Caribbean Region Closer to Eliminating Mother-to-Child HIV Transmission

On December 1, 2017, the Joint United Nations Programme on HIV/AIDS (UNAIDS) announced that 6 Caribbean states and territories have eliminated mother-to-child transmission of HIV and syphilis.

Mothers who are HIV-positive can transmit the virus to their children during pregnancy, labor, delivery, or breastfeeding. The World Health Organization (WHO) notes that without any intervention, about 15% to 45% of HIV-positive mothers pass the virus on to their children; however, with intervention, the rate of mother-to-child transmission can be reduced to 5%. Last year (2016), when WHO published the Global Health Sector Strategy on HIV for 2016 to 2021 on the goal of ending AIDS, they reported that although many countries have moved closer to the elimination of mother-to-child HIV transmission, a strong public health effort is still required to reach that goal worldwide.

One key to viral suppression and preventing mother-to-child transmission of HIV is antiretroviral drugs, which are given prophylactically for both pre-exposure and post-exposure. As such, WHO recommends that all pregnant and breastfeeding women with HIV receive antiretroviral therapy (ART). However, as of 2014, just 62% of the estimated 1.5 million pregnant women living with HIV received ART, a coverage level that exceeds that of non-pregnant adults, but still leaves many babies without protection from the virus.

Last week, the WHO validated Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat and Saint Kitts, and Nevis as having eliminated mother-to-child transmission of HIV and syphilis. The announcement noted that in 2015, Cuba became the first country in the world to achieve this goal and receive the validation from WHO. The countries of Thailand and Belarus also achieved this goal for both diseases, while Armenia has eliminated mother-to-child transmission of HIV, and the Republic of Moldova has eliminated mother-to-child transmission of congenital syphilis.

“This elimination is the result of our strong political commitment to public health and of making the health of mothers, children, and families a regional priority,” said prime minister of St. Kitts and Nevis, Timothy Harris. His statement noted that the Caribbean has cut new HIV infections in children by more than half over the last 6 years, from 1800 infections in 2010 to fewer than 1000 in 2016. “This is an amazing achievement given the high rates of HIV in the past, and we intend to improve on this success story even more in the future.”

The achievement also marks a success for the Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in Latin America and the Caribbean, which was launched in 2010 and coordinated by the Pan American Health Organization (PAHO) and the United Nations Children’s Fund (UNICEF). Thanks to the public health effort, 74% of pregnant women in the Caribbean living with HIV had access to ART in 2016, an increase of 64% since 2010. In addition, the region continues to report fewer than 50 cases of congenital syphilis per 100,000 live births, remaining below the goal, but that rate has not changed since 2010.

Along with expanded ART access, this public health achievement was made possible by intensive participation by both the public and private health sectors to implement comprehensive maternal and child health services, including quality antenatal and prenatal care and screening for HIV and syphilis. “The elimination of mother-to-child transmission of HIV and syphilis is not just a dream; it’s an achievable goal,” said Maria Cristina Perceval, regional director of UNICEF for Latin America and the Caribbean. “Today we can say we are closer to ensuring an AIDS-free generation.”