USAID chief: Put maternal and childhood HIV on the map

The global health community could be “underreporting and under-recognizing” HIV prevalence as a cause of child death due to a growing gap between child and adult diagnosis and treatment, according to an expert panel who spoke in Washington, D.C. on Tuesday.

That under-recognition creates the “insidious effect” of less political and financial support for HIV programs that target children, Chip Lyons, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, said at an event honoring the organization’s twenty-fifth anniversary.

One possible solution, U.S. Agency for International Development Administrator Rajiv Shah suggested, would be to invest more in mapping so global health programs and the national and sub-national governments they support can better “understand the market” for the services they seek to provide.

If donors and organizations can use mapping and data visualizations to identify where pregnant mothers and babies are not being served for HIV, Shah explained, then they can probably assume those populations are in need of a variety of other health services — many of which are complicated by the immune system deficiencies posed by HIV.

The USAID chief pointed out that with a better understanding and better visualizations of how and where maternal and child deaths occur, the health community can draw on the broad bipartisan and global support that has grown up around HIV programs — in particular, the President’s Emergency Plan for AIDS Relief — to use HIV diagnostics and childhood antiretroviral treatments as a “point of the spear” for an integrated package of health interventions that preferentially target women and children.

Deborah Birx, the Obama administration’s new global AIDS coordinator, found Shah’s mapping suggestion so compelling that she promised to leave the panel and get to work on building out PEPFAR’s mapping tools.

“We will go back today and work on that,” Birx said, calling the launch of a new mapping effort a “key announce-able” for an event on Wednesday which will highlight other programmatic shifts in USAID’s and its partners’ maternal and child health interventions.

Despite PEPFAR’s and the Global Fund’s advances in the fight against HIV and AIDS, which Michael Gerson, the Washington Post columnist who moderated the panel, referred to as a “great success of science as a humane enterprise,” 58 percent of eligible adults receive antiretroviral treatments, while only 28 percent of eligible children do. 3.2 million children are currently living with HIV, and 2 million of them do not have access to treatment.

Children can be more difficult to diagnose, and the stigma associated with HIV in many parts of the world often dissuades parents from seeking testing and treatment.

That means, according to Lyons, that many of the children we believe to be dying of causes like diarrhea, pneumonia, and infections, are actually unreported and undiagnosed victims of HIV. If so, estimates placing HIV as the cause of 3 percent of under-five child mortality are actually too low, and could contribute to insufficient political support for childhood HIV funding, she added.

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