This Pandemic Is Entirely Preventable

2/9/2009

The following op-ed appeared in The Globe and Mail, Canada's national newspaper, on February 9, 2009.

This Pandemic Is Entirely Preventable

By Pamela Barnes and Nicholas Hellmann

As Thomas Jefferson expressed some two centuries ago, every generation needs a revolution. The revolution of our generation — this generation — is to create a generation free of HIV.

Every day, 1,000 children around the world are infected with HIV; every day, more than 700 children die from AIDS. The primary cause of pediatric AIDS, mother-to-child transmission, occurs during pregnancy, labour, or breastfeeding. About 90 per cent of newly infected children worldwide are in sub-Saharan Africa. Without early treatment, half will die by their second birthday.

Imagine if we had a safe, effective, inexpensive vaccine for a deadly disease but we didn't use it. Now imagine that reality for more than a million HIV-infected pregnant women each year and their HIV-infected children, who face a high probability of serious illness and early death. This is an unimaginable, astonishing and entirely preventable tragedy.

In sub-Saharan Africa, we have utilized what is called PMTCT, or Prevention of Mother-to-Child Transmission. PMTCT is the drug equivalent of a vaccine. Inexpensive, relatively simple to administer, it can reliably prevent most transmissions of HIV from a mother to her infant.

The first study to prove PMTCT worked was completed in 1993; it was widely implemented in the U.S., Canada and elsewhere. In the following two years, mother-to-child transmission rates dropped by half in the U.S., and today the number of new pediatric cases in that country has fallen to approximately 100 to 200 a year.

On the other side of the globe, however, nearly 370,000 new pediatric infections occurred and 270,000 children died of AIDS-related illnesses in 2007. More than two million children are living with HIV and about two-thirds of women in low-and middle-income countries have no access to PMTCT medications. This is an astonishing failure not of science, but of implementation.

As the world's pre-eminent HIV/AIDS scientists meet this week in Montreal to discuss new efforts in the fight against AIDS, PMTCT, a method tantamount to a vaccine, remains inexplicably underresourced and underutilized.

Twenty years ago, the Elizabeth Glaser Pediatric AIDS Foundation was started to address the HIV/AIDS crisis in the U.S. Ten years later, we began our international efforts with a Call to Action in Africa to prove that PMTCT programs could work in resource-poor settings. Today, we are a global organization and part of an integrated worldwide HIV/AIDS care and prevention effort totalling billions of dollars. We are the largest provider of PMTCT services under the U.S. President's Emergency Plan for AIDS Relief, working in 18 countries around the world, and supporting programs at more than 3,600 sites that provide PMTCT services, care and treatment to HIV-infected children and families.

A decade ago, there were many who said we couldn't reach mothers in resource-poor settings. But there has been significant progress. Services increased from reaching just 14 per cent of HIV-positive pregnant women in 2005 to 34 per cent by the end of 2007.

Yet, dramatic scale-up of PMTCT programs in the areas hardest hit by HIV and AIDS is still desperately needed. HIV prevention, diagnosis, care and treatment should be integrated with other public-health interventions, including maternal and child health, family planning, nutrition, clean water, tuberculosis, malaria and other global health programs.

To succeed, we must work together with organizations and partners to maximize the impact of dollars spent and to develop more innovative solutions customized to local settings – such as conducting home visits on horseback in Lesotho or using existing newspaper delivery systems to carry blood samples to testing centres in Kenya.

Ultimately, to be successful, we must make proven prevention methods available to everyone who needs them, promote co-ordination between contributors, implementers and countries facing this pandemic to build the scaleable and sustainable health programs that will stop this devastation in its tracks.

Every day, together, we must commit to achieving a generation free of HIV. This is the revolution of our generation, a revolution we must fight for those who follow behind us.

Pamela Barnes is president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation. Nicholas Hellmann is executive vice-president of medical and scientific affairs for the foundation.