Preventing mother to child transmission

GENEVA, 13 July 2023—A new report released today by UNAIDS shows that there is a clear path that ends AIDS. This path will also help prepare for and tackle future pandemics and advance progress towards achieving the Sustainable Development Goals. The report, ‘The Path that Ends AIDS’, contains data and case studies which highlight that ending AIDS is a political and financial choice, and that the countries and leaders who are already following the path are achieving extraordinary results.

Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe have already achieved the “95-95-95” targets. That means 95% of the people who are living with HIV knowing their HIV status, 95% of the people who know that they are living with HIV being on lifesaving antiretroviral treatment, and 95% of people who are on treatment being virally suppressed. A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65% of all people living with HIV, are also close to doing so.

“The end of AIDS is an opportunity for a uniquely powerful legacy for today’s leaders,” said Winnie Byanyima, Executive Director of UNAIDS. “They could be remembered by future generations as those who put a stop to the world’s deadliest pandemic. They could save millions of lives and protect the health of everyone. They could show what leadership can do.”

The report highlights that HIV responses succeed when they are anchored in strong political leadership. This means following the data, science, and evidence; tackling the inequalities holding back progress; enabling communities and civil society organizations in their vital role in the response; and ensuring sufficient and sustainable funding.

Progress has been strongest in the countries and regions that have the most financial investments, such as in eastern and southern Africa where new HIV infections have been reduced by 57% since 2010.

Thanks to support for and investment in ending AIDS among children, 82% of pregnant and breastfeeding women living with HIV globally were accessing antiretroviral treatment in 2022, up from 46% in 2010. This has led to a 58% reduction in new HIV infections among children from 2010 to 2022, the lowest number since the 1980’s.

Progress in the HIV response has been strengthened by ensuring that legal and policy frameworks do not undermine human rights, but enable and protect them. Several countries removed harmful laws in 2022 and 2023, including five (Antigua and Barbuda, the Cook Islands, Barbados, Saint Kitts and Nevis, and Singapore) that have decriminalized same-sex sexual relations.

The number of people on antiretroviral treatment worldwide rose almost fourfold, from 7.7 million in 2010 to 29.8 million in 2022.

However, the report also sets out that ending AIDS will not come automatically. AIDS claimed a life every minute in 2022. Around 9.2 million people still miss out on treatment, including 660 000 children living with HIV.

Women and girls are still disproportionately affected, particularly in sub-Saharan Africa. Globally, 4,000 young women and girls became infected with HIV every week in 2022. Only 42% of districts with HIV incidence over 0.3% in sub-Saharan Africa are currently covered with dedicated HIV prevention programmes for adolescent girls and young women.

Almost one quarter (23%) of new HIV infections were in Asia and the Pacific where new infections are rising alarmingly in some countries. Steep increases in new infections are continuing in eastern Europe and central Asia (a rise of 49% since 2010) and in the Middle East and North Africa (a rise of 61% since 2010). These trends are due primarily to a lack of HIV prevention services for marginalized and key populations and the barriers posed by punitive laws and social discrimination.

Funding for HIV also declined in 2022 from both international and domestic sources, falling back to the same level as in 2013. Funding amounted to US$ 20.8 billion in 2022, far short of the US$ 29.3 billion needed by 2025.

There is an opportunity now to end AIDS by increasing political will by investing in a sustainable response to HIV through financing what matters most: evidence-based HIV prevention and treatment, health systems integration, non- discriminatory laws, gender equality, and empowered community networks.

“We are hopeful, but it is not the relaxed optimism that might come if all was heading as it should be. It is, instead, a hope rooted in seeing the opportunity for success, an opportunity that is dependent on action,” said Ms Byanyima. “The facts and figures shared in this report do not show that as a world we are already on the path, they show that we can be. The way is clear.”

In 2022, an estimated:

• 39.0 million people globally were living with HIV
• 29.8 million people were accessing antiretroviral therapy
• 1.3 million people became newly infected with HIV
• 630 000 people died from AIDS-related illnesses

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.

Globally, only half (52%) of children living with HIV are on life-saving treatment. UNAIDS, UNICEF, and WHO have brought together a new alliance to fix one of the most glaring disparities in the AIDS response.

MONTREAL/GENEVA/NEW YORK, 1 August 2022 – Globally, only half (52%) of children living with HIV are on life-saving treatment, far behind adults where three quarters (76%) are receiving antiretrovirals, according to the data that has just been released in the UNAIDS Global AIDS Update 2022. Concerned by the stalling of progress for children, and the widening gap between children and adults, UNAIDS, UNICEF, WHO and partners have brought together a global alliance to ensure that no child living with HIV is denied treatment by the end of the decade and to prevent new infant HIV infections.

