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Experts call for urgent action on PMTCT and Paediatric HIV in Eastern and Southern Africa

© UNICEF Kenya/2009
L to R: UNICEF ESARO Senior Advisor on HIV and AIDS David Alnwick; Executive Director for Mothers to Mothers Mitch Besser; and Coordinator for Kenya Treatment Access Movement James Kamau during the two-day regional PMTCT Consultation in Nairobi.

By Kun Li and Athanas Makundi

NAIROBI, Kenya, 4 June 2009 – In 2007, there were 2.7 million new cases of HIV in Sub-Saharan Africa. At the recent Regional Consultation on Accelerating Prevention of Mother-to-Child Transmission (PMTCT) and Paediatric Care and Treatment, governments of nine countries with high HIV prevalence were urged to take immediate action to expand and strengthen existing PMTCT services, as well as to increase treatment to infected mothers and children.

“The HIV and AIDS epidemic continues to have a devastating impact on children and women in this region, contributing to increased deaths of both children and mothers as well as creating more orphans,” said UNICEF Regional Adviser on HIV and AIDS David Alnwick. “It is critical at this juncture, when many countries are faced with shrinking budgets and competing demands that we do not lose the momentum of what needs to be done to create an AIDS-free generation.”

Reviewing progress

The consultation was convened by UNICEF, UNAIDS and WHO and brought together senior staff from Ministries of Health of South Africa, Kenya, Mozambique, Tanzania, Zambia, Ethiopia, Malawi, Uganda and Swaziland, along with experts from international and non-governmental agencies working in the Eastern and Southern Africa region.

During the two-day meeting, they reviewed progress as well as identified bottlenecks and discussed what needs to be done to address them.

“We need to have sustained, predictable funding,” said PMTCT Coordinator at the Government of Zambia, Maximilian Bweupe. “That is the only way to sustain what we have being doing.”

In Swaziland, one of the countries with the highest HIV prevalence in the world, availability of resources is not the issue.

“Resources are there but getting people to access testing is an issue,” said Coordinator of Swaziland’s National AIDS Programme Velephi Okello. “There are many myths surrounding antiretroviral drugs. Especially because we are a country where its people still believe and rely heavily on traditional medicines.”

Implementing services

For countries like Uganda, the major challenge to implementing PMTCT services lies at community antenatal clinics.

“Because of the limited resource setting of the clinics, many times we have interrupted drug stock or HIV-testing stock, so if the mother comes once, twice or three times and the service is not available to her, she will obviously get discouraged and never come back again,” explained Associate Professor of Pediatrics at Makerere University in Uganda, Philippa Musoke.
Whether the obstacles faced are social, economic or cultural, there is still confidence among the experts that most of these countries could meet the Universal Access Goal of 80 per cent PMTCT coverage and 50 per cent reduction of new paediatric infections by 2010.

Meeting goals

A preliminary analysis by UNICEF of the best available data suggested that two of the nine countries – South Africa and Tanzania – would be likely to meet that goal based on their continued increased coverage in 2007 and 2008.  With the exception of Ethiopia, seven countries could possibly meet the coverage goal with substantial increases in effort. For some, this would mean increasing coverage by over a third this year, compared with 2007 and by a quarter again in 2009.

Currently, the average PMTC coverage for countries in Eastern and Southern Africa remains at around 50 per cent.

"At this day and age after all what we know about HIV and AIDS, vertical transmission is a crime, it must not happen,” said Coordinator of Kenya Treatment Access Movement James Kamau. “We need to ask the African Governments, the African Union to dedicate budget lines for PMTCT and paediatric treatment. We need to bring the society into place, we need to have the mother understand the issues. Not only the mothers, we need the fathers to be there, as well.”

At the end of the Consultation, a detailed set of recommendations was made, focusing mainly on relatively low cost and straightforward actions that governments could take before the end of 2009, which would allow for substantial acceleration in 2010, and beyond.



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