It never crossed Khonjiswa Mdyeshana’s mind that she could be HIV-positive. So, in 2006, when she tested positive for HIV while pregnant with her first child, she couldn’t believe it. She insisted on taking the test three times. Much to her shock, every result came back positive. “In my mind, it was the end of the world for me and my child,” she says.

What Ms Mdyeshana didn’t know was that working alongside the doctors and nurses at her health clinic were HIV-positive Mentor Mothers, employed and trained by Africa-based nongovernmental organization mothers2mothers (m2m). The Mentor Mothers provided women just like her with education and support to initiate and adhere to their HIV treatment.

“The women at m2m made me feel welcome and unafraid. They told me their own stories of living with HIV. They taught me how to prevent spreading the virus to my baby and live positively. I have to be honest, I was not 100% sure about everything, but somehow I had new hope that it was not the end,” Ms Mdyeshana says.

Since m2m was founded in 2001, it has become a global leader in efforts to bring paediatric HIV infections to zero and improve the health and well-being of mothers, families and communities.

The m2m Mentor Mother model has been proven to reduce the number of infants who become infected with HIV and improve the health outcomes of mothers and babies, while also saving money in averted HIV treatment costs. A recently released annual evaluation of m2m’s programmes found that, in 2015, m2m achieved significant results:

• m2m virtually eliminated mother-to-child transmission of HIV among its clients for the second year in a row, with a mother-to-child transmission of HIV rate of 2.1% after 24 months.
• In South Africa, m2m’s transmission rate was even lower—1.1% after 18 months.
• Mothers who met two or more times with a Mentor Mother were more than seven times more likely to have their babies tested for HIV at six weeks compared to mothers who had met a mentor just once.

“It’s a joy to go into a site and hear a nurse or the head of the clinic say, “You need to know that it’s been three years since we have had a baby born in this clinic with HIV because of mothers2mothers,”” says m2m President and Chief Executive Officer, Frank Beadle de Palomo.

However, children are still becoming infected during the breastfeeding period. And there is a rising number of infections and deaths among adolescents, particularly adolescent girls and young women.

Responding to this need, m2m now engages mothers and their families over a longer period of time with a family-centred approach. m2m looks beyond survival, focusing on giving children the opportunity to thrive through its early childhood development and paediatric case finding and support programmes. And the new DREAMS initiative in South Africa is providing adolescents with the skills and knowledge necessary to protect themselves and the next generation from HIV.

As for Ms Mdyeshana, she has come a long way since 2006. She now works as a Mentor Mother, helping other women realize that living with HIV is not the end of their world. She is a proud mother to two HIV-free children, who are full of life, happiness and big dreams.

Her oldest, Luthando, now nine years old, tells his mother he is studying hard so that when he grows up he can get a good job and buy them a bigger house. That job? He says he is going to become a doctor, because he sees “a lot of sick people around” and wants to help them. While he works towards that dream, he is practising his medical skills at home, reminding his mother, who he describes as “strong and beautiful,” to take her HIV medicine every day. 

To achieve the Fast-Track Targets and end the AIDS epidemic by 2030, new HIV infections among children must be eliminated. HIV can pass from mother to child during pregnancy, childbirth and breastfeeding, but with antiretroviral therapy mother-to-child transmission rates can fall to 5% or less.

The World Health Organization (WHO) promotes a comprehensive approach to preventing mother-to-child transmission of HIV. One important part of this strategy is to provide appropriate treatment, care and support to mothers living with HIV, their children and other family members.

Since 2005, owing to effective programmes that prevent mother-to-child transmission, the number of children born HIV-positive has dropped by about 70%. In 2015, around 1.4 million mothers living with HIV gave birth and 150 000 infants were infected with HIV globally. HIV-positive infants have their highest mortality in the first three months of life, so their HIV status must be diagnosed quickly in order that they can receive the treatment they need.

However, a serious diagnostics gap exists. Only 51% of infants exposed to HIV globally are tested by the time they are six weeks old, the age recommended by WHO. Half will never receive their results. Of those who do test positive and receive their results, only half are linked to care. So of the 150 000 babies born HIV-positive in 2015, only around half will be linked to care.

