Friday, June 19, 2015

Eliminate mother-to-child transmission of HIV and keeping mothers alive

Progress to eliminate new HIV infections among children and keeping their mothers alive has been one of the most impressive achievements of the AIDS response to date.

In 2013, for the first time since the 1990s, the number of new HIV infections among children in the 21 Global Plan1 priority countries in sub-Saharan Africa dropped tounder 200 000. This represents a 43% decline in the number of new HIV infections among children in these countries since 2009 (58). 

Despite successes, progress among young women and adolescent mothers has been slow with many challenges. The average adolescent birth rate in Africa is 115 per 1000 girls, more than double the global average of 49 per 1000 girls (6). In western and central Africa, 28% of women aged 20–24 years have reported a birth before the age of 18 years, the highest percentage among developing regions. In Chad, Guinea, Mali, Mozambique and Niger, 1 in 10 girls has a child before the age of 15 years (9). In sub-Saharan Africa, an estimated 36 000 women and girls die each year from unsafe abortions, and millions more suffer long-term illness or disability (9).

 Many young women who marry or enter into partnerships early do not have the knowledge or the personal agency that enables them to protect themselves from HIV – for example, they cannot negotiate when to have sex or to use condoms. 

A core strategy to eliminate mother-to-child transmission of HIV is to prevent pregnancy in young women and adolescent girls who do not want to have a child at that time. According to the United Nations Population Fund, 33 million women aged 15–24 years worldwide have an unmet need for contraception, with substantial regional variations. For married girls aged 15–19 years, the figures for an unmet need for contraception range from 8.6% in the Middle East and North Africa to 30.5% (one in three married girls) in western and central Africa (10). Among unmarried sexually active adolescent girls, the unmet need for contraception in sub-Saharan Africa is 46–49%; there are no data for North Africa (10).

 According to 2013 data, in sub-Saharan Africa, only eight male condoms were available per year for each sexually active individual. Among young people, and particularly among young women, condom access and use remain low, despite offering dual protection against HIV and unwanted pregnancy (11). Sub-Saharan Africa accounts for 44% of all unsafe abortions among adolescent girls aged 15–19 years in low- and middleincome countries (excluding east Asia) (9).

 Governments in Africa have already made important commitments in this area that can be leveraged. Among the strongest is the 2013 Ministerial Commitment for Comprehensive Sexuality Education and Sexual andReproductive Health and Rights in Eastern and Southern Africa. This commitment includes action to “reduce early and unintended pregnancies among young people by 75%”(12).

 Providing access to comprehensive sexuality education, keeping girls in school and implementing social protection programmes such as cash transfer programmes have all proven effective in reducing new infections among young women and adolescent girls. Stopping child marriage and early pregnancy is also central to success. Across Africa, 41% of girls in western and central Africa, 34% of girls in eastern and southern Africa and 12% of girls in the Arab states are married as children (13). Child marriage has been associated with higher exposure to intimate partner violence and commercial sexual exploitation (13). Child marriage is a form of violence.

1. ECOSOC E/CN.61201513. Review and appraisal of the implementation and the outcomes of the twenty-third special session of the General Assembly Report of the Secretary-General. Geneva: United Nations; 2015.
2. No ceilings: the full participation report. New York: Clinton Foundation and Bill & Melinda Gates Foundation; 2015.
3. World development report: gender equality and development. Washington, DC: World Bank; 2012.
4. Women’s Health. Women’s health Fact sheet N°334; World Health Organisation. Updated September 2013;
5. All in! Towards ending the AIDS epidemic among adolescents. Geneva: UnitedNations Children’s  Fund and Joint United Nations Programme on HIV/AIDS; 2014.
6. Adolescents: health risks and solutions. Fact sheet 345. Geneva: World Health Organization; 2014 (
7. Advancing young women’s sexual and reproductive health and rights in the context of HIV. Geneva. GCWA. 2014
8. Most-at-risk Populations: Unveiling New Evidence for Accelerating Programming. Kenya. National AIDS & STI Control Programme (NASCOP) 2013.
9. Motherhood in Childhood. Facing the challenges of adolescent pregnancy. New York. UNFPA 2014
10. The power of 1.8 billion. New York: United Nations Population Fund; 2014.
11. The gap report. Geneva: Joint United Nations Programme on HIV/AIDS; 2014.
12. Young People Today. Time to Act Now. Regional Accountability Framework.
Ministerial Commitment on comprehensive sexuality education and sexual and reproductive health services for adolescents and young people in Eastern and Southern African (ESA). 2013
13. Ending child marriage: progress and prospects. New York: United Nations Children’s Fund; 2014 ( LR.pdf).
58. UNAIDS 2014 Progress Report on the Global Plan

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