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Political Declaration Target 3 - Children and Maternal Deaths
Eliminate HIV infections among children and reduce maternal deaths
Services to prevent mother-to-child transmission (PMTCT) of HIV have been scaled up significantly, with pregnant women’s access to them increasing from 57 percent in 2011 to 63 percent in 2012.
Eight low- and middle-income countries (including four priority countries) have met the goal of providing antiretrovirals (ARVs) to 90 percent of pregnant women living with HIV. This has helped to reduce the number of HIV-infected children, which was 35 percent lower in 2012 than in 2009. Overall, from 2001-2012, there has been a 52 percent decline in new HIV infections among children as a result of preventing mother-to-child transmission of HIV.
Despite significant progress in the majority of countries, the expansion of PMTCT services needs to accelerate if the target is to be reached. There is also a problem in that half of all new incidences of HIV transmission occur during the breastfeeding period. This suggests women are not receiving the necessary treatment to prevent HIV transmission via breast milk, or are not being advised to continue taking ARVs until cessation of breastfeeding. Since 2008, the decline in the number of new child HIV infections has decreased slowly or, in some cases, stalled altogether, compared to adult HIV infections.
Globally speaking, the gap in the provision of family planning services has lessened, but it remains a particular problem in Eastern and Western Africa, where 20 percent of women are unable to access contraception. Unintended pregnancies create huge barriers to reducing HIV infections in children and maternal deaths. Overall, the percentage of pregnant women accessing treatment was approximately 7% lower than for adults overall in 2012. In addition to this, treatment coverage for children was half that of adults, and the pace of scale up of that treatment was significantly slower.
What still needs to be done?
- Scale-up HIV treatment by offering lifelong antiretroviral therapy for all pregnant and breastfeeding women with HIV. This is in line with the most recent guidelines issued by the World Health Organisation (WHO) and will help to ensure that HIV treatment for pregnant women is scaled up and continued for life.
- Ensure that treatment is integrated into sexual and reproductive health services. This could make both HIV treatment and family planning services easier to access.
- Expand access to early infant diagnosis. Current coverage of infant diagnostic services in five priority countries is estimated to be less than 5 percent; HIV treatment coverage for children is generally much lower than it is for adults.
- Monitor the impact of services provided. By carefully monitoring attendance at antenatal clinics, the receipt of HIV test results and medicines, and early diagnosis of newborns, more children can be linked to systems of care, and countries will be better able to understand how current programmes should be developed.
- Provide focused training and support for health care workers to ensure that HIV positive women receive the specialist advice and care that they need.
- Reach more HIV-positive breastfeeding women with prevention services. This would greatly increase the likelihood of achieving the 2015 target.
- Currently, only half (11) of the Global Plan’s 22 priority countries are on track to meet the target.
- However, if the scale-up of PMTCT services is continued, 90 percent of pregnant women living with HIV around the world will have access to them by 2015. If other services designed to prevent mother-to-child transmission and promote maternal health are continued, it is possible to reduce the number of new child HIV infections by 90 percent. This includes ensuring the elimination of drug stock-outs, increasing male involvement and correct guidance on infant feeding.