The new Global Alliance for Ending AIDS in Children by 2030 was announced by leading figures at the International AIDS Conference taking place in Montreal, Canada.

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 have joined the alliance in the first phase: Angola, Cameroon, Côte d'Ivoire, The Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

Consultations by the alliance have identified four pillars for collective action:

1. Closing the treatment gap for pregnant and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment;
2. Preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women;
3. Accessible testing, optimized treatment, and comprehensive care for infants, children, and adolescents exposed to and living with HIV;
4. Addressing rights, gender equality, and the social and structural barriers that hinder access to services. 

Addressing the International AIDS Conference, Limpho Nteko from Lesotho shared how she had discovered she was HIV positive at age 21 while pregnant with her first child. This led her on a journey where she now works for the pioneering women-led mothers2mothers programme. Enabling community leadership, she highlighted, is key to an effective response.

“We must all sprint together to end AIDS in children by 2030,” said Ms. Nteko. “To succeed, we need a healthy, informed generation of young people who feel free to talk about HIV, and to get the services and support they need to protect themselves and their children from HIV. mothers2mothers has achieved virtual elimination of mother-to-child transmission of HIV for our enrolled clients for eight consecutive years—showing what is possible when we let women and communities create solutions tailored to their realities.” 

The alliance will run for the next eight years until 2030, aiming to fix one of the most glaring disparities in the AIDS response. Alliance members are united in the assessment that the challenge is surmountable through partnership.

“The wide gap in treatment coverage between children and adults is an outrage,” said UNAIDS Executive Director Winnie Byanyima. “Through this alliance, we will channel that outrage into action. By bringing together new improved medicines, new political commitment, and the determined activism of communities, we can be the generation who end AIDS in children. We can win this – but we can only win together.”

"Despite progress to reduce vertical transmission, increase testing and treatment, and expand access to information, children around the world are still far less likely than adults to have access to HIV prevention, care, and treatment services," said UNICEF Executive Director Catherine Russell. "The launch of the Global Alliance to End AIDS in Children is an important step forward – and UNICEF is committed to working alongside all of our partners to achieve an AIDS-free future."

“No child should be born with or grow up with HIV, and no child with HIV should go without treatment,” said Dr Tedros Adhanom Gheberyesus, WHO Director-General. “The fact that only half of children with HIV receive antiretrovirals is a scandal, and a stain on our collective conscience. The Global Alliance to End AIDS in Children is an opportunity to renew our commitment to children and their families to unite, to speak and to act with purpose and in solidarity with all mothers, children and adolescents.”

Dr. Osagie Ehanire, Minister of Health of Nigeria, pledged to “change the lives of children left behind” by putting in place the systems needed to ensure that health services meet the needs of children living with HIV.

Nigeria, Dr Ehanire announced, will host the alliance’s political launch in Africa at a Ministerial meeting in October 2022.

About 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.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. Follow UNICEF on Twitter and Facebook.

About WHO

Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues, and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable. Learn more at www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube, and Twitch.

New HIV infections among children declined by more than half (53%) globally from 2010 to 2020, but the momentum has slowed considerably. There are particularly large gaps in services to prevent vertical (mother-to-child) transmission of HIV in western and central Africa, home to more than half of pregnant women living with HIV who are not on treatment. 

Nigeria accounts for 24% of pregnant women living with HIV worldwide who are not on antiretroviral therapy and is the largest contributor among the seven countries that account for half of all new HIV infections among children globally. One in every seven babies born with HIV in the world is a Nigerian baby. Because of this, there is an urgent need to scale up sustainable programmes for the elimination of vertical transmission of HIV in the country, and the government has committed to end vertical transmission by the end of 2022.

The Nigerian Minister of Health, Osagie Ehanire, chaired a national consultation on vertical transmission of HIV in May 2021 and pledged the government’s full support and commitment to work with all partners in order to ensure that no baby is born with HIV, directing the National AIDS, Sexually Transmitted Infections Control and Hepatitis Programme (NASCP) to provide technical support to all Nigerian states to develop actionable operational plans to meet the objective. In addition, the Federal Ministry of Health has delivered 1.7 million of the 4 million HIV and syphilis test kits ordered as a step towards ensuring that all pregnant women are screened, regardless of where they live in the country.

“The procurement of the HIV test kits is a powerful demonstration of political leadership and country ownership by the Government of Nigeria for an AIDS-free generation. As a priority, the United Nations Joint Team on AIDS remains committed to fully support the government in its efforts to eliminate vertical transmission of HIV in the country,” said Erasmus Morah, the UNAIDS Country Director for Nigeria.

