PMTCT

There are around 1.4 million people living with HIV in China and women make up around 23.7% of them, according to the latest data from Chinese health authorities. Among those living with HIV are pregnant women who are in a particularly vulnerable position due to the stigma surrounding the disease.

In order to counter such stigma and discrimination, women living with HIV and Hepatitis B came together at The Voice of Resilience event to tell their stories and to call for additional resources for community-based organizations (CBOs) working on the frontlines providing services for women living with and affected by HIV.

In 2023 alone, more than 5,000 pregnant women were diagnosed with HIV and over 400,000 with hepatitis B, and some of them were diagnosed at very late stage to be able to receive HIV services to prevent transmission to their children, according to China’s National Health Commission. Even though services are in place to prevent the transmission of HIV to their babies, discrimination, including denial of healthcare, obstructs women from accessing such services.

“I received a call from the doctor telling me that I couldn’t receive services from their hospital because I was HIV positive,” explained Xia Jing, one of the mothers, after she went to a general hospital in Beijing for a routine maternal exam. She still cannot hold her tears when she remembers her traumatic experience. She challenged back and told the doctor r that under the law they had no right to reject her.

She was eventually referred to Beijing’s You’an Hospital, a designated hospital for infectious diseases and people living with HIV where she delivered her baby. Now she is a happy mother of a four-year-old boy. Doctor Zhu Yunxia was the doctor who helped Jing deliver her baby. Dedicated to her job for more than 30 years, she is proud of having helped so many women deliver healthy babies. She calls for empathy with people facing discrimination and unfair treatment and urges all people to look at women living with HIV without prejudice.

“Stigma undermines public health objectives by creating barriers to accessing health and social services and can reduce the quality of the services that members of affected communities receive,” said Mark Vcislo, the First Secretary at Canadian Embassy to China, which has supported the work to tackle stigma. He called for breaking down “the prejudices that can prevent and deter marginalized communities, including persons living with HIV, from accessing the health and social services they need and deserve.”

Community-based organizations (CBO) are vital support for women living with HIV. Sister Xin, for instance, who herself received help from community volunteers when she was first diagnosed with HIV, created Firefly, a community-based organization that has help more than 20,000 women living with HIV in the last 20 years. Zhang Yu whose CBO supports women living with HIV in rural areas of China’s southwestern Yunnan Province, called for more resources for CBO’s work. “CBOs are struggling with their survival due to lack of resources,” she said. “I sincerely hope the government, the charity organizations and everybody can support us to continue our work.”

China has developed a strong and ambitious plan to significantly reduce the transmission rates of HIV, syphilis, and hepatitis B by 2025 outlined in China Women’s Development Plan and Healthy China 2030. China has achieved around 99 percent national screening rates among pregnant women living with HIV over the past five years. In 2023 alone, more than 9 million pregnant women have received HIV testing services. 

The Chinese government has partnered with UN agencies for the “last mile” by building a patient-centred and family-centred community service model to enable a holistic set of services and help break the barriers for both mothers and infants.

“Thanks to the combination of development of technology and social progress, women living with HIV can today give birth to healthy babies,” said Sister Xin.

Read the profile of the storytellers and more unsung community heroes committed to  helping mothers and babies: http://www.unaids.org.cn/page122?_l=en&article_id=1233.

Despite significant gains in many countries, critical gaps continue to undermine efforts to end AIDS in children

GENEVA/MUNICH, 22 July 2024—Despite progress made in reducing HIV infections and AIDS-related deaths among children, a new report released today by the Global Alliance for Ending AIDS in Children by 2030 shows that an urgent scale up of HIV services in countries worst affected by the pandemic is required to end AIDS by 2030.

The report, Transforming Vision Into Reality, shows that programmes targeting vertical transmission of HIV have averted 4 million infections among children aged 0-14 years old since 2000. Globally, new HIV infections among children aged 0-14 years old have declined by 38% since 2015 and AIDS-related deaths have fallen by 43%.     

Among the 12 Global Alliance countries, several have achieved strong coverage of lifelong antiretroviral therapy among pregnant and breastfeeding women living with HIV, with Uganda nearing 100%, United Republic of Tanzania at 98%, and South Africa at 97%. Mozambique has achieved 90% coverage, with Zambia at 90%, Angola at 89%, Kenya at 89%, Zimbabwe at 88%, and Cote d'Ivoire at 84%.

