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.

The need for a holistic approach to HIV prevention among young women and girls was the focus of the 15th Ordinary Assembly of the Organization of African First Ladies, (OAFLA). The meeting was held on the side lines of the 25th African Union Summit, held on 15 June in Johannesburg, South Africa. 

The African First Ladies stressed that addressing the needs of young women and adolescent girls must be a priority at all levels of society—from the highest political leadership to schools, families and community leaders. They called for an integrated approach to HIV prevention, treatment and care that addresses all socio-economic and structural drivers which place young women and adolescent girls at a higher risk of HIV infection, including poverty, gender inequality and harmful cultural practices.

Lordina Mahama, First Lady of Ghana and newly-elected President of OAFLA, encouraged all African First Ladies to ensure that the UNAIDS and UNICEF All In! campaign, which focuses on ending adolescent AIDS, is rolled out in their countries.

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The President of Malawi, Arthur Peter Mutharika, met with UNAIDS Executive Director, Michel Sidibé, on 13 June 2015, on the side lines of the 25th African Union Summit, in Johannesburg, South Africa.

Mr Sidibé congratulated President Mutharika on the breakthrough results that Malawi has achieved in its AIDS response in recent years. Malawi was the first country in the world to implement the World Health Organization’s Option B+ for HIV-positive pregnant women (access to lifelong antiretroviral treatment), which has resulted in a dramatic 67% decline in mother-to-child transmission since 2009. The President expressed his commitment to continue to invest in prevention of mother-to-child transmission of HIV to meet the target of bring new HIV infections down to below 5% as outlined in the Global Plan to eliminate new HIV infections among children and keeping their mothers alive.

Earlier in the day, Mr Sidibé met with the African Union Commissioner for Social Affairs, Mustapha Kaloko, who also expressed his desire to see an AIDS-free generation by 2030. Mr Sidibé affirmed UNAIDS’ commitment to continue to work on the Fast-Track approach to ending the AIDS epidemic as a public health threat by 2030, taking advantage of the next five years to leverage country ownership and global solidarity.

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To commemorate this year’s Mother’s Day, UNICEF and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) released a new video and special website featuring mothers who are HIV-positive.

In 2013 and 2014, UNICEF and the Global Fund asked six women in South Africa and Malawi to share their reflections, hopes and fears as they went through their pregnancies and the delivery of their babies, and in the months after their children were born.

A Journey of Motherhood acknowledges the particular challenges HIV-positive mothers experience to give birth to healthy HIV-negative children, and to remain healthy themselves. The initiative also stresses the progress made in providing HIV medicines to prevent new HIV infections among children worldwide.

Each year, approximately 1.5 million women living with HIV give birth. With no medical intervention, the risk of passing on the virus to their babies during pregnancy, delivery and the breastfeeding period can be as high as 45%. But today, medicine to prevent mother-to-child transmission of HIV—a single, daily pill—reduces that risk to 5% or less.

JOHANNESBURG, 13 April 2015—The Champions for an AIDS-Free Generation gathered together today to announce new efforts to ensure that all children in Africa are born free from HIV and that children living with HIV have access to life-saving treatment. Since young people continue to be deeply affected by the epidemic, the Champions also announced that they will add adolescents and HIV to their portfolio of work. 

“The Champions are determined to keep HIV high on the continental agenda,” said Festus Mogae, Chairperson of the Champions. “We will leave no one behind and we will not rest until Africa has reached the goal of an AIDS-free generation.”

During their three-day meeting, the Champions are scheduled to hold high-level discussions with the President of South Africa, Jacob Zuma, the Deputy President of South Africa, Cyril Ramaphosa, and leading figures from the private sector.

The Champions for an AIDS-Free Generation was launched in 2008 by Mr Mogae, the former President of Botswana. The Champions transcend political partisanship to speak freely and independently about the issues that need solutions, both publically and behind the scenes. Since November, five new leaders have joined their distinguished ranks: Kgalema Motlanthe, former President of South Africa; Joyce Banda, former President of Malawi; Alpha Oumar Konaré, former President of Mali; Olusegun Obasanjo, former President of Nigeria; and Hifikepunye Pohamba, former President of Namibia.