NASCP, supported by the National Agency for the Control of AIDS (NACA), is providing technical support to all Nigerian states, but with a priority given to five states—Abia, Anambra, Ebonyi, Kaduna and Taraba. The Joint Team has provided financial and technical support, including support for data analysis for each state. Each state is driving its own planning process and choice of strategy and key activities.

According to the government, Anambra state has an HIV prevalence of 2.2%. In 2020, less than 30% of pregnant women were tested for HIV and less than a quarter of pregnant women living with HIV accessed antiretroviral therapy, even though more than 90% of pregnant women attended a health facility for antenatal care in Anambra. There was a 73% increase in the estimated number of new HIV infections among children in the state from 2015 to 2020. Given its HIV prevalence, and the increase in new HIV infections among children, Anambra was recently supported to develop an operational plan for the elimination of vertical transmission of HIV.

The state’s leadership, including the Secretary of the State Government, Solo Chukwulobelu, and Anambra’s Commissioner for Health, Vincent Okpala, met together with representatives of NASCP, NACA and the United Nations Joint Team. The resulting Framework for Anambra State Action to Eliminate Mother-to-Child Transmission of HIV provides a summary of the current provision of services to prevent vertical transmission of HIV in the state and outlines strategies to reach every pregnant woman in the state, the state government’s commitments and key activities, along with timelines. The framework provides specific action by service providers from both the private and public sectors to reach every pregnant woman in the state with HIV testing services and provide antiretroviral therapy and viral load testing to every pregnant women who tests HIV-positive. The framework also commits to ensuring antiretroviral therapy prophylaxis at birth and early infant diagnosis of HIV for every infant, along with continuity of care for both mothers and their babies. The federal and state governments and existing donors will fund the initiative.

Akudo Ikpeazu, the National Coordinator of NASCP, said, “It’s important to work extensively with the First Lady of the State as a Champion for Eliminating Mother-to-Child Transmission of HIV to ensure every pregnant woman is reached in Nigeria.”

GENEVA, 11 August 2021—UNAIDS welcomes the announcement by Chile that it recognizes international responsibility for violating the rights of a woman living with HIV who was sterilized without her consent almost 20 years ago. The government has agreed a friendly settlement with the woman, Francisca, that includes the payment of reparations for the violation of her human rights. It has also committed to ending forced sterilization and to guaranteeing reproductive rights as human rights without discrimination.

Francisca delivered a healthy baby boy in 2002 and was then sterilized without her consent by the doctor who carried out her Caesarean section, making the decision that a woman living with HIV should not be able to have children. The friendly agreement announced this week comes after more than a decade’s litigation by the woman and her legal teams.

“This settlement is a significant moment for women around the world who have been fighting for reproductive justice for decades. Coercive sterilization of women living with HIV is a violation of women’s most fundamental human rights,” said UNAIDS Executive Director, Winnie Byanyima. “Unfortunately, this practice is still happening in many countries and efforts to stop it and bring justice to more women must be stepped up.”

This settlement comes after years of efforts before the Inter-American Commission on Human Rights (IACHR) after an earlier complaint in the Chilean justice system was unsuccessful. The case was litigated by the Chilean organization, Vivo Positivo, and the international human rights organization, Center for Reproductive Rights.

UNAIDS submitted an amicus brief to inform the IAHCR the standards that governments must uphold to address the HIV stigma and discrimination that impact women living with HIV. These include the obligation to respect, protect and fulfil women’s autonomy in decision making on matters related to their sexual and reproductive lives, their right to physical integrity and their right to be free from violence, including from violence by health personnel.

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.

Despite the great progress made since the early days of the HIV epidemic, the HIV response for children is still lagging behind the response for adults.

Children living with HIV are particularly susceptible to tuberculosis (TB), one of the leading causes of AIDS-related deaths. In 2020, according to government statistics, 9400 people died of AIDS-related illnesses in Côte d’Ivoire, including 800 children under the age of 14 years. There were 21 000 people under the age of 15 years living with HIV in the country—only 49% had access to antiretroviral therapy. How to correct such an inequality was the question at the heart of a national consultation on paediatric HIV and TB that was held from 8 to 10 June in Abidjan, Côte d'Ivoire.

The consultation, Acting Together for a Generation without AIDS and Tuberculosis, was aimed at improving the prevention and management of HIV and TB among children and adolescents in Côte d’Ivoire.

In her opening speech, Dominique Ouattara, the First Lady of Côte d’Ivoire, called for “The development of an ambitious road map that will enable Côte d'Ivoire to achieve its commitments.” She invited all the participants to engage in a dialogue on the challenges and priority actions needed, and to discuss the roles, responsibilities and contributions of each partner.