UNITAID is helping to close the diagnostics gap. Through its partners, UNITAID has invested more than US$ 300 million to widen availability to affordable, quality-assured diagnostic technologies in low- and middle-income countries. Crucially, UNITAID is making those tests available where people seek care, even in remote settings, to ensure that young patients quickly get the treatment they need.

Early infant diagnosis (EID) tests are suitable for infants, whereas rapid diagnostic tests are unsuitable for young infants, as a mother’s antibodies can be present in her child’s blood for up to 18 months after birth. UNITAID aims to make EID tests available for less than US$ 30. The test takes less than two hours to run, so infants can get same-day diagnosis and be linked immediately to care. This reduces the number of infants whose results are lost or delayed, and saves on the costs of later diagnosis.

With additional refinements, point-of-care testing of infants could further decrease infant mortality. UNITAID Operations Director Robert Matiru stresses the importance of regular testing. “Testing at birth can tell physicians if a baby was infected in utero,” he says. “But if a child is infected at birth, HIV seroconversion will not be detectable in the blood until weeks later. Re-testing at the recommended 6 weeks is essential.”  

UNITAID currently has projects under way to make point-of-care EID and viral load tests available and affordable in 16 African countries. Innovative platforms, tailored to decentralized health settings, make it easy for health workers to carry out several types of tests. UNITAID funds operational research to check that each health solution is cost-effective, appropriate to the setting and scalable. The insights gained from this work in turn inform treatment guidelines, national plans and policies for preventing and treating HIV, and global HIV strategies, feeding back into a cycle of ever-more effective programmes.

Ahead of the United Nations High-Level Meeting on AIDS, which will take place in New York in June, the Organisation of African First Ladies against HIV/AIDS (OAFLA) has called for the response against the epidemic to be stepped up.   

Meeting in Addis Ababa, Ethiopia, OAFLA First Ladies recognized the huge progress already made in reducing the impact of HIV, but warned against complacency, calling on stakeholders to increase investment in the response. The First Ladies said more resources were required to prevent new HIV infections among children and keep their mothers healthy and alive and to broaden access to testing services. They also said that increased resources were necessary in order to ensure that people access treatment immediately if need be, to allow young people, particularly young women and girls, to access combination prevention services, and to end gender-based violence, which increases the risk of HIV exposure.

Addressing the OAFLA General Assembly, UNAIDS Executive Director Michel Sidibé congratulated the First Ladies for playing a transformative role by championing social justice and keeping the issue of HIV high on the political agenda. He added that achieving zero mother-to-child transmission of the virus, reaching universal health access for children and ending the AIDS epidemic by 2030 were possible if the right decisions were made now.

Quotes

In 2011, global leaders committed to working towards ending new HIV infections among children and reducing AIDS-related maternal mortality. They launched the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan). The Global Plan prioritized 22 countries with the highest number of pregnant women living with HIV in need of services, encompassing more than 90% of all women in need of services to prevent mother-to-child transmission of HIV.

At the 18th International Conference on AIDS and STIs in Africa, which is taking place in Harare, Zimbabwe, UNAIDS hosted a discussion on how to maximize the role of communities in preventing mother-to-child transmission of HIV. The panel included prominent specialists and activists from Côte d’Ivoire, Kenya, Nigeria and Zimbabwe, who explored promising and innovative ways to accelerate progress towards the elimination of new HIV infections among children and the improvement of maternal health.

The Global Plan calls for broader thinking and action both within and outside the formal health-care delivery system. An important feature of country programmes since the beginning has been their emphasis on communities. Community-based programmes have increased demand for health services and commodities and strengthened their quality.

In addition, community organizations are building their capacity to advocate for better access to appropriate services in line with international guidelines, and are empowering themselves to ensure continuity of care for mothers and children within a family-based approach.

Quotes

An estimated 15.8 million people are now on HIV treatment, a doubling from five years ago, as countries adopt the UNAIDS Fast-Track Strategy using data to fine-tune delivery of HIV prevention and treatment services to reach people being left behind

GENEVA, 24 November 2015—Ahead of World AIDS Day 2015, UNAIDS has released a new report showing that countries are getting on the Fast-Track to end AIDS by 2030 as part of the Sustainable Development Goals. By adapting to a changing global environment and maximizing innovations, countries are seeing greater efficiencies and better results.

