What We're Reading: Combination Prevention for an AIDS-Free Generation
February 7, 2012
This week we’ve been reading about the important role of preventing mother-to-child transmission of HIV (PMTCT) as a part of a larger prevention strategy to help end the AIDS epidemic.
The blog Science Speaks wrote about
a packed Capitol Hill briefing on the subject last week, which was sponsored by amfAR, the Center for Global Health Policy, and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
The event featured speakers discussing a number of methods to reduce HIV infections, including the Foundation’s own Dr. RJ Simonds talking about PMTCT, and the potential to virtually eliminate pediatric AIDS.
With new HIV infections on the decline in almost every sub-Saharan African country, as well as recent scientific advances that have the potential to change the way we fight against HIV, the idea of an AIDS-free generation has become a real possibility.
Continuing to build on this momentum, PEPFAR is prioritizing prevention methods such as PMTCT based on well-grounded evidence of their effectiveness.
Opening the briefing, Ambassador Eric Goosby, the U.S. Global AIDS Coordinator, reflected upon “the tremendous opportunity new science has given us…to pursue an AIDS-Free generation.”
He outlined the “Combination Prevention Strategy” introduced by Secretary of State Hillary Clinton last November, and gave a brief overview of the three pillars of the strategy: PMTCT, HIV treatment as prevention, and voluntary medical male circumcision
Foundation Vice President for Program Innovation and Policy, Dr. RJ Simonds, discusses PMTCT at the Congressional briefing on
Combination Prevention. (Photo:EGPAF)
Dr. Simonds, the Foundation’s Vice President for Program Innovation and Policy, talked about the issue of PMTCT through the lens of three success stories.
The first was a research success story: In the 1990s, scientists discovered that giving antiretroviral drugs (ARVs) to pregnant women during pregnancy and to the baby after birth reduced HIV transmission rates by two-thirds. Since then, global research has found improved regimens to lower the risk of transmission to less than 2%.
Dr. Simonds next presented a public health success story: In the U.S., these findings led to a more than 95% reduction of mother-to-child transmission in just ten years, culminating in the virtual elimination of pediatric AIDS in the developed world. But pregnant women in sub-Saharan Africa, which is home to more than 90 percent of new HIV infections in children, have been harder to reach with these services.
In its 2008 reauthorization, PEPFAR gave a special focus to PMTCT. Since then, there has been steadily increasing coverage of PMTCT and treatment for pregnant women living with HIV in high-burden countries. Last year, nearly half of HIV-positive pregnant women received access to PMTCT and treatment services, compared to only one in ten women in 2004.
Still, much work needs to be done to reach the other half of mothers in need, and to prevent the 1,000 new pediatric infections that still occur globally every day.
Dr. Simonds illustrated the success of research and public health programs through the story of Florence Ngobeni-Allen
. Florence lost her first child to AIDS before ARVs were made available to women in South Africa. She became a counselor to other HIV-positive women at a time when things seemed hopeless.
But she witnessed a dramatic shift in the AIDS epidemic in South Africa. Because of programs like PEPFAR, women gained access to the drugs that could keep them healthy and protect their babies from HIV.
Florence became one of those success stories – she’s now the proud mother of two HIV-negative children.
Over the past seven years, PEPFAR has helped nearly 400,000 mothers like Florence give birth to babies free of HIV.
Florence and her son, Kulani. (Photo: EGPAF/James Pursey)
Other equally impressive aspects of the combination prevention strategy were also covered by a USAID article on the briefing
- Dr. Diane Havlir, Chief of the HIV/AIDS Division at San Francisco General Hospital, discussed the groundbreaking study and outcomes of HIV treatment as a means to prevent new infections.
- Dr. Renee Ridzon, a consultant with the Gates Foundation, focused on voluntary medical male circumcision as a method for drastically reducing HIV transmission, particularly in heterosexual couples in Africa.
- Dr. Chris Beyrer, Director of the Center for Public Health and Human Rights at Johns Hopkins, emphasized the importance of modifying combination preventions for various populations, such as injecting drug users (IDUs).
All of the speakers pointed out the cost-effectiveness of implementing these combination prevention methods, particularly through the decreased burden of disease over time. Other benefits include economic growth and development, fewer orphans and vulnerable children, and less social stigma.
While there continue to be programmatic and implementation challenges, all the evidence suggests that – absent an HIV vaccine – this combination of prevention methods will be our best way to achieve an AIDS-Free generation.
Samantha Ritter is a Department Assistant for Global Communications and Strategic Branding based in Washignton, D.C.