If the newly adopted Sustainable Development Goals (SDGs) are to be achieved the needs of women, children and adolescents must be at the heart of the development agenda, said United Nations Secretary-General Ban Ki-moon as he launched a bold initiative at the 70th session of the UN General Assembly.

The updated Global Strategy for Women’s, Children’s and Adolescents’ Health is intended to ensure that the SDG commitment to accelerate progress in reducing newborn, child and maternal mortality becomes a reality for women, children and young people around the globe.

Launched on 26 September during the UN Sustainable Development Summit, the initiative builds on the Global Strategy for Women’s and Children’s Health, spearheaded by the Secretary-General in 2010, that blossomed into the Every Woman Every Child global movement. This movement has seen the galvanizing of political commitment, multi-stakeholder partnerships and action that has led to significant progress in reducing maternal and infant mortality. However, Ban Ki-moon told the gathering that efforts now need to step up a gear.

To ensure that the necessary resources are available, a major section of the high-level two-hour event involved the announcement of key strategic commitments from world leaders, multilateral organizations, CEOs from the private sector and other partners.

Young people also played a vital role, taking the floor to tell the gathering what they want and need over the next 15 years and what they commit to do to improve the health of their generation. Young people representing The PACT, a coalition of youth organisations supported by UNAIDS, as well as Restless Development and Y-PEER shared commitments to the updated Global Strategy to end all preventable maternal, child and adolescent deaths by 2030 and the end of the AIDS epidemic by 2030.

Introduced by UNAIDS Executive Director Michel Sidibé, Ishita Chaudhry spoke about the importance of governments committing to adolescents and to support young people to be agents of change to help ensure that mothers, children and adolescents everywhere survive and lead healthy lives.

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“When I was 30 years-old, I was surprised to learn that I was pregnant,” said Prem Paika, who lives in Chiang Mai, Thailand. “My partner, who I had been with for the past eight years, thought he was infertile, so we did not use any birth control.”

Ms Paika was also concerned because she and her partner had been diagnosed with HIV five years earlier. She had been taking antiretroviral medicine for the past few years and went to consult with the doctor overseeing her HIV treatment at a public hospital. 

“I was very worried my baby would have HIV, but my doctor reassured me that the antiretroviral medicine would protect my baby,” said Ms Paika.

Untreated, women living with HIV have a 15–45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, that risk drops to under 5% if antiretroviral medicines are given to both mother and child through the stages when infection can occur.

Thailand has made the elimination of new HIV infections among children a priority and has consistently adapted its prevention of mother-to-child transmission programme in accordance with the latest research findings. The country is currently following the World Health Organization’s guidelines to provide lifelong antiretroviral medicine to all pregnant women living with HIV. The Ministry of Public Health has implemented measures in its hospitals to ensure that mothers living with HIV receive key services.

“We have developed a system in hospitals where the mother’s confidentiality is guaranteed. Health sector staff have been trained to communicate well with their patients,” said Danai Teewanda, Director from the Bureau of Health Promotion at the Ministry of Public Health in Thailand.

Ms Paika found her regular doctor supportive and she was happy because the hospital provided psychological counselling for her through her pregnancy and until her child was one year old. She could also access her HIV treatment and receive her antenatal check-ups in the same hospital and so did not have to travel from one part of town to another, visiting different specialists.

However, despite efforts by Thailand’s health authorities to create a supportive environment, stigma remains a problem among staff working in other health areas. Ms Paika found that the hospital’s gynaecologist treated her badly and was often misinformed.

“From my first antenatal examination, the gynaecologist encouraged me to have an abortion. He wouldn’t let me see the sonogram as he said in any case there was no point. He told me my baby only had a 2% chance of being born free of HIV.”

Ms Paika turned to her HIV treatment doctor for comfort and her partner complained to the hospital’s director. After this, she found that the gynaecologist treated her better. Finally, the big day arrived: she gave birth to a baby girl.

“They provided her with an antiretroviral prophylaxis and she was tested at one month and then every six months. She was HIV-negative each time. I am so happy she is free of HIV,” said Ms Paika.

Through its efforts, Thailand has achieved remarkable progress in eliminating new HIV infections among children. In 2014, country programme data showed that almost 95% of HIV-positive pregnant women received antiretroviral medicines to reduce the risk of HIV transmission and almost 98% of their babies were born free of HIV.

The country is hoping to further reduce new HIV infections among children. “We have a few weak spots, such as early detection. We are encouraging women to seek antenatal care within the first 12 weeks of their pregnancy,” said Mr Danai.

Since 2013, Thailand has provided free antenatal services to pregnant women at all health centre facilities, promoted HIV counselling and testing for couples and provided antiretroviral medicines to infants as soon as possible after birth. The country hopes by 2016 to have virtually eliminated new HIV infections among children.

Senior government health authorities from Thailand were among representatives from 20 countries who attended the 10th Asia–Pacific United Nations Elimination of Parent-to-Child Transmission of HIV and Syphilis Task Force meeting in Beijing, China, from 15 to 17 September. The meeting examined regional successes, but also roadblocks to stopping new HIV infections among children.

