Reduce the proportion of infants infected with HIV by 20 per cent by 2005 and by 50 per cent by 2010*

Prevent mother-to-child transmission of HIV

The challenge

WHO, UNICEF and UNAIDS, Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector, 2008.

In 2007, an estimated 1.5 million [1.2–1.8 million] pregnant women in low- and middle-income countries were living with HIV. Close to 90 per cent of all pregnant women living with HIV in low- and middle-income countries live in 20 countries, and 75 per cent are concentrated in 12 countries, which include South Africa, Nigeria, United Republic of Tanzania and Mozambique.

Preventing new HIV infections among women is critical not only for their own health but also to reduce future HIV infections among infants, especially in sub-Saharan Africa, where half the female population is of childbearing age. This is even more important as far too few pregnant women are aware of their HIV status. In 2007, only 18 per cent of pregnant women in low- and middle-income countries where data were available received an HIV test.

Each year, many children are newly infected with HIV, mainly through mother-to-child transmission. An overwhelming majority—more than 90 per cent—of HIV infections in infants and children are passed on by mothers during pregnancy, labour, delivery or breastfeeding. Without any intervention, between 15 per cent and 45 per cent of infants born to mothers living with HIV will become infected (5–10 per cent during pregnancy, 10–20 per cent during labour and delivery and 5–20 per cent through breastfeeding). Approximately 50 per cent of infants infected with HIV from their mothers die before their second birthday. The transmission of HIV infection from mother to child can be sharply reduced if antiretrovirals are administered to a woman during pregnancy and delivery and to her infant shortly following its birth.

Reducing HIV transmission from a pregnant woman living with HIV to her infant requires a range of interventions beginning with voluntary and confidential counselling and testing for pregnant women; followed by antiretroviral prophylaxis for pregnant women with HIV and their newborn baby or antiretroviral therapy for the mother if eligible, safe delivery practices and guidance in selecting a suitable infant-feeding option in order to prevent mother-to-child transmission (PMTCT) of HIV.

Progress

The majority of countries are making substantial progress towards preventing mother-to-child transmission of HIV. Low- and middle-income country reports show that about 33 per cent of pregnant women living with HIV—491,000 of the total estimated 1.5 million pregnant women living with HIV—received antiretrovirals to prevent mother-to-child transmission in 2007. This represents a noteworthy increase from 23 per cent in 2006, 15 per cent in 2005 and 10 per cent in 2004. Certain countries have succeeded in dramatically reducing transmission by increasing the coverage of interventions to prevent mother-to-child transmission. The estimated mother-to-child transmission declined from 30.5 per cent in 2001 to 11.4 per cent in 2007 in Cambodia and from 30.5 per cent in 2001 to 8.9 per cent in 2007 in Rwanda.

Progress is especially noticeable in sub-Saharan Africa. In western and central Africa, the number of pregnant women with HIV who received antiretrovirals to prevent mother-to-child transmission increased 5.5-fold between 2004 and 2007. However, despite this increase, only 11 per cent [range 10–13 per cent] of pregnant women who needed antiretrovirals had access in 2007 in this sub-region. Coverage with antiretrovirals in eastern and southern Africa, which includes 12 of the 20 countries with the highest numbers of pregnant women with HIV, increased four-fold, reaching 403,000 women in 2007 versus 106,700 women in 2004 (coverage of 43 per cent [range 40–47 per cent])

Percentage of HIV-infected pregnant women who received antiretrovirals for PMTCT in low- and middle-income countries, 2004–2007

Note: The lines on the bars show the uncertainty bounds for the estimates. Data were insufficient to calculate an average for the Middle East and North Africa region.

Source: UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third Stocktaking Report, New York, 2008. UNICEF calculations based on data collected through the PMTCT and Paediatric HIV Care and Treatment Report Card process and reported in Towards Universal Access: Scaling up HIV services for women and children in the health sector – Progress Report 2008 (UNICEF, UNAIDS, WHO), pp. 19, 43. Regions were recalculated according to UNICEF classification of regions.

In general, coverage of antiretrovirals for PMTCT depends on a multitude of factors, including uptake of HIV testing, early reporting of women for antenatal care, attendance at delivery by skilled personnel, and health-system infrastructure, including laboratory and human resource capacity. Strong political commitment and leadership, enabling policies and the adoption of innovations in service delivery – namely, the introduction of provider-initiated testing and counselling, combined with rapid testing with same-day results, within antenatal and delivery care settings – have contributed to increasing access and uptake of HIV testing in the context of PMTCT. Despite the marked increase in access to PMTCT services during the past year, the world is far short of the 80 per cent coverage target. Poor geographical service reach, aggravated by weak health systems, and the fear, stigma and denial that discourage women from being tested for HIV are significant barriers to wider uptake of PMTCT services.

Notes

*Follows the United Nations General Assembly Special Session (UNGASS) on HIV and AIDS goals.

References

UNAIDS, Report on the global AIDS epidemic, Geneva, 2008.

Expanded Inter-Agency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and their Children, A Report Card on Prevention of Mother-to-Child Transmission of HIV and Paediatric HIV Care and Treatment in Low- and Middle-Income Countries: Scaling up Progress from 2004–2005, 2007.

UNAIDS and WHO, Aids Epidemic Update, Geneva, 2007.

UNICEF, Progress for Children: A World Fit for Children Statistical Review, No. 6, New York, 2007.

UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third Stocktaking Report, New York, 2008.

UNICEF, UNAIDS and WHO, Children and AIDS: Second Stocktaking Report, New York, 2008.

UNICEF, UNAIDS and WHO, Children and AIDS: A Stocktaking Report, New York, 2006.

WHO, UNICEF and UNAIDS, Towards Universal Access: Scaling up HIV Treatment, Care and Prevention Interventions in the Health Sector, Geneva, 2008.