“When I was 30 years-old, I was surprised to learn that I was pregnant,” said Prem Paika, who lives in Chiang Mai, Thailand. “My partner, who I had been with for the past eight years, thought he was infertile, so we did not use any birth control.”

Ms Paika was also concerned because she and her partner had been diagnosed with HIV five years earlier. She had been taking antiretroviral medicine for the past few years and went to consult with the doctor overseeing her HIV treatment at a public hospital. 

“I was very worried my baby would have HIV, but my doctor reassured me that the antiretroviral medicine would protect my baby,” said Ms Paika.

Untreated, women living with HIV have a 15–45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, that risk drops to under 5% if antiretroviral medicines are given to both mother and child through the stages when infection can occur.

Thailand has made the elimination of new HIV infections among children a priority and has consistently adapted its prevention of mother-to-child transmission programme in accordance with the latest research findings. The country is currently following the World Health Organization’s guidelines to provide lifelong antiretroviral medicine to all pregnant women living with HIV. The Ministry of Public Health has implemented measures in its hospitals to ensure that mothers living with HIV receive key services.

“We have developed a system in hospitals where the mother’s confidentiality is guaranteed. Health sector staff have been trained to communicate well with their patients,” said Danai Teewanda, Director from the Bureau of Health Promotion at the Ministry of Public Health in Thailand.

Ms Paika found her regular doctor supportive and she was happy because the hospital provided psychological counselling for her through her pregnancy and until her child was one year old. She could also access her HIV treatment and receive her antenatal check-ups in the same hospital and so did not have to travel from one part of town to another, visiting different specialists.

However, despite efforts by Thailand’s health authorities to create a supportive environment, stigma remains a problem among staff working in other health areas. Ms Paika found that the hospital’s gynaecologist treated her badly and was often misinformed.

“From my first antenatal examination, the gynaecologist encouraged me to have an abortion. He wouldn’t let me see the sonogram as he said in any case there was no point. He told me my baby only had a 2% chance of being born free of HIV.”

Ms Paika turned to her HIV treatment doctor for comfort and her partner complained to the hospital’s director. After this, she found that the gynaecologist treated her better. Finally, the big day arrived: she gave birth to a baby girl.

“They provided her with an antiretroviral prophylaxis and she was tested at one month and then every six months. She was HIV-negative each time. I am so happy she is free of HIV,” said Ms Paika.

Through its efforts, Thailand has achieved remarkable progress in eliminating new HIV infections among children. In 2014, country programme data showed that almost 95% of HIV-positive pregnant women received antiretroviral medicines to reduce the risk of HIV transmission and almost 98% of their babies were born free of HIV.

The country is hoping to further reduce new HIV infections among children. “We have a few weak spots, such as early detection. We are encouraging women to seek antenatal care within the first 12 weeks of their pregnancy,” said Mr Danai.

Since 2013, Thailand has provided free antenatal services to pregnant women at all health centre facilities, promoted HIV counselling and testing for couples and provided antiretroviral medicines to infants as soon as possible after birth. The country hopes by 2016 to have virtually eliminated new HIV infections among children.

Senior government health authorities from Thailand were among representatives from 20 countries who attended the 10th Asia–Pacific United Nations Elimination of Parent-to-Child Transmission of HIV and Syphilis Task Force meeting in Beijing, China, from 15 to 17 September. The meeting examined regional successes, but also roadblocks to stopping new HIV infections among children.

A new three-part series on faith-based health care published in The Lancet this week has outlined the importance of faith-based organizations in achieving universal health coverage and an adequate standard of health care for all people, especially in resource limited settings and for marginalized groups.

The Lancet Series explores the provision of health care by faith based organizations and examines the nexus of faith, religion and health care controversies.  The series was launched at an international conference at the World Bank on “Religion and Sustainable Development: Building Partnerships to End Extreme Poverty”.

The series argues that the extensive experience, strengths and capacities of faith-based organizations offer a unique opportunity to improve health outcomes and that faith-based health providers play an important part in meeting public health needs.

