A new three-part series on faith-based health care published in The Lancet this week has outlined the importance of faith-based organizations in achieving universal health coverage and an adequate standard of health care for all people, especially in resource limited settings and for marginalized groups.

The Lancet Series explores the provision of health care by faith based organizations and examines the nexus of faith, religion and health care controversies.  The series was launched at an international conference at the World Bank on “Religion and Sustainable Development: Building Partnerships to End Extreme Poverty”.

The series argues that the extensive experience, strengths and capacities of faith-based organizations offer a unique opportunity to improve health outcomes and that faith-based health providers play an important part in meeting public health needs.

Katherine Marshall, senior fellow at Georgetown University’s Berkley Center for Religion, Peace, and World Affairs, and Sally Smith, UNAIDS adviser on faith-based organizations, commented on The Lancet Series, religion and Ebola. They outlined how the uptake of health services and the success of health systems' interface with communities are affected by complex interrelationships between culture, tradition, religion, stigma and discrimination. They wrote that HIV has demonstrated this clearly over many years and that the Ebola crisis has also shown that interdisciplinary approaches to public health are critical to success. 

Speaking at the conference on the response to the Ebola crisis, Sheikh Abu Bakarr Conteh, President of the Inter-religious Council of Sierra Leone, highlighted the work the Sierra Leone Inter-religious AIDS Network (SLIRAN) has done to provide support to Ebola survivors and address stigma and discrimination towards them. Created by the Council primarily to support work with people living with HIV, SLIRAN was able to draw on their rich experience in raising awareness and mobilizing religious congregations for HIV services and in providing care and support for people living with HIV. 

Presentations at the conference focused on reviewing the evidence base and developing specific recommendations for action to strengthen effective partnerships between religious and faith-based groups and the public sector. Both The Lancet Series and the conference made recommendations for future action and partnerships.

UNAIDS was closely involved in shaping and developing The Lancet Series and in organizing key sessions at the conference. UNAIDS shared with participants evidence on the extent, scale and nature of partnerships with the faith community in providing services for HIV. An additional contribution was a discussion on how partnerships and skills developed over 30 years of responding to HIV have been mobilized quickly and effectively to support the Ebola response. 

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WASHINGTON DC/GENEVA, 30 June 2015—Cuba today became the first country in the world to receive validation from the World Health Organization that it has eliminated mother-to-child transmission of HIV and syphilis.

“Eliminating transmission of a virus is one of the greatest public health achievements possible,” said Dr Margaret Chan, WHO Director-General. “This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation” said Dr Margaret Chan, WHO Director-General.

Michel Sidibé, Executive Director of UNAIDS, added: “This is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”

The challenge

Every year, globally, an estimated 1.4 million women living with HIV become pregnant. Untreated, they have a 15-45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding.  However, that risk drops to just over 1% if antiretroviral medicines are given to both mothers and children throughout the stages when infection can occur. The number of children born annually with HIV has almost halved since 2009 - down from 400 000 in 2009 to 240 000 in 2013. But intensified efforts will be required to reach the global target of less than 40 000 new child infections per year by 2015.

Nearly 1 million pregnant women worldwide are infected with syphilis annually. This can result in early foetal loss and stillbirth, neonatal death, low-birth-weight infants and serious neonatal infections. However, simple, cost-effective screening and treatment options during pregnancy, such as penicillin, can eliminate most of these complications.

Cuba’s achievement

PAHO/WHO have been working with partners in Cuba and other countries in the Americas since 2010 to implement a regional initiative to eliminate mother-to-child transmission of HIV and syphilis.

As part of the initiative, the country has worked to ensure early access to prenatal care, HIV and syphilis testing for both pregnant women and their partners, treatment for women who test positive and their babies, caesarean deliveries and substitution of breastfeeding. These services are provided as part of an equitable, accessible and universal health system in which maternal and child health programs are integrated with programs for HIV and sexually transmitted infections.

“Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV,” said PAHO Director, Dr Carissa F. Etienne. “Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis”.

Global efforts to stop mother-to-child transmission of HIV and syphilis

There have been major efforts in recent years to ensure that women get the treatment they need to keep themselves well and their children free from HIV and syphilis and a number of countries are now poised to eliminate mother-to-child transmission of both diseases.

In 2007, WHO launched the Global elimination of congenital syphilis: rationale and strategy for action. The strategy aims to increase global access to syphilis testing and treatment for pregnant women. By 2014, more than 40 countries were testing 95% or more of pregnant women in prenatal care for syphilis. But although progress has been made, many countries have still to prioritize preventing and treating mother-to-child transmission of syphilis. In 2012, syphilis affected 360 000 pregnancies through stillbirths, neonatal deaths, prematurity, and infected babies.

In 2011, UNAIDS with WHO and other partners launched the Global Plan towards the elimination of new HIV infections among children by 2015, and keeping their mothers alive. This global movement has galvanized political leadership, innovation and engagement of communities to ensure that children remain free from HIV and that their mothers stay alive and well.

Between 2009 and 2013, the proportion of pregnant women living with HIV in low- and middle-income countries receiving effective antiretroviral medicines to prevent transmission of the virus to their children doubled. This means that globally, 7 out of 10 pregnant women living with HIV in low- and middle-income countries receive effective antiretroviral medicines to prevent transmission of the virus to their children. Among the 22 countries which account for 90% of new HIV infections, 8 have already reduced new HIV infections among children by over 50% since 2009, based on 2013 data, and another four are close to this mark.

