Mothers and children in developing countries — primarily in sub-Saharan Africa — are profoundly affected by HIV and AIDS. The disease has become a leading cause of illness and death among women of reproductive age in countries with a high burden of infection.
This is despite quantum leaps in progress over the last decade to help scale up access to therapy for children and pregnant women. Since 2002, new infections in children have dropped 58 percent and according to the UNAIDS 2014 GAP report, providing access to antiretroviral — or ARV — medicines for pregnant women living with HIV has averted more than 900,000 new HIV infections among children since 2009.
But children still account for more than 3 million of current HIV cases, with close to 240,000 new infections occurring in 2013. Almost 91 percent of these children live in sub-Saharan Africa.
This reality contrasts with the significant advances achieved in developed countries in a variety of areas. These include HIV prevention of mother-to-child transmission, but also the health of mothers and children living with HIV, which have both lessened the number of pediatric HIV cases. These achievements demonstrate clearly that it is possible — and that it is a moral imperative — to do more in developing countries.
This urgent priority has been clearly recognized by the International AIDS Society, which has made pediatric HIV one its three key strategies, creating the Collaborative Initiative on Pediatric HIV Education and Research program. CIPHER aims to promote and invest in targeted research; strengthen collaboration and communication; and increase advocacy and outreach to support evidence-informed decision-making.
4 areas for increased action
We must focus on four key areas through interventions among multiple partners:
1. As often in infectious diseases, primary prevention has to remain a priority. Providing services allowing young people to access sex education, sexual health services and primary HIV prevention can contribute to reducing the numbers of HIV-positive parents in successive generations.
2. With primary prevention not where it should be yet, two additional areas need to be addressed. One is the prevention of mother to child transmission and the other how to provide support to children and their families. For the first, the solution is clear and with proper use of ARV treatment and appropriate breastfeeding regimes most mothers living with HIV can prevent their babies from being born HIV-positive.
3. For the second, infants, children and adolescents, born into families affected by HIV, both infected and uninfected, have a variety of needs. They include early testing and treatment, but also support on how young people cope with their status and treatment, sexual and reproductive health, and health and welfare of children and young people whose families and opportunities have been affected by HIV.
4. The final priority is tackling the issue of reproductive choice for people living with HIV. It is essential that they should be able to have a positive sexual and reproductive health and wellbeing. People living with HIV need to be equipped and empowered to make informed choices about children, through access to the appropriate technologies. Interventions have to be rooted in a rights-based approach that can enhance mainstream services as well as promoting the equitable treatment of people living with HIV.
What needs to be done?
One key success factor for most of the priorities — but most importantly for prevention of mother-to-child transmission — is that communities must be engaged and empowered to access and influence the services needed. Closely related to this, is the imperative to adopt more widely patient-focused and family-centered approaches to facilitate successful strategies for health care and social support.
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Two additional factors are needed to better integrate HIV and sexual and reproductive health services and to facilitate demand for these services. HIV and sexual and reproductive health services are generally not well-connected because of vertical funding and management approaches. This has been counterproductive: Without integrated services, optimizing the health impact of projects will be impossible. Once these services are better integrated, the following challenge is to achieve the greatest coverage, by working with communities, informing young people, women and families, to make sure they know and make use of the services, care and treatment.
Everything that is done should obviously be rooted in evidence. This means that every project must be grounded in grassroots evidence, which partly requires strong partnerships with local organizations, or committed to generating and publishing evidence that will either illustrate the success or challenges of these projects, or provide evidence — such as epidemiology or data about sexual health services — for developing projects.
Health care companies must continue to play their part and build on progress already made. Royalty-free voluntary licences with generic manufacturers and the Medicines Patent Pool — a U.N.-backed organization established in 2010 — are improving access to affordable HIV medicines for people in developing countries.
Finally, these four priorities will only be achieved if we nurture a greater level of advocacy across the spectrum of HIV-related maternal and child health, especially for effective — yet underfunded — interventions, including some of the approaches outlined above. Advocacy will be crucial in the fight against stigma and discrimination affecting pregnant women with HIV, their babies and families.
Taking these further actions could help us turn the tide against pediatric HIV. Not only will this give mothers and children a fighting chance wherever they are in the world, but could unlock the potential to defeat this disease altogether.
Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.