U.N. says PMTCT of HIV is achievable; efforts must target millions currently 'falling through the cracks'

Dec 2 2010

"A generation of babies could be born free of AIDS if the international community stepped up efforts to provide universal access to HIV prevention, treatment and social protection, the United Nations said on Tuesday," Reuters reports. The declaration came on the eve of World AIDS Day, as U.N. leaders released a new report (.pdf), which found "millions of women and children, particularly in poor countries, fall through the cracks of HIV services either due to their gender, social or economic status, location or education," according to the news service (Kelland, 11/30).

"To achieve an AIDS-free generation we need to do more to reach the hardest hit communities," UNICEF Executive Director Anthony Lake said in New York at the launch of the report, which was a collaboration between UNICEF, UNAIDS, UNESCO, UNFPA and WHO, U.N. News Centre writes. The U.N. has called for the virtual elimination of mother-to-child transmission of HIV by 2015, the news service notes (11/30).

The report documents the impact of efforts to prevent mother to child transmission (PMTCT) of HIV and provide treatments to children living with HIV/AIDS: "In 2005, only 15 percent of HIV-positive pregnant women in low- and middle-income countries received antiretrovirals for the prevention of mother-to-child transmission (PMTCT) of HIV; in 2009, 53 percent of women in need received antiretrovirals for PMTCT," the report states. "In 2005, only 75,000 children under 15 in need received antiretroviral treatment. Today, that figure is approximately 356,400, around 28 percent of those in need."

The report also notes that "for every problem solved or advance made, new challenges and constraints have arisen. PMTCT services are established - but they are not fully utilized. Progress has been made towards targets - but it has been inequitable. More children are diagnosed with HIV early in their lives - but their test results may not be picked up, they may not be enrolled in treatment, and many of them are likely to die" (2010).

"Although it is very rare for a child to be born with HIV in the developed world, there are still a thousand newborns a day infected in Africa," UNICEF's head of HIV and AIDS Jimmy Kolker said, according to Reuters. "According to the latest United Nations data, 370,000 children were born with HIV in 2009, the vast majority of them in Africa - the region that bears by far the highest AIDS burden," Reuters writes. HIV/AIDS also remains "one of the leading causes of death worldwide among women of reproductive age and a major cause of maternal death in countries with AIDS epidemics. In sub-Saharan Africa, nine percent of maternal deaths are attributable to HIV and AIDS, UNICEF said," according to the news service (11/30).

U.N. News Centre notes that the WHO recently revised its guidelines to improve PMTCT services for pregnant women living with HIV/AIDS and their infants, as well as new antiretorival guidelines for infants and children, "paving the way for many more children with HIV to be eligible for immediate antiretroviral therapy (ART)" (11/30).

"Even where early infant diagnosis is available and is offered to many thousands of children, the cascade, the number who do not end up, if the test is positive, getting on medication, which would be life saving, a remarkable impact on young children," Kolker said, VOA News reports. "But, the majority of kids in the countries we studied did not actually access the medication, even though the test results did show they were positive," he added (Schlein, 11/30).

The Guardian notes that HIV/AIDS prevention and treatment programs for mothers and infants vary "between and within countries" in terms of "the numbers who are reached."

"Throughout southern Africa, services are being scaled up, but we need to pay attention to those who are being missed," Kolker said. "Also, the demand question is key. How do you empower people to take advantage of the services which do exist in their country?" The article details UNICEF's efforts to provide HIV testing and, if necessary, mother-baby packs of treatment, to pregnant women during their "first - and sometimes ... only - antenatal check" (Boseley, 11/30).

"We have strong evidence that elimination of mother-to-child transmission is achievable," WHO Director-General Margaret Chan said, according to U.N. News Centre. "Achieving the goal will require much better prevention among women and mothers in the first place," she added. The news service notes women remain at a disproportionate risk of HIV infection. "[I]n many countries women face their greatest risk of infection before age 25. Worldwide, more than 60 percent of all young people living with HIV are female. In sub-Saharan Africa, that figure is nearly 70 percent," U.N. News Centre writes (11/30).

In a "statement before World AIDS Day ...  the UNAIDS director Michel Sidibe said: 'Nothing gives me more hope than knowing that an AIDS-free generation is possible in our lifetime,'" Reuters reports (11/30).

On World AIDS Day, Media Outlets Reflect On How Funding Squeezes Could Impact HIV/AIDS

Marking World AIDS Day Wednesday, news outlets examined how current economic conditions could threaten recent gains made in the global fight against HIV/AIDS.

"In October, donors pledged just under $12bn over the next three years to the UN-backed Global Fund to Fight Aids, TB and Malaria. That is more than the agency has ever received, but still short of the lowest of its three target scenarios of $13bn-$20bn," the Financial Times writes. "UNAIDS calculations suggest $16bn in total was spent last year, $10bn less than required. Funding is already being squeezed, including to the agency itself which, to make best use of its $250m annual budget, has frozen posts and cut staff and travel."

The article continues, "To critics, the axe could fall more aggressively still. Former U.S. President Bill Clinton, whose foundation has helped reduce treatment costs, and Bill Gates, the founder of Microsoft, whose philanthropy has supported much work in the field, both chose efficiency as their theme at the biennial AIDS conference last summer." The piece examines efforts underway to drive down the cost to treat people living with HIV/AIDS and to increase the efficiency of global HIV/AIDS programs (Jack, 11/30).