Katherine Marshall, senior fellow at Georgetown University’s Berkley Center for Religion, Peace, and World Affairs, and Sally Smith, UNAIDS adviser on faith-based organizations, commented on The Lancet Series, religion and Ebola. They outlined how the uptake of health services and the success of health systems' interface with communities are affected by complex interrelationships between culture, tradition, religion, stigma and discrimination. They wrote that HIV has demonstrated this clearly over many years and that the Ebola crisis has also shown that interdisciplinary approaches to public health are critical to success. 

Speaking at the conference on the response to the Ebola crisis, Sheikh Abu Bakarr Conteh, President of the Inter-religious Council of Sierra Leone, highlighted the work the Sierra Leone Inter-religious AIDS Network (SLIRAN) has done to provide support to Ebola survivors and address stigma and discrimination towards them. Created by the Council primarily to support work with people living with HIV, SLIRAN was able to draw on their rich experience in raising awareness and mobilizing religious congregations for HIV services and in providing care and support for people living with HIV. 

Presentations at the conference focused on reviewing the evidence base and developing specific recommendations for action to strengthen effective partnerships between religious and faith-based groups and the public sector. Both The Lancet Series and the conference made recommendations for future action and partnerships.

UNAIDS was closely involved in shaping and developing The Lancet Series and in organizing key sessions at the conference. UNAIDS shared with participants evidence on the extent, scale and nature of partnerships with the faith community in providing services for HIV. An additional contribution was a discussion on how partnerships and skills developed over 30 years of responding to HIV have been mobilized quickly and effectively to support the Ebola response. 

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Without addressing HIV among marginalized populations and human rights, it will not be possible to end the AIDS epidemic as a public health threat by 2030, according to experts at a World Health Assembly side event.

A high-level panel, which included UNAIDS Executive Director Michel Sidibé, called on health ministers to pledge to remove structural barriers to accessing HIV services and health care for all. The speakers also stressed the need for political commitment to leave no one behind. Ensuring that marginalized populations are not excluded from the universal health coverage target of the next sustainable development goals will be vital, they noted.

According to the participants, there is a risk that countries could seek to advance progress towards universal health coverage by focusing on easier to reach populations. In order to ensure that no one is left behind, measures will be needed to reduce the discrimination facing all marginalized groups and to ensure their meaningful participation in the development and implementation of health strategies.

The event set the stage for further dialogue among ministers of health to promote sharing of experiences on securing access to HIV services and health care for all.

Organized by the International HIV/AIDS Alliance, co-hosted by Luxembourg, Morocco and Ecuador and supported by UNAIDS, the event took place on 19 May at the International Red Cross and Red Crescent Museum in Geneva, Switzerland.

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Global health partners met in Geneva to begin the process of building a new approach to better determine health needs and constraints and addressing them in countries.

The new framework, the Equitable Access Initiative, aims to better inform international decision making processes on health and development, particularly where they rely on traditional gross-national-income classification as a measure of where to invest global health resources.

Relying solely on gross national income to determine investment priorities in global health has been increasingly questioned by partners.

Economic growth is lifting many countries from low- to middle-income status, yet those classifications and criteria may be too simple to capture overall needs and capacities.

Countries classified as middle-income are often in need of substantial resources to respond to disease burden, as a steadily larger percentage of those affected by the diseases live in middle-income countries.

Participants in the meeting discussed how the absence of new strategies to ease the transition of countries from low-income to middle-income status has led to a substantial risk of countries not being able to maintain or improve health outcomes. The initial meeting of the Equitable Access initiative was held on 23 February 2015 and co-chaired by Pascal Lamy, the Honorary President of Notre Europe, and Donald Kaberuka, the President of African Development Bank Group. The meeting, hosted by the WHO, was co-convened by Gavi, the Vaccine Alliance; The Global Fund to Fight AIDS, TB, Malaria; UNAIDS; UNICEF; UNDP; UNFPA; UNITAID; WHO and the World Bank.

The meeting looked at a process of engagement that may culminate in recommendations on how to support countries as they make vital health investments as they transition from low-income to middle-income status.

The Equitable Access Initiative seeks to establish a new way to measure a country's health needs and capacities, aimed towards sustainability, and in addition to propose nuanced health classifications that go beyond traditional economic metrics such as national income levels and are more relevant for better health outcomes. The initiative will be firmly grounded in human rights and will uphold the need for zero discrimination in access to medicines and health services.