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No Jamaican child should be born with HIV

Submitted by unaidsadmin on Mon, 2012-04-30 11:28 - 0 Comments

Yesterday Dr. Edward Greene, the United Nations Special Envoy for HIV in the Caribbean, arrived in Jamaica on an official mission. His initiative is well-timed as in a few days Jamaica begins its commemoration of National Child’s Month. This annual recommitment to the welfare of children is an admission of the shortcomings that lead to their abuse and neglect. Yet Jamaica’s month-long meditation is more than a sob story. It is a vision for joint action to create a country where all children are nurtured and protected, afforded justice and respect, and given a fair shot at success.

We have an equally purpose-driven mandate in relation to HIV. The dream of a world in which there are zero new HIV infections, zero discrimination and zero AIDS-related deaths, may seem pie-in-the-sky. But in recent years the community of nations and entities including the Global Fund, Centre for Disease Control and World Bank have regrouped and strategised to make it possible.

A key part of this vision is the elimination of mother-to-child transmission of HIV. This dream is expressed in many commitments and initiatives. It is included in the Political Declaration that came out of the 2011 United Nations General Assembly High Level Meeting on AIDS. It is contained in the 2010 Pan Caribbean Partnership against HIV/AIDS (PANCAP) Declaration. And the Elimination Initiative, a joint effort by the Pan American Health Organisation (PAHO), the United Nations Children’s Fund (UNICEF), UNAIDS and a host regional stakeholders, aims to eliminate this form of transmission by 2015.

In the region as a whole an estimated 1.1 percent of pregnant women are living with HIV.  Currently, between eight to ten percent of all HIV infections are due to mother-to-child transmission. Today we have the knowledge and skills to reduce the risk of transmission to babies to less than one percent. We have a moral imperative to optimise this know-how, saving lives and shrinking our epidemics in the process.

This is a fight that Jamaica can win. Before prevention of mother-to-child transmission (PMTCT) interventions became available, more than 25 percent of children born to mothers living with HIV were infected with the virus. By 2005 the mother-to-child transmission rate in Jamaica was ten percent. And by the start of this decade, in 2010, it had fallen to 4.6 percent. The number of reported paediatric AIDS cases has declined from 61 in 2004 to 19 in 2010. Today PMTCT is the segment of the HIV response that is most integrated with the rest of the health system.

How did this happen? First is the political will to prioritise prevention interventions including universal access to voluntary testing in pregnancy and antiretroviral treatment. The dedicated effort of healthcare workers has transformed evolving protocols and drug regimens into life-saving action. Excellent cooperation between Professor Celia Christie and her team at the University of the West Indies and the Ministry of Health has been invaluable. Civil society oragnisations have raised awareness about the issue and offered hands-on support to women and families navigating the process. And the love and concern of mothers have resulted in consistently high rates of testing among antenatal attendees in the public sector (more than 95 percent) and the follow-up necessary to reduce the risk of transmission to exposed infants.

Despite these strides there remains ground to be covered. In 2010, 13 percent of HIV positive pregnant women and two percent of HIV exposed infants did not receive antiretroviral medication in order to prevent transmission. An estimated 15 percent of pregnant women living with HIV continue to elude the programme. There are women who present late, or not at all, for antenatal care. Some refuse to be tested. Others do not reveal their HIV status to health staff. Others still switch location, making follow-up difficult or impossible. A minority of HIV positive women even breastfeed their infants, exposing them to the virus. These are not acts of hate. They are the actions of women who are ashamed and fearful of being treated differently by healthcare workers, their communities and their own families.

All Jamaicans have a role to play in making the island a place where women feel safe and confident to access life-saving interventions. It is the awareness that people living with HIV continue to be scorned, insulted, and set apart that leads a few women to risk the health of their children. People living with HIV perceive our prejudice—from the hesitant touch of a nurse to the whispered gossip of a neighbour. Every Jamaican has a responsibility to create a society in which people aren’t treated unfairly because of their HIV status. That assignment must play out in our homes and hospitals, churches and communities.

Eliminating HIV in children must become as important a political mandate as steering the economy or fighting crime. Throughout the region, healthcare sectors are coming to terms with how they must reorganise their systems to make these programmes more efficient and sustainable. HIV testing and treatment must be decentralised and more integrated with all other healthcare services. Our medical professionals need the mandate and resources from their governments to convert these plans into life-saving reality.

To women living with HIV: you have the same right as all women to decide on the number and spacing of your pregnancies. You are fortunate to live in a time and place that allows your child to be born HIV free. You have a responsibility to your child and to your country to access the timely testing, treatment and follow-up that would allow this to happen. There is no need to feel ashamed or afraid. 

Jamaica can be among the Caribbean leaders championing the elimination of mother-to-child transmission.  To do so there must be joint effort and partnership on this specific goal and its many connected issues. We need to strengthen prevention among young people. We need to address the social and economic vulnerability of women. We need to change our attitudes about and treatment of people living with HIV. There should be enhanced synergies and shared responsibility among all the institutions and programmes concerned. The elimination of HIV in children requires all hands on deck.

 

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About the Author

unaidsadmin's picture

The UNAIDS team offers the Caribbean the broad expertise of cosponsors and other UN organisations in areas such as program development and management, women and child health, education, legal networking, community care initiatives and resource mobilisation. The goal is an expanded response to HIV in the region with the world’s second highest HIV prevalence.