“Today, we come together as a strengthened group of Champions to reaffirm our commitment to ending mother-to-child transmission of HIV and to ensuring that mothers and children already living with HIV stay healthy,” said Ms Banda. “I am proud to be involved in the Champions for an AIDS-Free Generation.”

As the Champions reaffirmed their commitment to an AIDS-free generation, they were joined by partners that include UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and private sector representatives.

“The Champions have been steadfast in calling for improved HIV prevention and treatment options, and there has been progress,” said UNAIDS Executive Director, Michel Sidibé. “Now, with their ranks strengthened, the Champions will be even stronger advocates to fast-track the AIDS response in Africa to ensure that every baby is born free from HIV and that their mothers stay healthy.”     

“An AIDS-free generation is within our grasp if we use the scientific knowledge, data and tools at our disposal,” said Ambassador Deborah Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy. “I am inspired today by this committed group of leaders, who are using their wisdom and influence to move towards an AIDS-free generation in Africa.”  

“We need leaders like the Champions who are unafraid to speak out and put AIDS at the very top of Africa’s health agenda,” said Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Other partners of the Champions for an AIDS-Free Generation include UNICEF, the World Bank, the South African Development Community (SADC), the SADC Parliamentary Forum, the Economic Community of West African States and the South African Broadcasting Corporation.    

The risk of a mother living with HIV passing the virus to her child can be reduced to 5% or less if she has access to antiretroviral medicines during pregnancy, delivery and breastfeeding. 

“Women need strong partners like the Champions so they receive access to proper HIV counselling, treatment and prevention services,” said Lorraine Mashishi, a mother living with HIV. “Women living with HIV can avoid passing the virus on to their children if they get the support they need.”

Currently 21 of the 22 countries that are part of the Global Plan to eliminate new HIV infections among children by 2015 and keeping their mothers alive are in Africa. Since 2009, there has been a 43% decline in new HIV infections among children in these countries, but there were still 210 000 (180 000–250 000) new HIV infections among children in sub-Saharan Africa in 2013. Only 42% of children exposed to HIV were tested for the virus within the recommended two months. Without treatment, half of all children living with HIV will die by the age of two and the majority will die by the age of five.

Sub-Saharan Africa remains the region most affected by the AIDS epidemic—in 2013, there were 24.7 million (23.5 million—26.1 million) people living with HIV in the region.

The Champions are:

• Festus Mogae, former President of Botswana and Chairperson of the Champions.
• Joyce Banda, former President of Malawi.
• Joaquim Chissano, former President of Mozambique.
• Kenneth Kaunda, former President of Zambia.
• Alpha Oumar Konaré, former President of Mali. 
• Benjamin William Mkapa, former President of the United Republic of Tanzania.
• Kgalema Motlanthe, former President of South Africa.
• Olusegun Obasanjo, former President of Nigeria.
• Hifikepunye Pohamba, former President of Namibia.
• Desmond Tutu, Archbishop Emeritus of Cape Town and Nobel Peace Prize Laureate.
• Speciosa Wandira-Kazibwe, former Vice-President of Uganda. 
• Edwin Cameron, Justice of the Constitutional Court of South Africa.
• Miriam Were, former Chairperson of the Kenya National AIDS Control Council.

Champions for an AIDS-Free Generation

The Champions for an AIDS-Free Generation is a distinguished group of former presidents and influential African leaders committed to an AIDS-free generation. Individually and collectively, the Champions rally and support regional leaders towards ending the AIDS epidemic as a public health threat. The Champions transcend political partisanship to speak freely and independently about the issues that need solutions, both publically and behind the scenes. www.aidsfreechampions.org

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. Learn more at unaids.org and connect with us on Facebook and Twitter.

GENEVA, 19 March 2015—UNAIDS, in partnership with the hotel InterContinental Genève, Cartier and Etihad Airways, is holding its first fundraising gala, in Geneva, Switzerland. The event is part of UNAIDS’ efforts to ensure that children everywhere are free from HIV and that mothers have access to antiretroviral medicines to ensure that they stay alive and well.

