To reduce the proportion of infants infected with HIV by 20 per cent by 2005 and by 50 per cent by 2010*

Prevent mother-to-child transmission of HIV

The challenge

In 2008, an estimated 1.4 million (1.1–1.7 million) pregnant women in low- and middle-income countries were living with the human immunodeficiency virus (HIV). Close to 90 per cent of all pregnant women living with HIV in low- and middle-income countries live in 20 countries, and about 75 per cent are concentrated in 10 countries, which include Kenya, Mozambique, Nigeria and South Africa.

Preventing new HIV infections among women is critical not only for their own health but also to reduce future HIV infections among infants, especially in sub-Saharan Africa, where half the female population is of childbearing age. This is even more important as far too few pregnant women are aware of their HIV status. In 2008, only 21 per cent of pregnant women giving birth in low- and middle-income countries received an HIV test.

Each year, many children are newly infected with HIV, mainly through mother-to-child transmission. An overwhelming majority – more than 90 per cent – of HIV infections in infants and children are passed on by mothers during pregnancy, labour, delivery or breastfeeding. Without any intervention, between 15 per cent and 45 per cent of infants born to mothers living with HIV will become infected (5–10 per cent during pregnancy, 10–20 per cent during labour and delivery and 5–20 per cent through breastfeeding). Approximately 50 per cent of infants infected with HIV from their mothers die before their second birthday. The transmission of HIV infection from mother to child can be sharply reduced if antiretroviral drugs are administered to a woman during pregnancy and delivery and to her infant shortly after birth.

Reducing HIV transmission from a pregnant woman living with HIV to her infant requires a range of interventions beginning with voluntary and confidential counselling and testing for pregnant women; followed by antiretroviral prophylaxis for pregnant women with HIV and their newborn baby or antiretroviral therapy for the mother if eligible; and safe delivery practices and guidance in selecting a suitable infant-feeding option in order to prevent mother-to-child transmission (PMTCT) of HIV.

Progress

Many countries are making substantial progress towards preventing mother-to-child transmission of HIV. In 2008, 45 per cent (37–57 per cent) of pregnant women living with HIV living in low- and middle-income countries (628,400 of 1.4 million pregnant women with HIV) received antiretroviral drugs to prevent HIV transmission to their infants, including antiretroviral therapy for their own health. This represents a significant increase in coverage of antiretroviral drugs for the prevention of mother-to-child transmission from 10 per cent (8–12 per cent) in 2004, 15 per cent (12–18 per cent) in 2005, 24 per cent (20–31 per cent) in 2006 and 35 per cent (29–44 per cent) in 2007.

Percentage of HIV-infected pregnant women who received antiretroviral therapy for PMTCT in low- and middle-income countries, 2004–2008

Note: The lines on the bars show the uncertainty bounds for the estimates. Data were insufficient to calculate an average for the Middle East and North Africa region.
Source: UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third stocktaking report, 2008, New York, 2008. UNICEF calculations based on data collected through the PMTCT and Paediatric HIV Care and Treatment Report Card process and reported in Towards Universal Access: Scaling up HIV services for women and children in the health sector – Progress Report 2009 (WHO, UNAIDS, UNICEF), Geneva 2009. Regions were recalculated according to UNICEF classification of regions.

In general, coverage of antiretroviral therapy for PMTCT depends on a multitude of factors, including uptake of HIV testing, early reporting of women for antenatal care, attendance at delivery by skilled personnel, and health-system infrastructure, including laboratory and human resource capacity. Strong political commitment and leadership, enabling policies and the adoption of innovations in service delivery – namely, the introduction of provider-initiated testing and counselling, combined with rapid testing with same-day results, within antenatal and delivery care settings – have contributed to increasing access and uptake of HIV testing in the context of PMTCT. Despite the marked increase in access to PMTCT services during the past year, the world is still far short of the 80 per cent coverage target. Poor geographical service reach, aggravated by weak health systems, and the fear, stigma and denial that discourage women from being tested for HIV are significant barriers to wider uptake of PMTCT services.

Note

*Follows the United Nations General Assembly Special Session (UNGASS) on HIV and AIDS goals.

References

WHO, UNAIDS and UNICEF, Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector – Progress Report 2009, Geneva, 2009.

UNAIDS, Report on the global AIDS epidemic, Geneva, 2008.

Expanded Inter-Agency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and their Children, A Report Card on Prevention of Mother-to-Child Transmission of HIV and Paediatric HIV Care and Treatment in Low- and Middle-Income Countries: Scaling up Progress from 2004–2005, 2007.

UNAIDS and WHO, Aids Epidemic Update, Geneva, 2009.

UNICEF, Progress for Children: A World Fit for Children Statistical Review, No. 6, New York, 2007.

UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Fourth Stocktaking Report, New York, 2009.

UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third Stocktaking Report, New York, 2008.

WHO, UNICEF and UNAIDS, Towards Universal Access: Scaling up HIV Treatment, Care and Prevention Interventions in the Health Sector, Geneva, 2008.