This Mothers Day, the Global Fund celebrates the progress made for millions of HIV-positive mothers and mothers-to-be around the world, and the treatment which is making it possible for their children to be born with almost no risk of HIV infection. In 2013 and 2014, UNICEF and the Global Fund asked six brave women in South Africa and Malawi to share with us their reflections, hopes and fears as they went through their pregnancies and delivery of their babies, as well as the early months after birth.
Each year, approximately 1.5 million women living with HIV give birth. With no medical intervention, the risk of passing on the virus to their babies during pregnancy, delivery and the breastfeeding period can be as high as 45%. But today, treatment for Prevention of Mother-to-Child-Transmission or PMTCT, can be delivered in a single pill, taken once a day, which reduces that risk to 5% or less. The health of both a mother and her child depends on a broader package of health services, but as a component of those services PMTCT has proven to be remarkably effective.
For mothers like Lexina, Posha, Rita, Siphiwe, Queen and Luchrecia, the news that they were pregnant wasn’t something to be happy about at first. “I cried like somebody’s dead,” Luchrecia remembers. Having tested positive for HIV years earlier, she didn’t think of having another child for fear of the baby being born HIV-positive. But each of these mothers received treatment for prevention of mother-to-child transmission (PMTCT) and today, Luchrecia’s son Reabetso is the picture of health, a source of pure joy to his mother, father and siblings. All early tests show him to be HIV-negative.
Globally, the impact of treatment to prevent transmission from mothers to children is undeniable. Although PMTCT was first introduced in 1994, it has taken some time to become widely available. But as access to treatment grew exponentially from 2005 to 2013, infections among children have been cut in half. Malawi recorded the largest decline at 67 percent, while new HIV infections among children declined by 50 percent or more in Botswana, Ethiopia, Ghana, Malawi, Mozambique, Namibia, South Africa and Zimbabwe. Yet there is potential for even greater gains, so that no child is born with HIV. In 2013, three out of ten HIV-positive expectant mothers did not receive ART to prevent the transmission of HIV to their babies.
For mothers like Siphiwe, knowing her HIV status is a critical step toward a healthy child. She took an HIV test only after losing four babies during or just after they were born. “Sometimes when she’s sleeping I fear she’s not alive,” she says of her daughter Lundiwe. Today Siphiwe can laugh at herself for gently waking her daughter up to be reassured that she’s fine. Lundiwe is the picture of health however, and thus far has tested negative, to her mother’s delight.
Twenty-one countries in sub-Saharan Africa account for 90% of HIV transmissions from mothers to children, and therefore are priorities to address the problem. In these countries, the proportion of women accessing ART has doubled in just four years. With Global Fund grants, more than US$ 145 million has been invested in ARVs for HIV-positive pregnant mothers in order to prevent transmission of HIV to their babies.
While the value of keeping both mothers and babies alive and in good health is priceless, the cost of PMTCT is relatively modest: Aspects such as HIV testing, delivery by a skilled birth attendant in a medical setting and other aspects of care are also necessary, but the actual cost of PMTCT medicines for a mother and child is estimated at just US$ 130 per year. Factoring in the HIV testing that a mother should have during pregnancy, this cost is less than 40 cents per day, through the first year of the child’s life. It’s a wise investment when compared to the monetary and societal cost of care for an orphaned child, or one who must begin lifelong treatment at an early age.
The Global Fund works in partnership with UNICEF as well as a range of international and national partners in each country, to provide and expand access to PMTCT services. Through these partnerships, efforts are underway to strengthen package of services to ensure women and children’s health – among them PMTCT. As of end 2014, Global Fund-supported programs had reached 2.7 million women with PMTCT services.
UNICEF works to remove barriers such as poverty, isolation and distance from health care facilities that hinder access to life-saving care for women living with HIV. It does so by working with partners in the countries in which it works to make HIV testing and treatment as widely available as possible, including in remote urban areas. It also promotes the integration of HIV care, treatment and support for women living with HIV and their families into strengthened antenatal, postnatal and child health platforms including at the local level.
Leonie Marinovich, Chiara Frisone, Karin Schermbrucker for UNICEF and The Global Fund
Infographic Data Source: UNAIDS, UNICEF, WHO Global AIDS Response, Progress Reporting and UNAIDS, 2013 estimates
UNICEF, Statistical Update, Children, Adolescent and AIDS, 2014
Published 10 May 2015