The gala is being held under the patronage of Caroline Rupert, Kweku Mandela and Ndaba Mandela, and is being attended by personalities from both Switzerland and abroad.

The Executive Director of UNAIDS, Michel Sidibé opened the event, emphasizing the importance of stopping new HIV infections among children. “The science and medicines exist to ensure that no child becomes infected with HIV. Mobilizing innovative partnerships and increased resources will be vital to reaching all women and children in need of life-saving HIV prevention and treatment services.”

Florence Ngobeni-Allen, Global Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, from South Africa, and Ashley Rose Murphy, from Canada, spoke about their experiences of living with HIV. “I was born in 1998, when Canada had the medications and the ability to ensure that almost zero babies were born with HIV. I should not have HIV. But I do,” said Ms Murphy. “Now these life-saving medications can be available everywhere. If we work hard, we can make sure that no one, no matter where they live, is born with HIV.”

The musical highlight of the evening will be the Norwegian duo Nico & Vinz performing their hit songs Am I Wrong and My Melody, a song dedicated to people living with HIV.

A live auction will be curated by David Bennett from Sotheby’s, for which Maison Cartier has provided a set of high jewellry earrings and a lady’s watch. Further items include pieces from Victoria Beckham’s collection, Christian Louboutin custom-made shoes, a watch from Piaget and a Nelson Mandela limited edition print donated by Annie Leibovitz.

The theme of the gala is “Cities around the world”. Cities’ responses to HIV have been at the forefront since the start of the epidemic. Fast-Tracking the response to HIV in cities will be essential to ending the AIDS epidemic by 2030.

The partnership between UNAIDS and the hotel InterContinental Genève began in December 2013 with the launch of the Where History is Made campaign, a joint initiative to raise funds to support the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan).

In 2013, some 240 000 children became newly infected with HIV and 190 000 children died of AIDS-related illnesses. Without HIV treatment, half of all children born with HIV die by the age of two and most die before their fifth birthday.

The Global Plan aims to reduce the number of new HIV infections among children by 90% and AIDS-related deaths among pregnant women and children by 50%. It focuses on all countries, but particularly on the 22 countries where 90% of new HIV infections among children occur.

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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 Kenya, Margaret Kenyatta, and UNAIDS Deputy Executive Director Luiz Loures visited a Beyond Zero mobile health clinic in Kibera, an unofficial settlement in Nairobi that is home to more than a million people.

The mobile clinic is one of 18 around the country opened as part of Ms Kenyatta’s Beyond Zero campaign, which aims to boost efforts to eliminate new HIV infections among children and improve maternal survival rates by the end of 2015 among some of Kenya’s most vulnerable communities. Beyond Zero provides comprehensive medical services to residents, complementing care received at other facilities.

The clinic was established with the support of National Youth Service workers and young volunteers from the community itself. Half of Kibera’s residents are under 15 years old and youth unemployment rates are extremely high. Most residents of the settlement earn less than a dollar a day.

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In the 14th General Assembly of the Organization of Africa First Ladies Against HIV/AIDS (OAFLA), held on 31 January on the sidelines of the 24th African Union Summit in Addis Ababa, Ethiopia, African First Ladies reaffirmed their commitment to the elimination of mother-to-child transmission of HIV and to ending the AIDS epidemic by 2030. The First Ladies also highlighted the importance of paediatric care, strengthening of partnerships and ensuring that AIDS is a strong component in the post-2015 development agenda.

The OAFLA General Assembly was addressed by Yoo (Ban) Soon-taek, who emphasized that women, including young women, adolescent girls, women of child-bearing age, sex workers and transgender women, are a key population in the continental AIDS response and require focused and strategic interventions if we are to end the AIDS epidemic by 2030. She also called for a reinvigorated campaign against new infections among children.

Since the establishment of OAFLA in 2002, African First Ladies have advocated for and raised awareness on AIDS, championing many campaigns on eliminating mother-to-child transmission of HIV, underlining the burden of HIV on women and strengthening networks of people living with HIV. 

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