"[E]ven as overall donor funding is increasing for AIDS relief, it isn't keeping pace with the AIDS epidemic itself," the Christian Science Monitor writes. The article references the recent report by the U.S. Institutes of Medicine (IOM), which projected the number of people living with HIV/AIDS in Africa to outpace treatment resources by 2020. The piece quotes one of the co-chairs of the report, who notes the importance of preventing new infections in the long-term response to HIV/AIDS in Africa (Baldauf, 11/30).

On Tuesday, U2 lead singer Bono, during the launch of World AIDS Day in Sydney, noted the impact the financial situation in developed countries was having on funding levels for global HIV/AIDS programs. Bono "said agencies established to arrest acquired immune deficiency syndrome (AIDS) 'were fighting hard for funding' nearly three decades after the disease was first diagnosed," Reuters reports. "In recessionary times, people have to tell their politicians this is important to them," Bono said, the news service notes (Regan, 11/30).

Bloomberg reports on comments made by former UNAIDS Executive Director Peter Piot, who suggested success in the global fight against HIV/AIDS may have "caused 'fatigue' toward combating the virus and may result in reduced funding for treatment and prevention."

"While it's 'a spectacular success,' that more than 5 million people with HIV are being treated with antiviral drugs, there are 33 million people with HIV in the world, said Piot," in an interview last month, according to the news service. Piot called for funding for prevention to be better targeted to high-risk communities (Kay, 12/1).

Meanwhile, "[a]bout 200,000 more Ugandans will require antiretroviral therapy by 2015 but a looming funding crisis makes it unlikely that they all will receive the life-saving treatment, [Kihumuro Apuuli, the head of the Uganda AIDS Commission,] said," marking World AIDS Day, the Daily Monitor reports. "The only solution, he argued, is for Uganda to become much more serious about preventing spread of the disease in the first place," by targeting high-risk groups, the newspaper writes.

"The challenge is already huge, and if we don't change course and address the problem of HIV/AIDS prevention, then it's going to be hard to sustain the free treatment programme in the years ahead," Apuuli warned (Rukundo/Lirri, 12/1).

In related news, the New York Times reports on what the newspaper terms the "new breed" of HIV/AIDS advocates: "Unlike the first generation of patient-activists, this latest crop is composed of budding public health scholars. They are mostly heterosexual. Rare is the one who has lost friends or family members to the disease. Rather, studying under some of the world's most prominent health intellectuals, they have witnessed the epidemic's toll during summers or semesters abroad, in AIDS-ravaged nations."

The article focuses on "a loose-knit band of about two dozen Ivy Leaguers, mostly from Harvard and Yale, [who are] using … confrontational tactics, as well as some high-powered connections, to wangle encounters with top White House officials in a determined, and seemingly successful, effort to get under [President Barack] Obama's skin" about U.S. global AIDS funding. "While spending on global AIDS has gone up on Mr. Obama's watch, and the United States remains the world's largest contributor to such programs, independent analysts say that the rate of increase has slowed significantly and that it will be difficult for the president to keep his $50 billion pledge - or even meet a lesser goal, set in 2008 by Congress, of $48 billion for AIDS, tuberculosis and malaria by 2013," the New York Times writes. "The task may grow even harder under a new Congress, with the incoming House Republican majority intent on cutting spending and Tea Party-backed Republicans in both chambers expressing skepticism about all types of foreign aid," the newspaper adds (Stolberg, 11/30).

WHO Director-General Calls For Greater Protection Of The Rights Of HIV-Positive People, And Those At High Risk

Despite progress in the fight against HIV/AIDS, "intolerance on the part of health care workers is undermining global efforts to stop the spread of the AIDS virus, [WHO Director-General Margaret Chan] warned," in a statement prepared for World AIDS Day, CQ HealthBeat reports.

"All too often it is the negative attitudes and behaviors of health workers that make health services inaccessible and unacceptable to those people at greatest risk of HIV infection and in greatest need of prevention, treatment and care services," Chan said (Reichard, 11/30).

"The right to health is central to the HIV response, Chan said, according to Deutsche Presse-Agentur/M&C. "People living with HIV should not only enjoy their right to health but also their right to access crucial social services such as education, employment, housing, social security and even asylum in some cases" (11/30).

"The failure to promote and protect human rights increases vulnerability and can drive HIV epidemics," Chan said in the statement. "On the eve of a new decade, we need to address laws, policies, and regulations that increase HIV vulnerability and risk, impede access to health services or infringe on human rights, particularly for vulnerable and most-at-risk populations," she added (11/30).

In related news, the Financial Times examines the efforts to promote HIV education among sex workers, intravenous drug users (IDUs), and men who have sex with men (MSM) in Asia, and the laws that hinder such efforts. "In some countries, laws drive sex workers and drug users so far underground that they become hard to reach. In others, unconnected legislation against trafficking and illegal migration are changing the dynamics of the sectors of society worst affected by AIDS," the newspaper writes. "UNAIDS estimates that 90 percent of countries in Asia have laws that obstruct the rights of those living with HIV," Financial Times writes (Johnston, 11/30).

VOA News reports on the growing HIV/AIDS epidemic in Eastern and Central Asia, where according to a recent UNAIDS report "the number of HIV-positive people has nearly tripled in the past decade." The article examines how injecting drug use is fueling the spread of HIV/AIDS in the region. It also notes how resistance to use prevention strategies targeting IDUs, such as harm reduction, may be to blame for the rise in new infections (Hennessy, 11/30).