Top UN health officials are confident that an HIV-free generation is possible by 2015, but have warned of the need to fully fund HIV/AIDS prevention and treatment programmes to ensure that steady progress in recent years does not fall by the wayside.
“This is an unprecedented moment [of] unprecedented momentum. I urge development partners to support the Global Fund [to Fight AIDS, Tuberculosis and Malaria] in their replenishment,” said World Health Organization Director-General Margaret Chan, speaking on 21 September at an event on the sidelines of the three-day Millennium Development Goals summit at the UN headquarters in New York.
Chan added that without adequate funding all the good will, positive interventions and commitments from countries would amount to little.
The importance of preventing mother-to-child transmission of HIV (PMTCT) to achieve three of the Millennium Development Goals (MDGs) - reducing child and maternal deaths, as well as halting and beginning to reverse the spread of HIV/AIDS - “cuts out the fights and competition”, for funding and programming, Chan noted.
Efforts to achieve the three goals could benefit from various women’s health funding and policy commitments rolled out this week during the summit to mark 10 years since countries committed to the MDGs. But HIV, the leading cause of death among reproductive-age women worldwide, could also serve as a weak link causing women’s health targets to veer off track.
About 45 percent of HIV-positive pregnant women received antiretroviral (ARV) treatment to prevent HIV transmission to their children in 2008, an increase from the 35 percent that were treated in 2007.
Scaling up treatment to the 1.4 million pregnant women living with HIV who needed ARV treatment in 2009 to prevent mother-to-child transmission “can be done,” Jimmy Kolker, UN Children’s Fund (UNICEF) chief of HIV/AIDS, told IRIN/PlusNews before the high-level meeting. “It doesn’t require any specific breakthrough or work that isn’t already there.”
Global Fund seeking pledges
But efforts remain partially dependent on donor countries’ contributions to the Global Fund, a major contributor to PMTCT programmes. The international aid agency is seeking replenishment of US$13-20 billion for a three-year period in a “hugely challenging economic environment”, according to Global Fund Executive Director Michel Kazatchkine.
France pledged $1.4 billion to the Global Fund, which provides a fifth of all financing for AIDS globally, this week; Canada later followed with its own pledge of $540 million, while Germany will provide $25 million to Côte d’Ivoire in a debt swap agreement and Norway announced that it will increase its contribution to the Global Fund by 20 percent for the next three years, making a total contribution of $225 million.
Attention is now shifting to the USA, which is being lobbied by advocacy organizations like ONE to donate $6 billion. Kazatchkine said he was expecting an announcement this week from US President Barack Obama, but although Obama spoke of strengthening the US’s commitment to the Global Fund in his speech at the summit on 22 September, he did not reveal any funding pledges.
The US contributed a record-setting $1.05 billion to the Global Fund for the 2010 fiscal year, but has been criticized for not merging AIDS programming and funding laid out in the US President's Emergency Plan for AIDS Relief (PEPFAR), and in its new $63 billion Global Health Initiative with international strategies.
The Global Fund fell short by $3 billion in its last replenishment in 2007. It reached a partial goal of $10 billion to be distributed over 2008, 2009 and 2010.
“Each single dollar counts and when you cut the money short you jeopardize a few more lives,” said Sipho Moyo, Africa director for ONE. “We need to continue to invest in this. Donors have to put their money where their mouth is.”
Scaling up PMTCT services
High-burden countries, specifically in sub-Saharan Africa, have continued to do their part in tackling mother-to-child transmission of HIV, according to Kazatchkine, switching from sub-optimal single-dose nevirapine to “the most appropriate antiretroviral regimens”.
This gradual shift has resulted in an overall increase of 65 percent in PMTCT budgets in high-burden countries.
Seventy out of 123 reporting countries revealed plans to further scale up PMTCT services in 2008, a jump from the 34 countries that presented such plans in 2005.
Namibia, which has a 15 percent rate of HIV prevalence among adults, was singled out for its success in broadening its PMTCT services since 2005. Now more than 60 percent of HIV-positive pregnant women receive ARV treatment and HIV prevalence among children under one dropped from 13.5 percent in 2006 to 7 percent in 2009, according to Namibian President Hifikepunye Lucas Pohamba.
Chan praised Pohamba for his commitment to eradicating mother-to-child transmission, maintaining the upbeat tone that characterized much of the event.
“Even just a few years ago it would have been inconceivable that a panel discussion about women living with HIV could be called a time for hope,” said UNICEF’s Executive Director Anthony Lake. “A few years ago, for far too many women a diagnosis of HIV meant, in effect, a double death sentence for the mother and the baby.”
Yet it will take more than confidence, agreement on a common strategy to eliminate PMTCT, and adequate funding, to help HIV-positive pregnant women receive testing and treatment on a universal scale, said UNICEF’s Kolker.
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“In every context there are challenges of stigma so mothers are not tested, or don’t come back for the results,” Kolker explained. “Or they take the medicines home but they don’t take them as instructed. Many things must change in attitude and behaviour to make services readily available.”
In 2008, only 5 percent of pregnant women in low- and middle-income countries reported that their male partners were tested for HIV. Kolker said engaging fathers is “absolutely crucial” in making services more widespread and dispelling notions about women having “low moral character” and bringing the infection into their relationships.