Majority of HIV-positive pregnant women in developing world lack access to PMTCT services, report says

May 22 2009

Two-thirds of HIV-positive pregnant women in the developing world do not have access to treatment to prevent mother-to-child HIV transmission, which could lead to 370,000 new HIV cases annually among infants, according to a study released Thursday by the International Treatment Preparedness Coalition, Bloomberg reports (Chase, Bloomberg, 5/21).

Of the 1.5 million HIV-positive pregnant women each year in the developing world, about one-third receive any kind of drug therapy at all, the report said, adding that most of the treatment is inadequate and fails to prevent MTCT.

According to the report, eight years after world governments pledged to cut the number HIV cases among infants in half by 2010, only about 8% of pregnant women in developing countries are receiving the complete triple-dose combination therapy widely used in wealthy nations (York, Globe and Mail, 5/22).

The report cited poor government and donor coordination, as well as funding gaps, as the main reasons many women do not obtain the treatment, Stephen Lewis, founder of AIDS-Free World and a co-author of the report, said (Bloomberg, 5/21). According to the report, there is a "shocking lack of consistency and coordination" between governments and agencies, and about 18% of pregnant women worldwide were offered HIV tests in 2007. In addition, there is an acute shortage of prevention and counseling services for women, the report said. It added that one of the largest issues is a lack of counseling on infant feeding, as most women are not properly counseled and advice sometimes can lead to a bias toward using formula over breastfeeding.

Lewis also criticized United Nations health agencies for claims that an increasing number of pregnant women in developing countries are gaining treatment access. He added that the large majority of such women do not have access to the complete triple-dose treatment. "It makes the access a simple mockery," Lewis said.

The report found that in 61 countries -- such as Cameroon, Ethiopia, India and Nigeria -- more than three-quarters of HIV-positive pregnant women do not receive any drug treatment for PMTCT. It said that the world is tolerating a "shameful example of double standards" because MTCT has been virtually eliminated in wealthy nations, where most HIV-positive pregnant women have access to the complete drug regimen (Globe and Mail, 5/22).

According to Bloomberg, most HIV-positive pregnant women who do have access to prevention services in developing countries receive nevirapine for PMTCT, which is 40% effective at reducing transmission. Nevirapine can so lead to drug-resistant strains of HIV from developing, Bloomberg reports. Boehringer Ingelheim, which manufactures nevirapine, provides the drug at no-cost to pregnant HIV-positive women in developing countries, according to Bloomberg. According to CDC, the availability of PMTCT services in the U.S. has reduced the number of HIV cases in infants by more than 90%.

Officials from UNAIDS, the World Health Organization and 20 international groups are expected to meet this week in Nairobi, Kenya, to launch a campaign aimed at improving access to PMTCT services, UNAIDS Executive Director Michel Sidibe said.

Gregg Gonsalves, head of ITPC, said, "For millions of women, maternal and child health is about HIV/AIDS and we have failed them" (Bloomberg, 5/21). He added, "Our failure to prevent HIV transmission to babies is truly a failure to prevent disease progression in women living with HIV. If we treat mothers properly, if we treat women properly for their own health, we would have few or no HIV infections in babies" (VOA News, 5/21). Sidibe said, "There has been some progress" in PMTCT services, but added, "Overall coverage is still very low for this proven, inexpensive and effective intervention." Sidibe said that UNAIDS "agree[s] with the report that the combination of stigma, fragmented health services, inadequate knowledge within the community and insufficient political leadership are root causes of low coverage" (Bloomberg, 5/21). UNAIDS also has called for the "timely administration" of affordable combination therapy to prevent MTCT (VOA News, 5/21).

Nicholas Hellmann, executive vice president of medical and scientific affairs at the Elizabeth Glaser Pediatric AIDS Foundation, said the PMTCT treatment rate of 33% is a positive step. "I like to look at the glass as one-third full," Hellmann said, adding, "We feel it's best to get women and infants on some regimen, with the intent to scale up to triple drug combination." In addition, Hellmann said that comprehensive care is needed to reduce HIV prevalence among pregnant women (Bloomberg, 5/21).

The report is available online.