On 2 June, The Economist cover story asked, “Can AIDS be beaten?” And I’m here to tell you; the answer is a resounding “Yes”. Maybe not all AIDS but a significant piece of it. For the elimination of mother to child transmission of HIV, victory is in sight. At the recent United Nations High Level Meeting for HIV/AIDS, a Global Plan for the Elimination of Pediatric AIDS (Global Plan) by 2015 was launched. In it was a very detailed roadmap for how we get from where we are to where we want to be.
And where are we? 22 countries in the world shoulder 90% of the pediatric HIV infection burden. Of these, 21 are in sub-Saharan Africa (India is the exception). Some countries, like South Africa, have been remarkably successful in achieving reductions in new pediatric HIV infections. In June, a population study in South Africa reported that national HIV transmission rates from mother to child were 3.5% - which means 96.5% of HIV positive mothers do NOT transmit HIV to their infants during pregnancy, delivery and the first months of infant life. Other countries have had equal results; and others are not doing as well. Nigeria, after South Africa, has the highest burden of HIV among pregnant women with 210,000 mothers infected with the virus. Of these, only 22% are receiving medication that prevents mother to child transmission of HIV. But so many other countries are succeeding in building health systems and providing tests and treatment that contribute to babies born HIV negative and keeping mothers alive to raise them.
Where do we want to go? To a 90% reduction in mother to child transmission of HIV; to less than 5% mother to child transmission rates in each of the 22 high burden countries; and to a 50% reduction in maternal mortality related to HIV/AIDS. And we want to do this by 2015.
How do we get there?
1. Leadership. 5 years ago, South Africa was in the Dark Ages of HIV care with a President and Minister of Health who denied and misled. The new President, Jacob Zuma; and his Minister of Health, Dr. Aaron Motsoaledi, have initiated a period of enlightenment with dramatically effective programs that have been quickly taken to scale.
2. Health Systems. Sub-Saharan Africa has 25% of the world’s disease burden and only 3% of the health care providers. Doctors and nurses trained in Africa frequently leave for better paying jobs and working conditions off the continent; leaving health care facilities chronically understaffed and unable to deliver increasingly effective, yet complex, medical interventions. Health systems need to be strengthened and measures are underway to do this with appropriately trained care providers that can share tasks with doctors and nurses. Mentor Mothers, like the ones employed by mothers2mothers, were cited as an example in the Global Plan.
3. Engage Communities. The best health services are ineffective if people don’t access them. The lives of people living with HIV are complicated. Almost always, HIV isn’t the only challenge people face; and other priorities like finding food, caring for children and the stigma associated with HIV keep people out of care. Communities of people living with HIV need to be engaged in seeking solutions. Health services must leave the facilities and reach out to people in their communities. Local stakeholders must be heard and must contribute to solutions that are most often local.
4. Funds. Here’s the big one. Billions of dollars are going into meeting this challenge; and billions more are needed. The cost of life sustaining antiretroviral drugs has plunged dramatically, from thousands of dollars to one-hundred dollars for one year of therapy. But there have been increases in the number of people needing treatment. At present six million people are receiving drugs for life. Ten million more need these drugs today and aren’t getting them. And exciting evidence from a recent study suggests that by treating more people who are infected with HIV, one can dramatically reduce the number of new people infected. Treatment as prevention. But all of these measures take money. South Africa has invested heavily – both its own money and funds from the U.S. government and the Global Fund. To turn things around in Nigeria, massive investments will be necessary. Other countries are also tapped out; balancing priorities that extend beyond HIV/AIDS related care. And the well is running dry. The United States has been the most generous of countries contributing to fighting the epidemic, yet is being criticized for not doing more. The Global Fund was unable to meet its fund-raising targets for the coming five-years when it called out to donor countries in September 2010; so in the coming years will not be able to reach aspirational levels of funding country efforts to extend care. In June, at the launch of the Global Plan to Eliminate Pediatric AIDS, donors stepped up to make new funding commitments. Johnson & Johnson, Bill and Melinda Gates Foundation, U.S. Government and others matched money with words. Without more money, words will not get it done.
I’m writing from Ground Zero; where each dollar (or pound or Euro) contributes to more mothers being reached with education and support; that contributes to fewer babies born with HIV; that guides more mothers into life-sustaining care; that promotes family planning and fewer unplanned pregnancies; we know. We know that AIDS can be beaten. We see it every day. We see it mother after mother; family after family. We know that a better future is at hand if all hands come together and pull together.