A new book that tells the inspiring stories of 12 mothers living with HIV and their children born free of the virus has been launched at a community event near Polokwane in Limpopo province, South Africa, on the occasion of National Women’s Day (August 9). The book, Faces of an AIDS Free Generation in eastern and southern Africa, aims to promote the further uptake of mother-to-child transmission (PMTCT) services to help prevent the transmission of HIV to children during pregnancy and early motherhood.

In recent years, there has been a rapid scale-up of PMTCT services in the region that has produced significant results. By the end of 2014, an estimated 88% of pregnant women living with HIV in eastern and southern Africa were accessing services to stop them transmitting the virus to their children. This has resulted in a 60% decline in the number of HIV infections among children between 2009 and 2014, from 230 000 to 93 000.

Despite this progress, there is still work to be done to achieve the targets of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. High levels of gender inequality, including gender-based violence and stigma, continue to make it difficult for many women to access sexual and reproductive health care services.

The book highlights the urgent need to further expand PMTCT services to make pregnancy and breastfeeding safer for women living with HIV, as more than 90% of new HIV infections among children occur when women are inadequately supported during pregnancy and early motherhood.

It also stresses the need for the rapid scale-up of paediatric testing and treatment to prevent AIDS-related deaths among children. Without knowing the HIV status of a child it is impossible for them to receive life-saving treatment. Just 38% of children living with HIV in eastern and southern Africa had access to antiretroviral medicines in 2014. Without treatment, half of all children born with HIV will die by the age of two and the majority will die by the age of five.  

Faces of an AIDS Free Generation in eastern and southern Africa is published with the support of the Swedish International Development Cooperation (Sida) and the Norwegian Agency for Development Cooperation (Norad).

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Leading HIV researchers describing results from multiple clinical trials in sub-Saharan Africa report that innovative service delivery models are achieving results across the HIV treatment cascade that approach or exceed the 90–90–90 target.

Study results were presented at an all-day workshop hosted by the British Columbia Centre for Excellence in HIV/AIDS and the Division of AIDS at the University of British Columbia, prior to the opening of the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada. The studies are being undertaken in a number of high-burden countries in sub-Saharan Africa, including Botswana, Kenya, Malawi, South Africa, Swaziland, Uganda and Zambia.

“These exceptional clinical trial results show yet again how innovation is driving progress in the AIDS response,” said UNAIDS Executive Director Michel Sidibé. “The results demonstrate that the 90–90–90 target is more than a dream. It is entirely feasible.”

Diane Havlir, of the University of California, San Francisco, presented interim results from the Sustainable East Africa Research for Community Health (SEARCH) trial in more than 30 rural communities in Kenya and Uganda. Having enrolled more than 334 000 people, the SEARCH trial is evaluating a multicomponent programme, including use of community-centred, multidisease campaigns to provide HIV testing and link HIV-positive individuals to immediate initiation of antiretroviral therapy.

At a population level, the SEARCH programme has achieved 90% knowledge of HIV status. Among participants living with HIV, more than 90% of people in Uganda and 83% in Kenya are receiving antiretroviral therapy. At 24 weeks, 92% of trial participants who have initiated antiretroviral therapy have achieved viral suppression.

Similarly encouraging, although preliminary, results were reported from the PopART trial by Richard Hayes of the London School of Hygiene and Tropical Medicine. Working in 21 communities, the trial is evaluating a combination HIV prevention package that includes repeated rounds of community-level HIV testing and immediate initiation of antiretroviral therapy for all people who are diagnosed HIV-positive. Among more than 115 000 community members enumerated in the trial, 90% of all men living with HIV and 92% of all women living with HIV were aware of their HIV status following the PopART programme. Among people with an HIV diagnosis, 62% of men and 65% of women were receiving antiretroviral therapy, highlighting the need to further strengthen linkage to care for people living with HIV. Data on rates of viral suppression among PopART participations will be available next year.

Max Essex, of the Harvard University School of Public Health, presented baseline findings for the Botswana Combination Prevention Protocol. Mr Essex and his colleagues have found that 79% of all people living with HIV in Botswana knew their HIV status as of mid-2015, 86% of adults who have been diagnosed with HIV were receiving antiretroviral therapy and 96% of people receiving antiretroviral therapy had achieved viral suppression.

Comparably impressive results have been achieved by a Médicins Sans Frontières (MSF) programme in the District of Chiradzulu in Malawi, according to David Maman of MSF. In Chiradzulu, 77% of all people living with HIV know their HIV status, 84% of people with an HIV diagnosis are receiving antiretroviral therapy and 91% of people receiving antiretroviral therapy have achieved viral suppression.

François Dabis, of the Bordeaux School of Public Health, described preliminary results from a separate trial in the Hlabisa district in KwaZulu-Natal, South Africa, of a test-and-treat initiative that includes six-month rounds of community-level testing and establishment of antiretroviral treatment sites in all communities in the study. Among more than 26 000 people in the study communities, 85% know their HIV status. Among HIV-diagnosed people reached by the programme, 86% are receiving antiretroviral therapy. Study results indicate that linkage to care remains suboptimal and an important focus of further work and innovation.

Several important themes emerged from these study findings. Researchers emphasized the importance and value of engaging and collaborating with local communities in developing programme approaches tailored to local needs and circumstances. Most of the studies have also taken multidisciplinary approaches to the development, monitoring and evaluation of programmes, involving social scientists, economists and community representatives as well as clinicians and biostatisticians.