WHO validation process

In 2014, WHO and key partners published Guidance on global processes and criteria for validation of elimination of mother-to-child transmission of HIV and syphilis, which outlines the validation process and the different indicators countries need to meet.

As treatment for prevention of mother-to-child-transmission is not 100% effective, elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.

An international expert mission convened by PAHO/WHO visited Cuba in March 2015 to validate the progress toward the elimination of mother-to-child transmission of HIV and syphilis. During a five-day visit, members visited health centres, laboratories, and government offices throughout the island, interviewing health officials and other key actors. The mission included experts from Argentina, the Bahamas, Brazil, Colombia, Italy, Japan, Nicaragua, Suriname, the United States of America and Zambia.   

The validation process paid particular attention to the upholding of human rights, in order to ensure that services were provided free of coercion and in accordance with human rights principles.

Note to editors:

Required validation indicators include:

HIV

Impact Indicators – must be met for at least 1 year

• New paediatric HIV infections due to mother-to-child transmission of HIV are less than 50 cases per 100 000 live births; and
• Mother-to-child transmission rate of HIV is less than 5% in breastfeeding populations or less than 2% in non-breastfeeding populations

Process Indicators – must be met for at least 2 years

• More than 95% of pregnant women, both who know and do not know their HIV status, received at least one antenatal visit
• More than 95% of pregnant women know their HIV status
• More than 95% of HIV-positive pregnant women receive antiretroviral drugs

Syphilis

Impact Indicators – must be met for at least 1 year

• Rate of mother-to-child transmission of syphilis are less than 50 cases per 100 000 live births

Process Indicators – must be met for at least 2 years

• More than 95% of pregnant women received at least one antenatal visit
• More than 95% of pregnant women are tested for syphilis
• More than 95% of pregnant women with syphilis receive treatment.

The term “validation” is used to attest that a country has successfully met criteria (internationally set targets for validation) for eliminating mother to child transmission of HIV and/or syphilis at a specific point in time, but countries are required to maintain ongoing programmes.

In 2013, only two babies were born with HIV in Cuba, and only 5 babies were born with congenital syphilis.

WHO

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends and improving global health security.

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.

African Heads of State and Government reaffirmed their commitment to provide bold leadership for the AIDS response in Africa during the AIDS Watch Africa (AWA) meeting held on 14 June on the side lines of the 25th African Union Summit in Johannesburg, South Africa.

The need to invest in health, particularly for the sustainable financing of Africa’s massive HIV treatment programme, came under the spotlight. Participants stressed that, in order to end the AIDS epidemic as a public health threat by 2030 in Africa, it is critical to expand treatment coverage and ensure that the millions of people in Africa currently receiving antiretroviral treatment continue to have uninterrupted access for the rest of their lives. Furthermore, investing in local production of antiretroviral medicines, increasing domestic spending and continuing to implement the African Union Roadmap on shared responsibility and global solidarity for AIDS, Tuberculosis and malaria response in Africa were highlighted as key elements to achieve the 90-90-90 targets.

UNAIDS Executive Director, Michel Sidibé, urged African leaders, the AU Commission, representatives of regional economic communities, development partners and civil society present to ensure that the significant investment that has already been made is not lost.  

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During a three-day visit to Cameroon, UNAIDS Executive Director Michel Sidibé named the First Lady, Chantal Biya, as a Special Advocate. Through her foundation and the non-profit organization African Synergy against AIDS and Suffering, Ms Biya has been advocating for the protection, education and health of women and children for more than 20 years, especially in the context of HIV.

“This award recognizes the work the First Lady has done for decades for mothers and their children, said Mr Sidibé. “We cannot forget the pioneers.”

President Paul Biya, who participated in the ceremony, which was held at the Unity Palace on 1 June, expressed his commitment to the AIDS response and said, “The government and African Synergy against AIDS and Suffering will double their efforts in the response to HIV.”

During his visit, Mr Sidibé met with 16 mayors from the cities of Douala, Bamenda and Yaoundé, home to 30% of people living with HIV in Cameroon. The mayors signed the Paris Declaration on Fast-Track Cities, which calls for ending the AIDS epidemic in cities by 2030.

Mr Sidibé also met representatives of civil society, including religious leaders, and joined Minister of Health André Mama Fouda at the launch of an HIV prevention campaign with truck drivers. In a meeting with the minister, Mr Sidibé noted that the country’s increase in national funding for the AIDS response had had good results and would have a positive impact on development.

African ministers of social development, labour and employment meeting in Addis Ababa, Ethiopia, have called for expanded social protection for all to ensure inclusive development in Africa. During an event held from 20 to 24 April, and organized by the African Union, ministers agreed that a prosperous Africa can only become a reality if Member States extend comprehensive social protection measures.

Access to affordable and quality education and health services are among the measures that should be expanded to all, in particular vulnerable people. These include people living with and affected by HIV, women, children, people living with disabilities and older people.

The ministers further agreed that social protection policies and programmes in the continent should include social and cash transfers, as well as food and health security.

The 2014 UNAIDS Gap report highlights that cash transfers are a powerful tool for HIV prevention and treatment among young women and people living with HIV. In South Africa, a national study found that a publicly funded cash transfer programme had managed to reduce transactional sex by 53% and age-disparate sex by 71% among adolescent girls in families between 2009 and 2012. This is important in order to reduce their risk of exposure to unsafe sexual behaviour and the low condom use linked to relationships with large age differences.

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