By Antonia Chan
Cuba has become the first country to eliminate mother-to-child transmission of HIV, marking a global public health milestone. Executive director of UNAIDS Michel Sidibé called Cuba’s achievement proof that “ending the AIDS epidemic is possible.”
Key to the success was Cuba’s participation in a multi-country project started by the WHO and Pan-American Health Organization in 2010. Designed to eliminate both mother-to-child HIV transmission and syphilis, each country expanded early access to prenatal care and testing/treatment for both mothers and babies. Cuba provided these services as part of a universal health system, with resounding results: in 2013, only two babies in the country were born with HIV.
Despite proven low risk of mother-to-child transmission when mothers are on ARVs—just over 1%—such treatments are often inaccessible to pregnant mothers in lower-income nations. ARVs are included on the WHO essential medicines list. Margaret Chan, WHO Director General, stated: “The best part is that [the elimination of mother-to-child HIV transmission] was brought about by relatively simple strategies: namely, better testing and treatment of expectant parents, and providing HIV- and syphilis-positive mothers with options to protect their babies, such as bottle-feeding and C-sections.” Cuba’s strategy integrated these strategies into its affordable universal health care system, making them available for all pregnant women.
In a paper published in the June issue of Health and Human Rights, Kavanagh et al argued that restricting mothers’ and children’s access to early treatment—whether directly or indirectly—violates both individual and collective rights to health. The burden of HIV/AIDS still disproportionately affects stigmatized and socioeconomically vulnerable groups. In sub-Saharan Africa, where HIV is the leading cause of maternal death, isolated health interventions have proven inadequate: comprehensive rights-based approaches that also address human rights issues like gender equality and access to essential health services are needed to protect against HIV/AIDS and maternal mortality. The evidence that ARVs and bottle feeding stop mother-to-child HIV transmission is overwhelming. Making such treatments affordable and accessible to all, free from discrimination, is essential to both stopping the HIV/AIDS epidemic and achieving full realization of the human right to health.
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