“I applaud the progress that many countries are making in rolling out HIV services to keep young women healthy and to protect babies and children from HIV,” said UNAIDS Executive Director, Winnie Byanyima. “With the medicines and science available today, we can ensure that all babies are born – and remain – HIV-free, and that all children who are living with HIV get on and stay on treatment. Services for treatment and prevention must be ramped up immediately to ensure that they reach all children everywhere. We cannot rest on our laurels. The death of any child from AIDS related causes is not only a tragedy, but also an outrage. Where I come from, all children are our children. The world can and must keep its promise to end AIDS in children by 2030.”

Global Alliance countries are innovating to overcome barriers and accelerate progress towards ending AIDS in children. However, despite advances neither the world nor Global Alliance countries are currently on track to reach HIV-related commitments for children and adolescents and the pace of progress in preventing new HIV infections and AIDS-related deaths among children has slowed in recent years.

“Accelerating the delivery and uptake of HIV services for children and adolescents is a moral obligation, and a political choice,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Twelve countries are demonstrating they have made that choice, but significant challenges remain. While we have made progress in increasing access for pregnant women to testing and treatment to prevent vertical transmission of HIV, we are still far from closing the paediatric treatment gap. We need to further strengthen the collaboration and reach of the Global Alliance, and we must do this work with focus, purpose and in solidarity with all affected mothers, children, and adolescents.”

Around 120 000 children aged 0-14 years old became infected with HIV in 2023, with around 77 000 of these new infections occurring in the Global Alliance countries. AIDS-related deaths among children aged 0-14 years old numbered 76 000 globally with Global Alliance countries accounting for 49 000 of these unnecessary deaths. Vertical transmission rates remain extremely high in some locations, particularly in Western and Central Africa, with rates exceeding 20% in countries including Nigeria and the Democratic Republic of the Congo.

“In the fight against HIV, we must do a much better job for children,” said Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which provides funding for HIV programmes in over 100 countries through a country-led partnership model. “In support of national programmes, we have been procuring the latest dolutegravir-based paediatric treatment regimens at negotiated prices. Our investments in laboratory systems are helping ensure exposed infants are rapidly tested and that those that test positive are quickly initiated on age-appropriate antiretroviral treatment. Differentiated testing and treatment approaches are helping close the diagnostic gap and ensuring more child-centred service delivery.”

It is concerning that the treatment gap between adults and children continues to widen.

“Just 57 per cent of children living with HIV receive life-saving treatment, compared to 77 per cent of adults,” said UNICEF Associate Director HIV/AIDS, Anurita Bains. “Without early and effective testing and treatment, HIV remains a persistent threat to the health and well-being of children and adolescents and puts them at risk of death. To close the treatment gap, we must support governments to scale up innovative testing approaches and ensure children and adolescents living with HIV receive the treatment and support they need.”

In 2023, there were 210 000 new infections globally among young women and girls aged 15—24 years old (130 000 in Global Alliance countries), four times higher than the 2025 goal set at 50 000. Preventing new infections among this age group is critical both to protect the health and wellbeing of young women and to reduce the risk of new infections among children.

Gender inequalities and human rights violations are increasing women’s vulnerability to HIV and diminishing their ability to access essential services. Globally, nearly one in three women have encountered some form of violence during their lifetime, with adolescent girls and young women disproportionately affected by intimate partner violence. In the four Global Alliance countries with available data, countries are not currently on track to achieve the target of ensuring that by 2025 less than 10% of women, key populations and people living with HIV experience gender-based inequalities and gender violence.

"It has been remarkable to see how many more children's lives can be saved when all stakeholders and partners come together to commit to end AIDS in children. While much progress has been made, notably through the successful introduction of pediatric dolutegravir, large gaps still remain across the pediatric cascade and we must recommit ourselves with purpose and innovation to fulfill the promises we have made by 2025 and beyond,” said Ambassador John N. Nkengasong, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy.

The Global Alliance for Ending AIDS in Children by 2030 was launched in 2022 by WHO, UNICEF and WHO to reinvigorate the paediatric HIV agenda. It has now grown, and in addition to the United Nations agencies, the alliance includes civil society movements, including the Global Network of People living with HIV, national governments in the most affected countries, and international partners, including PEPFAR and the Global Fund. Twelve countries are members: Angola, Cameroon, Côte d'Ivoire, The Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Ibu Mawar (not her real name) learned she was living with HIV after receiving a test during an antenatal care visit.

