A Critical Tool Toward Creating an AIDS-Free Generation

Posted by Eric Goosby
May 12, 2013
Woman Feeds Her Baby a Bottle of Formula

On Mother's Day, we celebrate the many exceptional women in our lives and around the globe. Today, and every day, we are grateful for -- and indebted to -- the billions of mothers and other women who serve as the glue that keeps our families and communities together.

Unfortunately, in the fight against AIDS, women continue to bear a disproportionate burden. In many countries in sub-Saharan Africa, HIV remains the leading cause of death and disease for women of reproductive age, and in the region, 60 percent of those living with HIV are women. Despite these sobering statistics, countless women continue to prosper in the face of seemingly insurmountable odds.

Whether a woman is a mother today, or a mother to be, her health is paramount -- both for her own productivity and quality of life, and that of the next generation. One way that we can help to support women -- and their children -- is by ensuring that all mothers receive the essential health services they need, including for HIV. Moreover, by saving mothers' lives and allowing babies to be born without HIV, we are lessening future health care costs, stabilizing families and communities, and positively impacting economies and nations.

As of September 30, 2012, The United States President's Emergency Plan for AIDS Relief (PEPFAR) directly supported more than 5.1 million people on ART--61 percent of whom are women. In 2012 alone, PEPFAR reached more than 750,000 pregnant women living with HIV with antiretroviral drugs, enabling an estimated 230,000 babies who would have otherwise been infected, to be born without HIV. This is a remarkable achievement, and the pace of progress continues to accelerate.

Through PEPFAR's prevention of mother-to-children transmission (PMTCT) of HIV Acceleration initiative, launched in 2010, we increased investments in the 13 highest burden countries, while working with countries to develop strategies to expand access to quality PMTCT services. These efforts are paying off dramatically. In fact, between 2009 and 2011, we saw a 24 percent decline in the number of new pediatric infections globally, compared to a 23 percent decline in the previous six years.

Since June 2011, PEPFAR has proudly joined with UNAIDS, partner countries, and other key stakeholders to implement the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive. By focusing attention and effort on the 22 countries (21 in sub-Saharan Africa) that account for 90 percent of all new infant HIV infections, the Global Plan has served as a clarion call for uniting diverse partners around this critical and achievable mission.

One new and potentially revolutionary tool that has greatly simplified the approach to PMTCT is Option B+. Option B+ offers all pregnant or breastfeeding women living with HIV lifelong ART, rather than relying on laboratory testing to determine eligibility for treatment. Remarkably, not only can Option B+ reduce mother-to-child transmission of HIV to less than five percent, but it also maintains the mother's health, provides lifelong reduction of HIV transmission to uninfected sexual partners, and supports PMTCT in future pregnancies. Few other public health interventions offer such clear and widespread benefits.

Encouragingly, Option B+ is rapidly gaining momentum around the globe, especially in sub-Saharan Africa. Malawi -- where Option B+ was developed -- is a prime example. After one year of implementation of Option B+, the number of pregnant or breastfeeding women living with HIV on ART in the country increased by an extraordinary 700 percent, and the estimated number of infant infections averted nearly quadrupled.

In addition to being highly effective, Option B+ is also simpler. In Malawi, rollout of this approach enabled pregnant women to receive prenatal care and ART, if they tested positive for HIV, in the same clinic. Option B+ also reduced ART to a single daily pill that could be prescribed by doctors or nurses, lessening the burden for the provider and the patient.

Other countries are quickly moving to follow suit. Uganda, Rwanda, and Haiti have already begun actively implementing Option B+ or are pursuing a phased rollout of the approach. And 15 more countries in sub-Saharan African have officially endorsed, or are preparing to pilot or rollout, Option B+.

As outlined in the PEPFAR Blueprint for Creating an AIDS-free Generation, PEPFAR remains fully committed to working toward the elimination of new HIV infections among children by 2015 and keeping their mothers alive. To reach this goal, we are closely collaborating with partner countries, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and many others. Everyone has a role to play, and we all must step up our efforts.

By improving our ability to expand access to lifesaving HIV treatment for mothers and preventing transmission to their infants, Option B+ will be a game-changer in our collective push to achieve an AIDS-free generation. One future Mother's Day, let's hope that we can all celebrate such an achievement.

About the Author: Eric Goosby serves as U.S. Global AIDS Coordinator and leads the Office of Global Health Diplomacy at the U.S. Department of State.

Editor's Note: This entry originally appeared on The Huffington Post.

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