In-depth: Countdown to Universal Access

GLOBAL: Inching towards universal access to PMTCT services

NAIROBI, 1 October 2009 (PlusNews) - More than half of HIV-positive pregnant women in low- and middle-income countries continue to go without life-saving anti-retroviral medication that could prevent transmission of the virus to their unborn children, according to a new report, Towards Universal Access.

"Although there is increasing emphasis on women and children in the global HIV/AIDS response, the disease continues to have a devastating impact on their health, livelihood and survival," Ann Veneman, executive director of the UN Children's Fund (UNICEF), said in a statement.

According to the report, in 2008, 45 percent of pregnant women in low- and middle-income countries received anti-retrovirals for the prevention of mother-to-child transmission, up from 35 percent in 2007 and 10 percent in 2004, but still far off the goals set in 2006 by the UN General Assembly Special Session on HIV to achieve universal access to HIV prevention, treatment and care for all who need it by 2010.

Just 21 percent of pregnant women in low- and middle-income countries were tested for HIV in 2008, a small jump from 15 percent the previous year.

"Loss to follow-up remains high - many women who come for antenatal visits do not get tested, or if they do get tested they don't come for their results, and if they do get their results, they may not return for the medication," Jimmy Kolker, chief of UNICEF's HIV/AIDS programme division, said during a press conference.

Some regions registered impressive increases in the provision of ARVs for PMTCT - the Caribbean, for example, put 52 percent of HIV-positive pregnant women on ARV regimens in 2008, compared with 29 percent the previous year - while in other areas, the figures remain dismal; in North Africa and the Middle East, just 1 percent of pregnant women living with HIV received anti-retroviral drugs for PMTCT.

"The chief reason we are not reaching many of these women is that they do not give birth in medical facilities," he added. "We need to improve the health system aspects of maternal and neonatal health in order to improve PMTCT."

According to the UN World Health Organization (WHO), the global shortage of health workers exceeds four million; the report notes that in high-prevalence and resource-limited settings, health systems were "often weak, inequitable and unresponsive".

The chief reason we are not reaching many of these women is that they do not give birth in medical facilities.

Loss to follow-up has implications for the health of children born to HIV-positive mothers - the report found that in 41 reporting countries, only 15 percent of children born to HIV-positive mothers received an HIV test within the first two months of life. Nevertheless, this is progress: an estimated 32 percent of infants born to HIV-infected mothers in 2008 were reached with anti-retrovirals, more than five times as many as in 2004.

"It is very important that while trying to strengthen PMTCT services, we understand the interface and make the link between HIV/AIDS and maternal and child health," said Teguest Guerma, interim director of WHO's HIV/AIDS Department.

According to the report, there have also been significant increases in the number of women being placed on more effective combination ARV regimens rather than single-dose therapy. "In 97 reporting countries, around 31 percent of women receiving anti-retrovirals to prevent mother-to-child transmission were given a single-dose regimen, as compared to 49 percent in 2007," it found.

"The medicines exist and there is demand for them, we just need to ensure that we strengthen the PMTCT package as a whole so that women have access to them," said Karen Stanecki, senior adviser on epidemiology for UNAIDS.

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Countdown to Universal Access
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	Universal Access - an overview Mapping universal access progress Towards Universal Access: 2009 progress report Towards Universal Access: 2008 progress report Towards Universal Access: 2007 progress report Universal Access by 2010 What Countries Need. Investment needed for 2010 Targets
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