 “I was surprised, of course, when they told me. But I didn’t really doubt or deny the result,” she remembered from the Sorong City Health Office in West Papua. She immediately started treatment to prevent transmission to her son. “Even though I’m positive,” she said, “our child is not.”

In principle, since 2009 every pregnant woman receiving antenatal care in Indonesia should receive an HIV test. And every woman found to be living with HIV should receive medicines to prevent transmission to their babies just as Ms Mawar did.

But this isn’t yet the reality.

In 2022 more than one-third (37%) of all pregnant women in Indonesia did not get screened for HIV and just 18% of mothers living with HIV had access to antiretroviral therapy. There were an estimated 2800 new HIV infections among children that year.

But now stakeholders in Indonesia are mobilising. Not only will they scale-up prevention of mother-to-child HIV transmission services, but they will work toward eliminating vertical HIV transmission while assuring the health and wellbeing of women and children living with HIV. At the centre of this approach is the engagement of women, who comprise roughly one-third of the adult population living with HIV.

In June 2023 Indonesia established the National Alliance to End AIDS in Children. This partnership between government, civil society and international organizations seeks to provide access to health services and support for women and children living with HIV. It has committed to three main priorities. The first is advocacy for the needs of adolescent girls and children living with HIV. Second is promotion and dissemination of information on Prevention of Mother-to-Child Transmission (PMTCT), Early Infant Diagnosis, treatment literacy and comprehensive sexual education. And third is the empowerment of communities regarding issues pertaining to children living with HIV.

The Alliance’s first major initiative was an Elimination of Mother-to-child Transmission symposium—the first ever in Indonesia. Partners have embraced the World Health Organization (WHO) triple target of eliminating mother-to-child transmission of HIV, syphilis and hepatitis B by 2030. A series of sessions were delivered in-person and online. A total of 115 participants from the government, communities, academia, healthcare and media joined the EMTCT Symposium in Jakarta.

Dr. Laila Mahmudah, Head of the Neo Maternal Division at the Ministry of Health, underlined the importance of accelerating EMTCT efforts across the range of issues. She noted that currently 66% of pregnant women received hepatitis B early detection services while just 25% of pregnant women are tested for syphilis.

Multisectoral stakeholders and participants discussed strategies with participants from Malaysia and Thailand, which have both received EMTCT validation for HIV. Dr Anita Suleiman, Director of Disease Control of the Ministry of Health of Malaysia, pointed to the importance of effective leadership and health system governance for country-wide implementation.

“One of the lessons from countries that achieved EMTCT is that it is possible to end AIDS and vertical transmissions, especially in low-prevalence regions like Indonesia, through robust governance and good-quality performance. Indonesia can also achieve EMTCT by 2030, and I hope this symposium leverages the coordination efforts towards the elimination of HIV, syphilis and hepatitis B,” said Dr Shafflq Essajee, Senior Advisor, HIV, UNICEF New York.

However, it was emphasised that political commitment must be bolstered by community-led strategies to reach and retain mothers living with HIV. Community mobilization and community health workers are critical approaches. Ikatan Perempuan Positif Indonesia (IPPI), the national network of women living with HIV, also endorsed the Thai approach of providing free formula for mothers living with HIV in low-resource districts.

Ayu Oktariani, IPPI National Coordinator and a member of the National Alliance to End AIDS in Children reiterated her organization’s commitment to implementing the community-led strategies in support of EMTCT in the coming years.

“This Symposium means more than words I can explain,” said Ayu Raka from the Akar Cinta Kasih Foundation, a community organisation in Bali. “When I return to Bali, I will advocate for EMTCT with local multisectoral stakeholders and communities in my region. I am confident we can make a healthier society and improve health for all mothers and babies.”

UNAIDS Country Director for Indonesia, Krittayawan Boonto, promised the continuous backing of UNAIDS.

“We will continue to support not only mothers, but also fathers, in protecting babies from new HIV infections. I wish for Indonesia to become the fifth country in Asia Pacific to achieve EMTCT. But we can only do it with the leadership of communities,” she ended.