Counting Down to Zero: Progress in Ending Mother-to-Child Transmission
With last week's exciting announcement by UNAIDS, highlighting remarkable progress in meeting the Millennium Development Goals (MDGs) related to HIV and AIDS, the end of the epidemic has never been more clearly in our sights. For those of us who place a particular focus on children affected by the disease, the report, How AIDS Changed Everything, provided cause for great hope and even a bit of celebration. Between 2000 and 2014, new infections among children decreased 58 percent; in other words, the deaths of an estimated 1.4 million children have been averted.
The MDGs have proven critical in driving action in the fight against HIV and AIDS. Similarly, the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) has driven action related to children impacted by the disease, helping to ensure that they are an important part of the agenda and prioritized accordingly.
As its title suggests, the Global Plan's end date is December of this year. With that deadline fast approaching, we must continue to ensure financing, strengthen policy, improve service delivery and build on existing efforts to end mother-to-child transmission. Failure to do so could prove devastating.
It is widely recognized -- and was, in fact, reiterated in last week's report -- that "the first milestone on the way to ending the AIDS epidemic is to eliminate new HIV infections among children." Despite the progress, there is still much work to be done in order to reach that goal.
A Mechanism for Driving Progress
When launched in 2011, the Global Plan, developed by a team of experts co-chaired by UNAIDS and the President's Emergency Plan for AIDS Relief, set out bold goals: focusing on the 22 countries in which 90% of new HIV infections in children occur, it aimed to reduce the number of new HIV infections in children by 90% and the number of HIV-related maternal deaths by 50% by 2015.
Bold though they were, these goals were --and are -- achievable. Less than a decade ago, the idea of eliminating mother-to-child transmission of HIV seemed out of reach. The UNAIDS report indicates that the percentage of pregnant women living with HIV who have access to antiretroviral therapy rose to 73 percent between 2000 and 2014. In addition, eight Global Plan priority countries saw new infections among children decline by 50 percent or more while Botswana has virtually eliminated mother-to-child-transmission and South Africa is not far behind.
Continuing the Fight
Even with the remarkable achievements made to date, children are still infected with and dying from HIV. In fact, between 2012 and 2013, the pace of progress in reducing new HIV infections among children across Global Plan priority countries slowed substantially. While a number of countries made impressive headway, others stagnated or even lost ground. In addition, there was a significant slowdown in the percentage of women receiving ARVs. The reasons behind this are varied and complex, but make clear how fragile gains can be and how important it is to continue to strive for progress in eliminating mother-to-child transmission of HIV.
"Today, it is known that eliminating all new HIV infections among children is feasible, and there is consensus that this goal should be an urgent worldwide undertaking." - How AIDS Changed Everything, UNAIDS
The beginning of the end of AIDS starts with eliminating mother-to-child transmission of HIV. The collaboration around mechanisms like the MDGs and the Global Plan have shown what is possible when a group of varied stakeholders come together to address one of the most critical issues of our time. But we have not yet reached our goal.
This week, 6,000 clinicians, public health experts, community leaders and others are gathering to discuss the global fight against HIV/AIDS at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention. It is imperative that we give precedence to women and children in these discussions and redouble our efforts. If we do not, we risk rolling back the gains made to date.
Although last week's announcement is an opportunity to reflect on our progress, we cannot pause even for a moment in our efforts to end mother-to-child-transmission and to keep mothers healthy. We must continue to fight until no child has AIDS.