Cuba sets the bar by achieving elimination of mother-to-child HIV

Almost one month ago (end of June 2015), the WHO announced that Cuba is the first country in the world to eliminate mother-to-child transmission (MTCT) of HIV and syphilis. Elimination in this case is defined as a reduction of transmission to such a low level that the disease or circumstance is no longer a public health threat. In Cuba in 2013, only 2 babies were born with HIV and 3 with congenital syphilis. Cuba has certainly accomplished a major step towards an AIDS-free generation.

Around the world about 1.4 million women living with HIV become pregnant every year. With antiretroviral (ARV) treatment, those women have a 1% chance of transmitting HIV to their children through pregnancy, the birthing process, or breastfeeding. Without treatment, that chance for transmitting HIV ranges from 15-45%. Globally the number of children born with HIV has been dropping, with the number being almost cut in half since 2009.

To achieve elimination, Cuba worked with WHO and PAHO (Pan American Health Organization) to provide early access to prenatal care, HIV and syphilis testing for pregnant women and their partners, treatment for women who test positive, cesarean deliveries, and breastfeeding substitution. Cuba achieved these initiatives through its universal health care system which integrates maternal and child health into its HIV and STI programs.

While Cuba was the first country to reach this monumental achievement, other countries around the world are making progress towards eliminating MTCT of HIV. Figure 1 shows the Number of child HIV infections vs the number of infections that were averted due to PMTCT (prevention of mother-to-child transmission).

cuba mtct

Figure 1. Courtesy of UNAIDS, AIDS info. Taken from aidsinfo.unaids.org

As you can see MTCT HIV cases have been decreasing since the early 2000s. In 2014, almost 300,000 children born to HIV positive mothers were not born with HIV due to the PMTCT effort.

Below is a screenshot of an interactive map found at aidsinfo.unaids.org that allows you to see the progress of different countries on the many facets of the fight against HIV/AIDS.

cuba mtct2

Figure 2. Percent coverage of pregnant women who received antiretrovirals for PMTCT. Courtesy of UNIADS, AIDS info. aidsinfo.unaids.org

Figure 2 shows the percentage of pregnant women receiving antiretrovirals to prevent mother-to-child transmission of HIV in 2014. You can see that many countries have at least some color with the darker colors indicating a higher percentage of HIV positive pregnant women receiving ARVs.

The progress made on preventing MTCT of HIV is saving lives every day. Cuba is the first to succeed on the path to elimination of MTCT of HIV and syphilis, with many more countries striving to attain that same level of achievement. While many countries may have a few years to go before achieving elimination, Cuba has shown that such a goal is possible within our lifetime.

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