A handful of countries in the Americas appear to have virtually eliminated mother-to-child transmission of HIV and congenital syphilis, according to a new report from the Pan American Health Organization/World Health Organization (PAHO/WHO). But the goal of hemisphere-wide elimination requires stepped-up action in countries and population groups where progress is lagging, the report says.
"The Americas is the first region in the world to set its sights on eliminating mother-to-child transmission of HIV and syphilis through simultaneous efforts in a joint framework," said PAHO Director Dr. Mirta Roses. "This new report shows how much progress has been made but also suggests there is a lot of work that still needs to be done."
An estimated 5,000 children become infected with HIV in the Americas each year, most through mother-to-child transmission, and between 164,000 and 344,000 babies are born with congenital syphilis. If untreated, the conditions can produce miscarriages, fetal death, premature birth, stillbirth, newborn death, low birth weight, and congenital infection with different degrees of severity. These imply major human, social and economic costs.
The countries of the Americas have collectively committed to the goal of eliminating mother-to-child transmission of HIV and syphilis as public health problems by 2015, by improving the quality of care for pregnant women and babies, including wider and timelier treatment for HIV and syphilis. The report released today assesses progress in the Region's countries in implementing such efforts to advance toward elimination.
According to the report, Canada, Cuba, Antigua and Barbuda, the United States, and the British territory of Anguilla have all reported reduced rates of mother-to-child ("vertical") transmission of HIV to less than 2 percent and have reduced pediatric HIV cases to no more than 0.3 per 1,000 live births, while also reducing congenital syphilis cases to no more than 0.5 per 1,000 births. These levels are considered low enough to no longer constitute public health problems, although experts say sustained efforts are needed to keep these rates low. PAHO, UNAIDS, and UNICEF have begun developing a certification process to validate countries' progress toward elimination.
At the regional level, the report estimates the rate of mother-to-child transmission in Latin America and the Caribbean at 15 percent, significantly higher than the 2 percent rate needed to achieve elimination but lower than the 35 percent transmission rate that would occur without public health interventions. To further reduce rates, countries need to increase HIV testing in pregnant women, provide wider coverage with antiretroviral drugs for mothers and infants, and increase early diagnosis of exposed infants. Countries with the highest rates of mother-to-child transmission should rapidly scale up action in these areas, through joint efforts between health authorities, international agen­cies, academia, civil society, and other partners, says the report.
Other challenges and achievements highlighted in the report include:
- Rates of HIV screening for pregnant women are increasing in most countries and range from 21 percent in Guatemala to 97-98 percent in Canada and the United States. In Latin America, HIV screening rates are much lower for women from remote rural and indigenous areas than for urban women.
- On average, 61 percent of women receiving prenatal care in the Americas were screened for syphilis in 2010. To increase screening, the report urges wider use of rapid tests in primary health care settings.
- Coverage with antiretroviral medication increased in Latin America and the Caribbean from about 50 percent of HIV-positive pregnant women in 2005 to 61 percent in 2010.
- The percentage of pregnant women diagnosed with syphilis who receive appropriate treatment ranges from under 15 percent in El Salvador to 100 percent in Chile, Cuba, Guyana, Honduras, Trinidad and Tobago, and Venezuela (among 18 reporting countries).
- Most countries report access to prenatal care at 80 percent or better (that is, pregnant women have at least one visit with a skilled antenatal care attendant). However, early access is not necessarily the norm, and shortages of supplies and medications (HIV and syphilis tests, antiretrovirals and penicillin) often compromise the quality of care.
- Skilled attendance at birth ranges from 26 percent to 100 percent, with half of countries reporting 99 percent coverage or better. Countries with the lowest rates include Haiti (26 percent), French Guiana (49 percent), Guatemala (51 percent), Honduras (67 percent), Bolivia (65 percent), and Ecuador (71 percent).
- Indigenous women have consistently lower rates of access to prenatal care and delivery by skilled birth attendants, as indicated by data from Bolivia, Ecuador, Guatemala, Nicaragua, and Peru.
- In most countries for which data are available, less than half of youths aged 15 to 24 know how to prevent sexual transmission of HIV and also reject major misconceptions about HIV transmission.
- The percentage of unmet need for family planning/contraception ranges from a low of 6.6 percent in North America to over 20 percent in Haiti, Guatemala, Belize, Bolivia and the Caribbean overall.
The PAHO/WHO report recommends stepped-up efforts to overcome challenges in the delivery of prenatal and childbirth care and to eliminate geographic, social, economic and cultural barriers to early access to quality care.
It also recommends strengthening of surveillance and information systems related to HIV and syphilis among women and babies to eliminate data gaps, noting that many countries and territories in the hemisphere have not reported on key indicators of progress toward elimination.
PAHO was established in 1902 and works with all the countries of the Americas to improve the health and quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of the World Health Organization (WHO).
Links
- 2010 Situation Analysis: Elimination of Mother-to-Child Transmission of HIV and Congenital Syphilis in the Americas
- Mother-to-Child Transmission of HIV and Syphilis Elimination Initiative: www.paho.org/eliminationinitiative
- PAHO World AIDS Day page
- PAHO HIV-STI website: www.paho.org/HIV
- "Unparalleled global progress in HIV response but sustained investment vital" (WHO news release)
- WHO fact sheet on HIV
