Getting to Zero – How to create an HIV-AIDS-free generation.

For those of us who were there at the start of the HIV/AIDS crisis and watched friends die from this horrid epidemic, the state of the disease today is nothing short of a miracle.  In the last 30 years, it has gone from being a death sentence to being a chronic, but manageable disease and today we’re optimistic about the goal of achieving an AIDS-free generation in this decade.  People diagnosed with HIV/AIDS today can live a full life span and maintain their lifestyle in relatively good health.  That is, if they’re born in the right country, diagnosed before it’s too late, receive appropriate education and treatment and most importantly, if they have access to information and tools to prevent getting the disease in the first place. 

After years of focusing on treatment with positive results, the HIV/AIDS community has been able to turn their attention towards finding effective prevention strategies.  Among the most exciting efforts to come about in recent years has been the success and potential of programs that prevent vertical (Mother-to-Child) transmission (PMTCT) of HIV/AIDS and efforts to unify the goal of Getting to Zero (this year’s theme for World AIDS day). 

World AIDS day was first held in 1988 as the very first designated global health day. It’s now marked annually on December 1^st to provide a worldwide opportunity to unite in the fight against HIV, support people living with HIV and commemorate those who’ve died.  Currently, about 34 million people live with HIV. Almost 50% are women, 3.3 million are children and in developing countries where HIV/AIDS is rampant, most of them don’t know they’re infected.  Often infected mothers will unknowingly transmit HIV/AIDs to their babies during childbirth or through breastfeeding but with proper treatment, an HIV positive mother's risk of passing the virus on to her child drops to 2%. But that assumes two critical things: that she knows she is HIV positive and that she has access to the treatment. 

That means the more pregnant women we treat the more lives we can save and the better chance we of winning the fight against HIV/AIDS. Sound familiar?  HIV/AIDS contributes to thousands of maternal deaths and we’re in the business of preventing needless deaths in pregnancy and childbirth. If we can address the health needs of our girls and women we can prevent both. 

When we talk about maternal mortality rates, death from HIV/AIDS and its co-infections and conditions (like malaria and anemia) are still big killers.  That’s why increasing access to health care services, especially during pregnancy and whenever young women need reproductive health care, is critical.  We’ve made great headway in treating HIV/AIDS with antiretroviral medications, but unless those who have HIV are diagnosed, new infections will continue to drive this pandemic.  It’s no coincidence then that the areas where HIV/AIDS statistics are worst (like sub-Saharan Africa) are also the places where women die most often in childbirth and accessing healthcare is particularly difficult. 

Last week in Uganda we saw this first hand. Every site we visited shared their HIV testing results with us.  By tracking the women who come in to the clinic they’re able to show that 100% have been tested for HIV. By scaling up maternal health services at every level, these facilities are now better able to test women and get them on the path to treatment and/or prevention in a single visit. By the same token, if treatment is made available and women know they can get it, they're  more likely to make the effort to go to the clinic in the first place. For many, without this reassurance there's no point in knowing. Without that essential commitment that you’ll receive treatment, finding out you have HIV is still the death sentence it was for everyone diagnosed back in the 1980s.  With that commitment, mothers can live, their babies can avoid getting the disease, entire families can receive treatment and a generation can grow up HIV-free.

Integrating PMTCT into prenatal and reproductive healthcare isn’t easy and must include a comprehensive approach that incorporates solutions to all the issues and obstacles that are currently part of the HIV problem, including:

• Improved access and use of skilled delivery care 
• Making HIV and PMTCT information part of routine health education
• Offering provider-initiated testing and counseling 
•  Providing psychosocial support
• Providing infant feeding counseling
• Enhancing male participation
• Providing family planning counseling
• Providing health care for the expectant mother

Integrating PMTCT programs into Maternal Newborn and Child healthcare (MNCH) is a work in progress but many countries are already seeing tremendous successes. What we saw in Uganda last week is taking place all over Africa. The investments that the U.S. has made to fight HIV/AIDS provide the perfect platform not JUST to scale up PMTCT, but also to scale up access to maternal health care—which is in fact the whole idea behind Saving Mothers, Giving Life. These two go hand in hand and there's no reason NOT to let them do so. So this World AIDS Day, we are participating because we believe that an AIDS-free generation is possible.

Learn more about the fight against HIV/AIDS and watch ONE's video "It Starts With Me".