UNICEF in action: Strategy and priorities

Preventing mother-to-child transmission (PMTCT) of HIV

Providing paediatric treatment

Preventing HIV infection among adolescents and young people

Protection and care for children affected by AIDS

Infant and young child feeding in the HIV context

Medical male circumcision

Results for children

Children and AIDS Regional Initiative (CARI)


Preventing mother-to-child transmission (PMTCT) of HIV

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

In 2009, an estimated 860,000 pregnant women were found to be living with HIV  in Eastern and Southern Africa, more than in any other region of the world. The region is also home to 47 percent of the global total of children living with HIV, of which over 90 percent were infected through vertical transmission from the mother to the baby during pregnancy, delivery or breastfeeding.

Without effective treatment, more than half of all babies born with HIV will die before their second birthday. In high-burden countries in Southern Africa, HIV contributes to between 10 and 28 percent of all deaths among children under five years of age.

Moreover, HIV contributes to a high portion of maternal deaths in ESA, especially in Southern Africa where they ranged from 26.8 percent in Mozambique to 67.3 percent in Swaziland in 2010.

The risk of mother-to-child transmission of HIV can be reduced to less than 5 percent through  a combination of prevention measures (PMTCT) , including antiretroviral therapy (ART) for the expectant mother and her new-born child, hygienic delivery conditions and safe infant feeding. According to new guidelines issued by the World Health Organization (WHO), a woman with HIV can breastfeed her baby in settings where it is judged to be the safest infant feeding option. She must, however, breastfeed exclusively and she or her newborn need to receive ART at the same time.

The challenges to reach pregnant women in need of PMTCT services are immense in the region. Although many countries have made great efforts to establish PMTCT services, many pregnant women in rural areas do not have the means to reach them. Among those who attended antenatal care in 2010, less than a half received an HIV test.

When tested positive, many women drop out of PMTCT programmes, because they fear discrimination and rejection by their male partners and families. In addition, in countries such as Malawi and Zimbabwe, more than 80 percent of women enrolled in a PMTCT programme still receive single-dose nevirapine rather than another more efficacious ARV regimen.

© 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.

UNICEF in action

UNICEF’s overall PMTCT strategy is based on a comprehensive four-pronged strategy aimed at integrating key interventions into essential maternal, newborn and child health services:

  • The first prong emphasizes the importance of preventing HIV among women of reproductive age before they get pregnant.
  • The second prong is focused on the prevention of unintended pregnancies among women living with HIV.
  • The third prong focuses on pregnant women who are already infected and demands that HIV testing be integrated into antenatal care, that they receive ARVs to prevent transmission of the virus and for their own health and that they are counselled adequately on the best feeding option for their baby.
  • The fourth prong calls for better integration of HIV care, treatment and support for women found to be positive and their families.

In 2009, UNICEF endorsed the UNAIDS call for a “virtual elimination of mother-to-child transmission of HIV by 2015”, which aims;

  1. at ensuring that less than 5 percent of children born to women with HIV are themselves positive;
  2. to reduce the number of new infections among young children by 90 percent compared to 2009.

To achieve this goal, UNICEF in ESA agreed to reach two concrete goals in nine priority countries  that account for 90 percent of pregnant women living with HIV and for 90 percent of children estimated to be in need of ART, plus Lesotho:

  • Increase coverage of PMTCT interventions to at least 80 percent of HIV positive pregnant women by 2013 (from a baseline of 68 percent in 2009).
  • Increase coverage of paediatric ART by 2013 to at least 60 percent from a baseline of 32 percent in 2009.

In the three hyper-endemic countries that have already achieved both PMTCT coverage of 80 percent and paediatric ART coverage of 60 percent (Swaziland, Botswana, and Namibia), efforts will focus on strengthening the quality of PMTCT and paediatric AIDS interventions.

Results for children

An increasing proportion of pregnant women are being tested for HIV in Eastern and Southern Africa, rising from 15 percent in 2005 to 47 percent in 2010. Of those who tested positive, 64 percent received ART to prevent the transmission of the virus to their baby, up from only 19 percent in 2005. The regional average, however, masks huge disparities between and within countries. Countries such as Botswana, Lesotho, Namibia, South Africa and Swaziland already achieved coverage rates of more than 80 percent, while in others such as Eritrea have 3 percent of HIV-positive pregnant women were enrolled in PMTCT programmes.

The highest HIV burden among pregnant women in Eastern and Southern Africa in descending order

Country Estimated # of HIV-positive pregnant women (2009) % of HIV-positive pregnant women who received ARVs for PMTCT (2010)
South Africa 330,000 95
Mozambique 76,000 52
Kenya 76,000 43
Tanzania (United Republic of) 73,000 59
Zimbabwe 62,000 46
Uganda 61,000 42
Zambia 49,000 75
Malawi 47,000 23 - 31
Botswana 17,000 >95
Lesotho 16,000 89
Angola 11,000 20
Swaziland 10,000 >95
Namibia 9,500 >95
Burundi 9,000 36
Rwanda 8,800 60
Somalia 1,500 <1
Eritrea 1,300 3
Madagascar 700 <1 - 1
Comoros <100 67–<95
Ethiopia - -
Source: State of the World’s Children 2011, UNICEF: Global UNAIDS Response: Epidemic update and health sector progress towards Universal Access, Progress Report 2011, UNAIDS.

Botswana leads the way in wide-scale provision of PMTCT services. According to the 2011 Universal Access Progress Report, more than 95 percent of pregnant women were tested for HIV and more than 95 percent received ARVs to prevent vertical transmission. Mother-to-child HIV transmission has been reduced to 4 percent in the country.

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

Mozambique has also achieved impressive growth in PMTCT scale up. By the end of 2009, more than 700 health facilities provided PMTCT services, reaching almost 890,000 pregnant women (an increase from 668,000 in 2008). Of the total number of sites, 43 percent are UNICEF-supported.

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 to fight AIDS, Tuberculosis and Malaria for PMTCT and helping high burden countries apply for new funding rounds.

In Kenya, 60 percent of all health facilities (more than 3,000) are now offering PMTCT services, with 83 percent of all women attending antenatal services being tested in 2010.

Also in Kenya, the Government with support of UNICEF launched the “Maisha” MTCT-free Zone Initiative, an innovative approach to prevent mother-to-child transmission of HIV.



 Email this article

unite for children