Along with the new Political Declaration on AIDS the UN High Level Meeting on AIDS saw the launch of a new Global Plan to eliminate HIV among children and keep their mothers healthy. Kate Iorpenda looks at the strengths of the plan and points out a glaring omission: the lack of discussion of key populations.
World leaders have now completed their deliberations in New York at the 2011 United Nations High Level Meeting on AIDS. It is heartening to read the progress that has been made and the commitments now endorsed, relating to children and families.
The declaration promises significant progress on long neglected issues, such as infant diagnosis, use of prophylaxis for HIV exposed infants, access to treatment for children and adolescents, the central role of families the integration of HIV within the broader maternal and child health agendas and the strengthening of systems for child protection and social protection.
In addition to this progress made within the main declaration another output from the meeting was the launch of the Countdown to zero: Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. The plan is the work of a global task team headed up by UNAIDS and it is hoped that it will lead efforts towards eliminating new HIV infections among children in 22 of the countries which are most affected.
Keeping mothers and children healthy
“We believe that by 2015 children everywhere can be born free of HIV and that their mothers can remain healthy,” said Michel Sidibé, Executive Director of UNAIDS. “This new global plan is realistic, it is achievable and it is driven by the most affected countries.”
Building on the broader commitments of the High Level Meeting the Global Plan contains specific actions for communities, national governments and global leaders with specific targets and mechanisms for accountability. The plan puts HIV positive women at the centre. It highlights women’s rights to life-saving prevention and treatment by:
1) preventing new infections amongst women of reproductive age
2) meeting unmet family planning needs of women living with HIV
3) preventing vertical transmission through the use of testing , counselling and anti-retroviral drugs
4) care, treatment and support for women, children living with HIV and their families .
It calls for the allocation of adequate resources at country level and increased use of more efficacious treatments to prevent HIV transmission , co-trimoxazole prophylaxis for HIV-exposed infants and new technology for early infant diagnosis.
Community involvement and mobilisation is a key part of the plan. Community charters will explicitly present what women and their families can expect. This is welcomed as we know that in the past, the focus has mainly been on women receiving services within clinical settings, and on issues of ‘loss to follow up’. The community has a key role in this by supporting initial uptake of services, retention in care, and further follow up with families.
Countdown to Zero calls for improved measures of success beyond the simple administration of anti-retroviral drugs including longer term outcomes for the baby, testing and referral into treatment and the survival and health of the mother.
Key populations – a glaring absence
Although the plan provides a much more comprehensive and harmonised approach to ending vertical transmissions, there is a glaring absence of any discussion about the populations critical to halting the AIDS epidemic.
Women who use drugs, sex workers, female partners of people who inject drugs or of men who have sex with men are extremely susceptible to HIV infection, and they can all be pregnant women and mothers. The Global Plan discusses HIV and gender related stigma but fails to highlight issues of criminalisation and discrimination of key populations who are often unable to access HIV prevention, family planning and PMTCT services due to discriminating laws, policies and societal attitudes . If we are truly going to end vertical transmission, the specific barriers to these populations need to be on the agenda.
Within the broader political declaration, commitments were made to specifically address HIV prevalence amongst key populations. These commitments need to translate into concrete actions for ending vertical transmission
India: barriers to HIV prevention
India is one of the targeted countries in the global plan, where HIV prevalence is 0.3% within the general population, but much higher amongst people who inject drugs and sex workers especially in Manipur where Alliance partner SASO works.
Statistics from the Manipur State AIDS Control Society state HIV prevalence amongst injecting drug users is 28.5% and 10.8% amongst sex workers. Recent research performed by SASO shows that only 6% of female IDUS and female partners of IDUs have access to contraception, and 17% have experienced violence from their partners or from law enforcement agencies in the last 3 months. Violence, stigma and discrimination are driving them away from support.
A 26 year old female woman who injects drugs told SASO “When I fell sick a year ago, I approached [a particular drug treatment centre] for treatment. They refused to admit me with my daughter. I don’t know who my daughter’s father is… there was no one to look after her. She is no more…. I will never go for treatment. I am not interested.”
Poor treatment by service providers due to stigma and lack of awareness on how to support women who use drugs continue to be a major barrier to effective HIV prevention.
A service provider stated that “While working with female injecting drug users I have noticed that they face a lot of harassment from law enforcers and women’s prohibition groups. May be this is the reason why they don’t seek health services. They don’t even want to consult our doctor in the drop in centre. They come only when the problem is very serious.”
Many drug treatment services do not address women’s needs in SRH and family planning and consequently they are discovering pregnancies late and often delivering unassisted on the streets or in shelters. These women are not attending ANC services, they are not women who are ‘lost to follow up’ in the PMTCT cascade, they are not in services in the first place.
If we are to have any chance in ending vertical transmission then we need to work with communities and organisations who are reaching the most vulnerable and ensuring services are appropriate, targeted and accessible to these women.