“Determining what the end of AIDS could look like is complex. It is certain that ending the AIDS epidemic will mean so much to so many. It will mean zero new HIV infections, zero people dying of AIDS—and all people living with dignity and without fear of discrimination.

Ending AIDS will mean celebrating birthdays instead of attending funerals.  But make no mistake, stigma, denial and complacency are still among us, putting us in danger of failing the next generation. We must join our hearts and our voices––together we are stronger.  

The world is poised to end AIDS and if we stay true to our vision we will remember this as the day that a lifelong of dreams began to transform into reality”. These were words contained in the  2013 World AIDS Day message of Michel Sidibé, Executive Director of UNAIDS - Under-Secretary-General of the United Nations to the world. This statement I think is very imperative and can set a good tone for our conversation.

To bring to mind what others might have forgotten about “Mother-to-child HIV infection”, it is when an HIV-positive mother passes the virus to her child during pregnancy, labour, delivery or breastfeeding.  According to UNICEF, in 2011, about 900 newly born children were infected with HIV per day, over 90% occurring in Sub-Saharan Africa including Ghana. Out of this number, 57% of pregnant women living with HIV received antiretroviral drugs to prevent them from transmitting the virus to their babies. Globally, only 35% of infants born to mothers living with HIV in low- and middle-income countries received an HIV test within the first two months of life and only 28% of children under 15 living with HIV in low- and middle- income countries received antiretroviral treatment for the virus, as compared with 54% for adults.

Ghana’s Progress in eliminating MTCT

Ghana has reduced by 76% the number of new HIV infections among children due to increased coverage of anti-retroviral prophylaxis for pregnant women living with HIV in 2009, the proportion of children born with HIV to positive mothers declined to 9% in 2012. Ghana is the only country in West and Central Africa to reduce mother-to-child-transmission (MTCT) of HIV to this level. In the current hierarchy of preventive measures, the prevention of mother-to-child transmission is the highest national priority.

This significant milestone was achieved in MTCT through the assistance of HIV Ambassadors, who embarked on various advocacy campaigns to provide integrated sexual and reproductive health services for women. The Campaign seeks to galvanize community support to save the lives of mothers and their babies and encourage men to support their partners to access PMTCT services. This starts with couples receiving HIV testing and counseling together, in an environment free of stigma and discrimination.  Indeed, it is inexcusable that in Ghana today, babies are born HIV-positive.

The Heart–to-Heart campaign, which was launched in 2011, has toured the country to campaign against HIV and AIDS-related stigma and discrimination and to educate the population on the risk factors for HIV infection. The Heart to Heart Ambassadors and other persons living with HIV have used their personal lives and circumstances as ‘Models of Hope’ for other HIV positive persons.  

The general adult prevalence for HIV has dropped by over 60% in 10 years, from 3.6% in 2003 to 1.37% in 2012. New HIV infections have dropped from 26,000 per annum to fewer than 8000 in 2012 and the number of AIDS-related deaths has also declined significantly.

 

Challenges

There are a number of barriers and challenges facing the prevention of mother-to-child transmission in the country. Some regions still do not have enough PMTCT services and too many women live a long way from their nearest health clinics. The cost or unavailability of transport, as well as heavy workloads and other responsibilities, such as the care of children or other dependents, can further inhibit women from accessing PMTCT services.

Even where quality PMTCT services are locally available, there may be social, cultural or personal reasons why women do not access PMTCT services. The fear of stigma and discrimination, particularly if a woman is economically dependent on her partner, for example, may prevent her from getting tested, from disclosing her status to a partner or healthcare provider, or from accessing antiretroviral treatment for her own health and for PMTCT. Fear of disclosure is a common reason why women are reluctant to return to their HIV clinic.

Last but not the least is the poor health system in some regions of the country, especially in remote villages where health systems are often poorly staffed and resourced. As a result of this limited capacity, many regions are unable to adapt their existing health systems according to World Health Organization (WHO) standards.

The way forward

For Ghana to achieve less than 5% mother-to-child transmission of HIV by 2015, all stakeholders need to take pragmatic steps to realize this. Government and stakeholders must work hard on closing the resource gap needed to help Ghana accelerate to zero new infections, zero stigma and discrimination, zero AIDS-related deaths by 2015.  Some of these drastic steps should include; the Ghana AIDS Commission (GAC), the highest policy making body on HIV and AIDS in Ghana must continue to lead the implementation of their  well-designed, evidenced-based and results-oriented National Strategic Plan for  2011-2015,  while making adjustments as appropriate, and also leverage strong partnerships with stakeholders, and accelerate implementation of comprehensive and targeted prevention programmes for key populations and youth, in order to avert new infections.

GAC must scale-up treatment services with caution, ensuring that, People living with HIV who have already been initiated on treatment receive the highest quality of services and adhere to their treatment regimes. This means that commodities must be procured on time, in the right quantities and at optimum quality, even with little funding from Government and our Development Partners - United Nations, United States, Germany and Global Fund . This will serve as a catalyst for additional release of funds from both sources to the health sector.

Ghana Government should continue pioneering the role to actualize the African Union (AU) action plan on local production of ARVs.  Government must provide leadership for this initiative and ensure that our pharmaceutical companies meet the criteria to obtain the necessary WHO pre-qualification to produce ARV locally. This is the most efficient means to get more People Living with HIV/AIDS (PLWHA) on treatment.

The Ministry of Health should be receiving emergency consignments of antiretroviral drugs to cover all new clients initiated on treatment on time to enable PLWHIV receive effective and uninterrupted treatment. Civil Society and the media should continue the effective educations of populace on the disease to create more awareness, especially eliminate stigma which is a setback to the elimination of this illness.

All women must continue to have access to high quality life-saving HIV prevention and treatment services, both for themselves and their children; regardless of their wealth, status or geographical location. This means scaling up PMTCT programmes and ensuring that the barriers to PMTCT are overcome, whether they are practical, social or cultural.

Evidence shows that the hundreds of thousands of children that become infected with HIV during pregnancy, labour or breastfeeding can be averted. By expanding our efforts and ensuring the delivery of PMTCT services to all women, we can achieve universal access and the elimination of MTCT worldwide.

Quick Read

However, among mothers that take a regimen of ARVs for the prevention of mother-to-child transmission (PMTCT), the risk of HIV transmission can be reduced to less than 5 percent. UNAIDS has also advocated four key strategies for preventing mother-to-child transmission:

• Keeping women of reproductive age and their partners HIV-negative through reproductive health and HIV prevention services.
• Avoiding unwanted pregnancies among HIV-infected women and women at risk of HIV, through family planning and HIV testing and counselling services.
• Ensuring HIV testing of pregnant women and timely access to effective antiretroviral therapy, both for the health of HIV-infected mothers and for PMTCT, during pregnancy, delivery and breastfeeding.
• Better integration of HIV care, treatment and support for HIV-infected women and their families.

 

Writer’s e-mail: Mikeamedorr@gmail.com

Michael Father Amedor

Accra-Ghana