Getting to Zero: How Donors Can Help End Childhood HIV and Keep Mothers Healthy

Each day over 1,000 children get infected with HIV.[1] Almost all of these infections are preventable and donors can help. Next week, scientific researchers, community advocates, political leaders from around the world, and other stakeholders – such as Bill Gates, Sir Elton John, and Bill Clinton – will gather in Washington, DC to identify the best ways to address the HIV crisis during the 19th International AIDS Conference. Our team will be there too, looking for strategic opportunities for donors interested in fighting childhood HIV. But even before the conference starts, we wanted to highlight one strategy that can go a long way towards eliminating childhood HIV infections:  remove barriers so that pregnant women can fully access HIV testing, medications, and care to keep their babies HIV-free and themselves healthy. Since 90% of children living with HIV are infected during pregnancy, birth, or breast feeding, addressing mother-to-child transmission (MTCT) of HIV is a particularly impactful strategy.  In the US, studies have shown that transmission rates from mom to baby can be less than 1% with use of known, highly effective medications and support services for HIV+ moms  (rates can be 15 – 45% without HIV medications and safe infant feeding).[2] In order to ensure that an at-risk child is not born with HIV, all of the following steps need to happen:



The problem is that women fall off this critical cascade of care at many points – leaving many missed opportunities to prevent HIV infection in babies and ensure the health of women. For example, a 2007 study in South Africa found that only 54% of HIV+ pregnant women and 16% of HIV exposed infants received HIV medications.[3] This suggests that there is a huge gap in getting HIV+ pregnant women and HIV exposed infants on medication, and finding a solution to this gap will have a great impact on preventing childhood HIV. Missed opportunities for HIV prevention = strategic points for donors to target Research tells us that social barriers (such as fear of stigma), geographic barriers (such as underdeveloped roads), and health care system barriers (such as lack of access to HIV tests and medications) all prevent at-risk women from seeking, receiving, and adhering to the cascade of care.[4]Barriers-for-donors-to-target-to-eliminate-childhood-HIV

By targeting these barriers, donors can help stop HIV transmission. Promising strategies include using peer mentors to decrease the stigma and shame associated with HIV+ status, employing community health workers to make health care more accessible, and tracking clients with mobile phones to increase adherence to the cascade of care.

Over the next two months, we will be examining many of these approaches as well as the impacts achieved by nonprofits such as mothers2mothers and others.  Stay tuned for more details, including our takeaways from the International AIDS Conference for donors.

[1] “Fast Facts on HIV,” WHO website, [2] “Revised Recommendations for HIV Screening of Pregnant Women,” CDC Morbidity and Mortality Weekly Report, 50(RR19), p59-86 (2001). and “Mother-to-child transmission of HIV,” WHO website, [3] Cited in Mitch Besser Presentation, “HIV in Pregnancy: Doing More with Less,” available on m2m website, [4] Nestler, Nicolle. “A critical literature review of barriers to the prevention of mother-to-child HIV/AIDS in South Africa.” 2011. MPH Thesis. University of Pittsburgh.