Progress in responding to HIV over the past 15 years has been extraordinary. By June 2015, UNAIDS estimates that 15.8 million people were accessing antiretroviral therapy, compared to 7.5 million people in 2010 and 2.2 million people in 2005. At the end of 2014, UNAIDS estimates that new HIV infections had fallen by 35% since the peak in 2000 and AIDS-related deaths have fallen by 42% since the 2004 peak.

“Every five years we have more than doubled the number of people on life-saving treatment,” said Michel Sidibé, Executive Director of UNAIDS. “We need to do it just one more time to break the AIDS epidemic and keep it from rebounding.”

The life-changing benefits of antiretroviral therapy mean that people living with HIV are living longer, healthier lives, which has contributed to an increase in the global number of people living with HIV. At the end of 2014, UNAIDS estimates that 36.9 million people were living with HIV. Once diagnosed, people need immediate access to antiretroviral therapy.

Countries are gearing up to double the number of people accessing HIV treatment by 2020. This Fast-Track approach will be instrumental in achieving the UNAIDS 90–90–90 treatment target of ensuring that 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are on treatment and 90% of people on treatment have suppressed viral loads.

“Today, we have more HIV prevention options than ever before. And with better data, we can become better matchmakers, finding the right prevention options for the right people,” said Mr Sidibé.

To end AIDS as a public health threat, an accelerated and more focused response is needed using better data to map and reach people in the places where the most new HIV infections occur. To support countries with this approach, UNAIDS has released a new report, Focus on location and population: on the Fast-Track to end AIDS by 2030, which gives examples of more than 50 communities, cities and countries that are using innovative approaches to reach more people with comprehensive HIV prevention and treatment services.

Through the responsible use of detailed national data sets, countries are able to focus at a more granular level, mapping where new HIV infections occur and where people need services most.  The report demonstrates how countries can redistribute resources to improve access to HIV prevention and treatment services. With the Fast-Track approach and front-loaded investments, gaps are closed faster and resources go further and from 2020 annual resource needs will begin to fall.

The report highlights how high-impact HIV prevention and treatment programmes, such as pre-exposure prophylaxis, voluntary medical male circumcision and sexual and reproductive health services, are being successfully implemented in various locations and for different populations, including adolescent girls and young women and their partners, pregnant women living with HIV, sex workers, transgender people, gay men and other men who have sex with men and people who inject drugs.

Examples of high-impact programmes are:

• A nationwide mapping in Kenya has helped to reach more female sex workers with a comprehensive package of HIV services and reduce the number new HIV infections among sex workers. Most dramatic has been the reduction in the incidence of sexually transmitted infections, from 27% among people screened in 2013 to just 3% in 2015.
• In Botswana, a policy change increased access to secondary school. Each additional year of secondary education was shown to reduce the cumulative risk of acquiring HIV by 8.1 percentage points.
• In the Islamic Republic of Iran in 2002–2003 only one prison provided methadone for just 100 prisoners dependent on opioids. By 2009, however, 142 prisons across all 30 provinces offered this vital harm reduction service, reaching 25 000 prisoners.
• A quarter of El Salvador’s transgender people live in the capital, San Salvador. In 2014, community centres were established in the country’s three largest cities to provide a comprehensive package of HIV prevention and health-care services tailored to the specific needs of this highly marginalized population. Within the first six months of 2015, these specialist services had reached a quarter of San Salvador’s transgender population.

These innovative programmes use national and subnational data and local knowledge from populations at higher risk of HIV to direct tailored HIV and related services to reach the people currently being left behind, resulting in greater impact at lower cost.

• Since July 2014 the community organization Colectivo Amigos contra el SIDA (CAS) has provided comprehensive HIV services in Guatemala City that are promoted on popular social networking websites and gay dating apps. The services are then provided through outreach activities in popular meeting places, such as parks, pedestrian walkways, saunas and nightclubs. These efforts have increased the reach of HIV prevention services by 61%, and the number of people tested increased by 32%. However, the map shows that coverage of services is still very low in many parts of the city.
• In the Blantyre district of Malawi, self-test kits were provided to 16 000 residents. Some 76% of residents self-tested and shared their results with a volunteer counsellor within one year.
• In 2012 and 2013, health facilities in Guangxi, China, began offering immediate initiation of antiretroviral therapy following diagnosis of HIV. As a result, the average time between diagnosis of HIV and initiation of treatment plummeted from 53 days to five days. Mortality also fell by approximately two thirds, from 27% to 10% during that same time period.
• Rwanda has integrated programmes to prevent mother-to-child transmission of HIV into maternal, neonatal and child health services and by 2014 had reduced new HIV infections among children by 88% compared to 2009.   

