On 29 November, UNICEF releases Children and AIDS: Sixth Stocktaking Report, the first report of its kind since 2010.
An AIDS-free generation once seemed like a far-off dream. But, now, the world has what it takes to make this dream a reality. Advancements in preventing mother-to-child transmission of HIV have greatly decelerated the rate of new infections in babies in low- and middle-income countries. However, the same progress has not been seen in treatment for children living with HIV, and the trajectory of AIDS deaths among adolescents living with HIV remains alarming.
Lexina Lungu has been following her simple antiretroviral treatment plan throughout her pregnancy. In the meantime, 12 other countries have rolled out the same (or a similar) option for preventing mother-to-child transmission of HIV that has proven so effective in her native Malawi.
KASUNGU, Malawi, 27 November 2013 – To see the promise of an AIDS-free generation drawing closer, look no further than Lexina Lungu. When we last left the Lungus, she was 36 weeks pregnant and attending her regular antenatal check-up. She had earlier learned that she was HIV-positive, as was her husband. The couple were expecting a baby girl.
The couple were concerned about their child. Women can transmit the virus to their babies during pregnancy, birth or breastfeeding.
Ms. Lungo had started treatment to protect her baby and herself. And, in doing so, she had become part of her country’s bold new approach to safeguarding infants from HIV – an approach that has since been adopted by other countries.
Protecting babies from HIV
Protecting babies from HIV used to combine testing, antiretroviral treatment and counselling, with care tailored to the health of individual mothers based on how sick they were. For this conventional approach to be effective, countries needed robust infrastructure that could provide the necessary tests, results and medicines consistently – and was close to the women who needed it.
Such infrastructure is common in industrialized countries, where HIV infections among babies are now almost unheard of. But, in the developing world, where health systems are weak and obstacles including distance, poverty and persistent stigma can stand in the way, mothers and their infants remain at risk.
Globally, about 260,000 children aged 0–14 years were newly infected with HIV in 2012. Almost 90 per cent live in the 22 Global Plan priority countries, including Malawi. In these countries, mothers and babies may not be able to make repeated trips to far-away clinics, and test results may arrive late or not at all. Each new pregnancy presents women with fresh obstacles – including starting the process all over again.
Malawi knew that it was years away from creating the infrastructure to solve these problems. Its breakthrough came in realizing that, by changing its testing and treatment model from complex to simple, it could bypass the weaknesses in its own system.
Rethinking prevention
The new approach places women at the centre. It depends on simplicity to keep mothers and babies healthy.
When Ms. Lungu tested positive for HIV, she was offered antiretroviral treatment for life, in line with the new approach. The treatment protects the mother, her baby and children from any future pregnancies – as long as she stays on treatment. It also decreases the risk that she will pass the virus on to an uninfected sexual partner.
Instead of managing several pills each day, mothers like Ms. Lungu now take just one pill. This single pill, taken once a day, combines three antiretrovirals. And, while old approaches called for a special CD4 test to show whether a mother living with the virus needed treatment for her own health, the new approach starts all pregnant women on antiretrovirals right away, with a positive HIV test result alone.
This approach has proven remarkably effective – so much so that Malawi is now among 13 countries of the 22 Global Plan countries using the same policy, or something similar.
Hope for the future
Not long after her antenatal check-up, Ms. Lungu gave birth to a healthy baby girl. She named her daughter Chriselda.
When Chriselda was 6 weeks old, Ms. Lungu brought her back to the clinic for her first HIV test. She was about to learn whether her lifelong treatment had protected Chriselda. Chriselda was free of HIV.
There are more tests to come, and Ms. Lungu must continue to take her one pill a day faithfully to protect her own health and the health of her baby. But, for now, this family remains protected by lifelong treatment.
Malawi pioneered lifelong treatment for all pregnant and breastfeeding women living with HIV. Some other countries have shifted toward simplified treatment that lasts just through the risk period of pregnancy, birth and breastfeeding.
Expanding the simplified approaches used among Malawi and other Global Plan countries demands collaborative effort. UNICEF and partners including the World Health Organization are coordinating technical assistance, monitoring and development of guidance for countries implementing lifelong treatment, or treatment through the risk period only.