By Elke Weesjes
Across the globe, nations are announcing major triumphs in the fight against AIDS, most notably in the area of mother-to-child transmission (MTCT) of HIV.
The chain of positive reports began this summer in Cuba when the World Health Organization formally validated the country as the first to have eliminated MTCT of HIV, according to a WHO statement. The WHO defines elimination as an infection rate of 2 percent or less.
To achieve the validation, countries must participate in a monitoring program that includes transmission data for at least two years and on-site visits by WHO members who examine health care throughout the country—especially in impoverished, underserved, and isolated areas. Cuba has worked with the WHO on MTCT of HIV since 2010.
“This is a celebration for Cuba and a celebration for children and families everywhere,” Michel Sidibé, Executive Director of UNAIDS, said in the statement. “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.”
That could be very likely if the success stories that followed the announcement of Cuba’s achievement are any indicator. Around the world, reports of similar results underscore progress in the fight to eradicate the virus, which has killed 39 million people worldwide.
A July UNAIDS report stated that the world has exceeded the AIDS targets of Millennium Development Goal 6—halting and reversing the spread of HIV. New infections have fallen by 35 percent and AIDS-related deaths by 41 percent. Along with those results, stopping new HIV infections in children has been one of the most remarkable successes in the AIDS response, according to the report. Between 2000 and 2014, access to antiretroviral therapy for pregnant women living with HIV rose to 73 percent and—as a result—new HIV infections among children dropped by 58 percent.
Thailand could be the next country to follow in Cuba’s footsteps. There, the Ministry of Public Health stated on August 5 that the MTCT of HIV infection rates had dropped from the previous range of 20-45 percent to only 2.1 percent. The government is now in the process of applying for official validation by the WHO. Thailand is one of 30 countries that might be very close or may have already achieved the elimination targets, according to WHO estimates.
In North America, Canada has also reached a successful elimination of MTCT, which was announced the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention on July 17. In 2014, the country registered only one case of a mother who passed HIV to her infant.
The methods to achieve these results are the same in all of these countries—wide access to HIV testing for pregnant women and their partners, treatment for women who test positive and their babies, caesarean deliveries, and substitutions for breastfeeding.
For those wondering where the United States stands in all this, the outlook is bright here, as well. The rate of transmission of HIV through pregnancy and childbirth is already below the two percent mark, although unlike Cuba, the United States has pockets of underserved populations in both rural areas and inner cities.
“On a national level, the United States has already achieved the elimination target, “ Sonja Caffe, WHO regional adviser on HIV, told NPR. “But a criteria for validation is that it be met in an equal manner, even in subgroups of the lowest performing areas.”
In that sense, Caffe said, the United States and other nations might consider taking a page from Cuba’s book on lowering infection rates uniformly.
“I think the rest of the world can learn from the way the system is designed in Cuba,” she said. “In Cuba, the health services are very close to the people. There is universal coverage, and the services are free. They don't simply invest in hospitals. There is a philosophy of bringing health care to the people in the community.”