The consultation is part of the Confessional Initiative, a UNAIDS and United States President’s Emergency Plan for AIDS Relief initiative that is organizing national consultations and training in Cameroon, Côte d’Ivoire, Kenya, Nigeria and the United Republic of Tanzania.

“The consultation presented the national situation regarding diagnosis, treatment and prevention of HIV and tuberculosis among children, identified the key challenges, outlined the solutions, priority actions and resources needed to improve the national roll-out of optimal paediatric HIV and tuberculosis treatment and diagnosis and identified good practices for replication through civil society and faith-based organizations,” said Patrick Brenny, the Director for the UNAIDS Regional Support Team for Western and Central Africa.

The targets in the 2016 United Nations Political Declaration on Ending AIDS and in Start Free, Stay Free, AIDS Free for paediatric AIDS have not been met. Globally, during 2020 an estimated 160 000 children acquired HIV, far from the global 2020 target of 20 000. Modelling has also shown that the COVID-19 pandemic could have a major impact on new HIV infections among children in sub-Saharan Africa.

Ms Ouattara appealed to the 350 participants to work towards reducing inequalities and asked all stakeholders to join forces to achieve certification of the elimination of mother-to-child transmission of HIV. “Today, in 2021, no child should die of AIDS or tuberculosis in our country," she added.

Over four consecutive years, no child in the eastern Caribbean country of Dominica was born with HIV, including in 2017 when, within two weeks, the island braved back-to-back hurricanes that ultimately damaged 90% of its infrastructure.

Dominica has now received validation from the World Health Organization (WHO) for the elimination of mother-to-child transmission of HIV and syphilis. It is the eighth Caribbean country or territory to have achieved this dual elimination goal—joining Cuba, which achieved it in 2015, and Anguilla, Antigua and Barbuda, Bermuda, the Cayman Islands, Montserrat and Saint Kitts and Nevis, which achieved it in 2017.

During a virtual ceremony, partners reflected on the mix of political, health-care and community components required to create a sustainable framework for preventing HIV and other illnesses in the maternal and child health context.

Roosevelt Skerrit, the Prime Minister of Dominica, reiterated the importance of the government’s commitment to the Sustainable Development Goal health agenda. He noted that the investments made in health infrastructure and systems would help Dominica reach other targets, including a “reduction in maternal and child mortality, universal access to sexual and reproductive health services and universal health coverage.”

“Dominica’s journey to this ambitious achievement represents a cumulation of years of expanding the capacity of its primary care services to address communicable diseases and adopting harmonized and integrated approaches to improving the health outcomes for women and their children within maternal and child health services,” said Carissa Etienne, WHO Regional Director for the Americas and Director of the Pan American Health Organization.

All pregnant women in Dominica are offered HIV and syphilis testing when they enrol for antenatal care. For those found to be positive, treatment is provided free of charge. Access to health services is available to everyone regardless of nationality. And Dominica now provides early infant diagnosis in-country, thereby ensuring accurate and timely care for infants exposed to HIV.

Health-care workers, including a cadre of community health nurses and staff of the National HIV and AIDS Response Unit, who coordinated psychosocial support and care services, were critical for the strategy’s success.

Critically, Dominica worked to strengthen its health information system so it could provide evidence relating to the coverage of antenatal care, testing and treatment services and their impact. The validation process also included assessments on human rights, gender equity and community engagement.    

Meeting the rigorous data and reporting requirements for elimination of mother-to-child transmission certification is a key next step for several Caribbean countries that have already achieved remarkable gains in the prevention of mother-to-child transmission of HIV. Since 2010, the proportion of pregnant women living with HIV in the region receiving antiretroviral therapy to prevent transmission to their babies has doubled. 

The Director of the UNAIDS Caribbean Sub-Regional Office, James Guwani, noted during the ceremony that next month the world will adopt a new United Nations political declaration on AIDS.

“One of the most powerful testaments to our capacity to end the AIDS epidemic is success in ensuring that children are not born with HIV. But the work does not end there,” Mr Guwani said. “We must shift the attitudes and prejudices that make it difficult for families affected by HIV to live, learn, work and play freely. We must give all young people the education, empowerment and access to services they need to remain HIV-free throughout their lives. And we must do a better job at preventing HIV infections at all age groups and among all communities. By putting people first, we can end the AIDS epidemic.”

There have been successes in the commitment to end vertical transmission of HIV (from mother to child). For example, in eastern and southern Africa, 95% of pregnant women living with HIV received antiretroviral therapy to prevent vertical transmission of HIV in 2019.

Such successes have not been universally seen, however. In western and central Africa, the picture is not so positive—coverage of services for the prevention of vertical transmission in the region is among the lowest in the world. In 2019, only 58% of pregnant women living with HIV in the region received antiretroviral therapy to prevent vertical transmission.