Providing pregnant mothers with antiretroviral medicines can reduce the risk of HIV transmission from 45 percent to just one percent, according to the World Health Organisation (WHO). Credit: Jeffrey Moyo/IPS

By Kanya D'Almeida
UNITED NATIONS, Jun 30 2015 (IPS)

In 2013, an estimated 240,000 children were born with HIV. This was an improvement from 2009, when 400,000 babies tested positive for the infection, but still a far cry from the global target of reducing total child infections to 40,000 by 2015.

Bucking the global trend, one small island nation has made gigantic strides towards the 2015 goal. That country is Cuba, and in 2013 it recorded just two babies born with HIV.

Today, Cuba has become the first country in the world to receive validation from the World Health Organisation (WHO) that it has eliminated mother-to-child transmission of HIV and syphilis.

Executive Director of UNAIDS Michel Sidibé said in a press release today, “This is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”

Every single year, over 1.4 million women living with HIV become pregnant. Without proper treatment, they run a 15-45 percent chance of transmitting the virus to their kids – during pregnancy, labour, delivery or breastfeeding.

But if both mother and child receive proper antiretroviral treatment, the risk of transmission falls to just one percent.

Since 2010, the Pan American Health Organisation (PAHO), which serves as the Regional Office for the Americas of the WHO, has been working with its partners in Cuba and other states in the region to roll out a comprehensive programme to eliminate mother-to-child transmission of both HIV and syphilis.

This process has involved improving early access to prenatal care, testing for pregnant women and their partners, caesarean deliveries and substitution of breastfeeding.

Such services were undertaken and provided within the larger framework of equitable access and universal healthcare, in which maternal and child health is integrated with programmes to combat sexually transmitted diseases.

“Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV,” PAHO Director Carissa F. Etienne said in a statement on Jun. 30.

“Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis,” she added.

WHO and its partners first published comprehensive guidelines on the processes and criteria for validation of eliminating mother-to-child transmissions in 2014.

Because treatment and prevention can never be 100 percent effective, ‘elimination’ is defined as “a reduction of transmission to such a low level that it no longer constitutes a public health problem”, according to PAHO.

In March of 2015, a group of international experts visited Cuba to assess its progress towards the elimination target, and spent five days visiting health clinics, labs and government institutions interviewing a range of experts and other stakeholders.

Comprised of experts from 10 countries including Argentina, Japan and Zambia, the mission considered a number of indicators – all of which must be met for at least one year – including confirming that new child infections as a result of mother-to-child transmissions are less than 50 cases per 100,000 live births.

Other indicators, which must be met for at least two years in order to receive validation, include ascertaining that more than 95 percent of HIV-positive women know their status, receive at least one ante-natal visit, and receive antiretroviral drugs.

“Eliminating transmission of a virus is one of the greatest public health achievements possible,” WHO Director-General Margaret Chan announced on Jun. 30.

“This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation,” she added.

According to the World AIDS Day 2014 Report, there were 35 million people living with HIV/AIDS in 2013. Since the start of the epidemic in the 1980s, 39 million people have died of AIDS-related illnesses and close to 78 million have become infected with HIV.

Thanks to sustained local and global efforts to fight the epidemic, the death toll has fallen significantly in the past decade, from 2.4 million deaths in 2005 to 1.5 million in 2013, representing a 35-percent decline.

New infections have also declined by an estimated 38 percent since 2001, from 3.4 million to 2.1 million in 2013.

Among children, new infections have fallen from an estimated 580,000 in 2001 to 240,000 in 2013. If more countries emulate Cuba’s example, the international community will be closer to its 2015 goals, and the ultimate goal of eliminating AIDS altogether.

Edited by Kitty Stapp

A billboard in Freetown, Sierra Leone, urging people to go to hospital to be tested for HIV. Ebola has stopped people from doing that. Credit: Lansana Fofana/IPS

By Lansana Fofana
FREETOWN, Dec 1 2014 (IPS)

The outbreak of the deadly Ebola epidemic in Sierra Leone has dwarfed the campaign against HIV/AIDS, to the extent that patients no longer go to hospitals and treatment centres out of fear of contracting the Ebola virus.

“It is a big challenge for us. HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected,” Abubakar Koroma, Director of Communications at the National AIDS Secretariat, told IPS.“HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected” – Abubakar Koroma, Director of Communications, Sierra Leone’s National AIDS Secretariat

Sierra Leone records one of the lowest HIV/AIDS prevalence rates in the West African region. For over five years, the country has managed to stabilise the figures at 1.5 percent, out of a population of 6 million, mainly because of massive countrywide awareness raising. The authorities also offer free medicines and treatment to people living with HIV/AIDS.

But all this may be reversed if the Ebola crisis is not contained soon.

Before the outbreak of the Ebola crisis in Sierra Leone in April, one key area of success in the fight against HIV/AIDS had been in curtailing mother-to-child transmission. Today, however, there are concerns that it may surge again because pregnant women are now reluctant to go to hospitals for treatment.

In 2004, the prevalence rate among pregnant women was 4.9 percent but, just before the Ebola in April this year, the figure had dropped to 3.2 percent.

According to Koroma, “between January and now, that service [for pregnant women] has dropped by 80 percent. We are worried that the Ebola crisis may worsen the situation.” From the point of view of those already living with HIV/AIDS, this is already happening.

Idrissa Songo, Executive Director of the Network of HIV Positives in Sierra Leone (NETHIPS) advocacy group, says that its members fear going to hospitals for care and treatment and that they are constrained by what he described as a cut in the support they were receiving from donors and humanitarian organisations before the outbreak of Ebola.

“Donors and other philanthropists have turned their attention away from the fight against HIV/AIDS,” he said. “Now it’s all about Ebola. Most organisations have diverted their funding to the fight against Ebola and this is badly affecting our activities.”

Songo added that the core activities of NETHIPS, which include community awareness raising and training of members in care and prevention, have all come to a standstill because of the government’s ban on all public gatherings following the Ebola outbreak.

Given the current crisis, the National Aids Secretariat and the Ministry of Health have set up telephone hotlines to connect with people suffering from HIV/AIDS. The aim is to be able to trace and locate them and then get treatment to them. At the same time, HIV/AIDS patients are now receiving a quarterly supply of the drugs they need, compared with the monthly dosage they were receiving before Ebola struck.

According to Songo, these measures are working because “that way, our members, who fear going to hospitals and treatment centres, can stay at home and take their medication. We know it is risky to go to treatment centres nowadays because of the possibility of contracting Ebola, another killer disease,” Songo told IPS.

Notwithstanding the Ebola crisis, Ministry of Health officials say that they have not lost sight of the fight against HIV/AIDS.

Jonathan Abass Kamara, Public Relations Officer at the Ministry of Health, told IPS that attention is still focused on the fight against HIV/AIDS. “Even though Ebola has taken centre-stage, the Ministry is still very much focused on the fight against HIV/AIDS. We supply drugs to patients regularly and we try our best to give care and attention to them,” Kamara told IPS.

However, while Sierra Leone has made tremendous progress in the fight against HIV/AIDS and its success in this fight surpasses that of almost all countries in the West Africa region, it may well find it difficult to maintain its achievements in this sector if the Ebola epidemic is not brought under control.

(Edited by Phil Harris)