important strategy for preventing new infections [2].

Increased community involvement, mobilization and engagement is also key, particularly in reducing stigma and discrimination. In addition, UNICEF works together with partners to ensure HIV-exposed children are identified early and provided with follow-up treatment, care and support throughout childhood, and into adolescence and adulthood.

Results for children

  • Ten countries in the region developed, launched or started implementing strategic and operational plans to eliminate mother-to-child transmission of HIV as per the Global Plan. These are Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland and Tanzania.

  • In several countries, UNICEF and partners supported the adaptation of the new WHO guidelines, as well as reprogramming of existing grants by the Global Fund for PMTCT and helping high burden countries apply for new funding rounds.

  • Among the 22 priority countries for eliminating mother-to-child transmission, five – all in ESA – reached the 2001 UNGASS goal of providing ARVs (excluding single-dose nevirapine) for PMTCT to 80 per cent of pregnant women living with HIV. They are Botswana, Lesotho, Namibia, South Africa and Swaziland.

  • Botswana leads the way in wide-scale provision of PMTCT services. According to the 2011 Universal Access Progress Report, more than 95 per cent of HIV-positive pregnant women received ARVs to prevent vertical transmission. As a result, mother-to-child transmission has been reduced to 4 per cent.

  • The availability of PMTCT in Lesotho has further increased to 94 per cent of all health facilities, and the proportion of pregnant women who receive PMTCT services rose to 89 per cent in 2010, from only 16 per cent in 2006.

  • Mozambique has also seen its national PMTCT programme developing in the right direction. The country registered a 16 per cent increase in the number of PMTCT sites integrated with maternal and child health services in 2011.

  • In Zimbabwe, an innovation that addresses the lower coverage of ART for rural pregnant women was successfully piloted with UNICEF support. The programme involves the use of point-of-care technology - new diagnostics that are enabling immediate results of HIV tests. By reducing long waits for test results, point-of-care devices also reduce the risk that mothers and babies will be lost to follow-up by health workers.

[1] Cohen, Myron S., et. al., ‘Prevention of HIV-1 Infection with Early Antiretroviral Therapy’,  The New England Journal of Medicine, vol. 365, no. 6, 11 August 2011, pp. 493–505.
[2] World Health Organization, Guidance on couples HIV testing and counselling - including antiretroviral therapy for treatment and prevention in serodiscordant couples. WHO, Geneva, 2012.



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