In the report UNAIDS identifies 35 Fast-Track countries that account for 90% of new HIV infections. Focusing on location and population and programmes that deliver the greatest impact will reap huge benefits by 2030: 21 million AIDS-related deaths averted; 28 million new HIV infections averted; and 5.9 million new infections among children averted.

“Everyone has the right to a long and healthy life,” said Mr Sidibé. “We must take HIV services to the people who are most affected, and ensure that these services are delivered in a safe, respectful environment with dignity and free from discrimination.”

The report shows that areas with fewer numbers of people living with HIV and lower HIV prevalence are more likely to have discriminatory attitudes than areas that have more cases of HIV. This seemingly contradictory result is explained by education and understanding about HIV usually being higher in countries where HIV is more prevalent and where more people are receiving treatment. However, these discriminatory attitudes make it more difficult for people in low-prevalence areas to come forward to seek HIV services for fear of stigma and reprisals.   

Adopting the UNAIDS Fast-Track approach through strong leadership and investment within the communities, cities and countries most affected, the AIDS epidemic can be ended by 2030 as part of the Sustainable Development Goals. 

Read the publication on ISSUU

• Part 1 (Foreword - Conclusions)
• Part 2a (Where services are needed - Lesotho)
• Part 2b (Malawi - References)

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.

The First Lady of Djibouti, Kadra Mahamoud Haid, and the Executive Director of UNAIDS, Michel Sidibé, have taken part in an event to announce a further acceleration of the country’s campaign to eliminate mother-to-child transmission of HIV.

At the event, the Djibouti Minister of Health, Kassim Issak Osman, said that projects to prevent mother-to child-transmission of HIV had shown clear benefits and would be expanded to allow more pregnant women and new mothers to access them.           

At the end of 2014, about one in five pregnant women living with HIV in Djibouti were accessing antiretroviral medicines to keep them healthy and prevent them from transmitting the virus to their children.

Quotes

At a high-level event in New York on 28 September, the Organization of African First Ladies Against HIV/AIDS (OAFLA) endorsed the newly adopted Sustainable Development Goals (SDGs) and pledged to redouble their efforts to help ensure a safe and healthy future for women, children and young people. 

The event, Building on MDGs to invest in the Post-2015 Development Agenda, took place during the 70th session of the UN General Assembly and was led by Gertrude Mutharika, the First Lady of Malawi and Vice-Chair of OAFLA. The meeting brought together First Ladies from across the continent, as well as heads of UN agencies and major international donors, to explore how the SDGs will tackle the ‘unfinished business’ of the Millennium Development Goals. In addition, Lorena Castillo de Varela, First Lady of Panama, and UNAIDS Goodwill Ambassador Victoria Beckham attended the meeting as special guests.

They were joined by representatives of the Fashion 4 Development (F4D) initiative which aims to harness the influence of the fashion world to create positive social change. F4D co-hosted the meeting with OAFLA, with support from UNAIDS, the UN Population Fund (UNFPA), the International Planned Parenthood Federation (IPPF) and the Global Fund.

OAFLA reviewed its own role in helping attain the SDGs, linking its Strategic Plan 2014-2018 with global efforts to reach the new goals. It also took the opportunity to increase its profile at the global gathering with the aim of developing new partnerships and platforms through which to share its messages, programmes and activities.  

After introductory presentations, including one given by UNAIDS Executive Director Michel Sidibé, the meeting broke up into two roundtable discussion groups to examine HIV treatment and prevention for young people; and investing in women’s and adolescents’ health in the post-2015 development framework.

The First Ladies reaffirmed their commitment to eliminate mother-to-child transmission of HIV and keeping mothers alive by championing the end of early marriage and adolescent pregnancy, improving access to HIV services and ensuring that all children diagnosed with HIV receive treatment.

OAFLA members also committed to end new HIV infections among young women and adolescent girls and ensure AIDS is no longer the leading cause of death among adolescents. These commitments are expected to be key priority areas of implementation for 2015 and 2016 by OAFLA member states and their partners.

Quotes