HIV elimination and lessons from Cuba

Born HIV free. PHOTO: Courtesy UNAIDS

IN 2014, Cuba officially became the first country in the world to eliminate the transmission of HIV and syphilis from mother to child. That country has gone down in history as the first in the world to be validated by the World Health Organization, WHO, for the elimination of mother-to-child transmission of HIV and syphilis.

Margaret Chan, Director General for the World Health Organisation, WHO, described the feat as one of the greatest public health achievements possible.

“This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation” Chan noted.

Cuba’s success story broke the jinx of elimination of mother to child transmissions. It emphasized the importance of intervention and assistance of a regional organisation in reducing transmission and providing access to anti-retroviral drugs.

This achievement provides inspiration for other countries to advance towards elimination of mother-to-child transmissible disorders.

This set the stage for other countries to eliminate mother-to-child transmission of HIV and syphilis. Next in line were Belarus, Armenia and the Republic of Moldova. In Asia, Thailand set the pace. The success for these countries is also a celebration for children and families all over the world. These countries are validated proof that it is possible to realize the right of all children to be born HIV-free.

HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth and breastfeeding. Mother-to-child transmission accounts for over 90 percent of new HIV infections among children.

Elimination of mother-to-child transmission (eMTCT) programmes provides antiretroviral treatment to HIV-positive pregnant women to stop their infants from acquiring the virus. Without treatment, the likelihood of HIV passing from mother-to-child is 15 – 45 percent.

However, antiretroviral treatment and other effective PMTCT interventions can reduce this risk to below 5 percent. But elimination drops it to zero. So what can other countries in particular learn from Cuba?

Nigeria, which has the 2^nd highest rate of HIV/AIDS in Africa and the world, needs to take heed. First, it is fact that Cuba’s success did not occur by chance, but as a deliberate and orchestrated resolve.

Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed the key to success, even against daunting challenges.

For those that know better, the main driver in Cuba’s successful elimination of mother-to-child HIV transmission was a combined effort of political will and a resolute populace to stop the progression of transmission.

Everyone knows Cuba’s health system is a model for the provision of access to health care delivery, research and development. Cuba’s health system is based on preventive medicine, rather than curative.

Nigeria can and should adopt the same level of success with its own health care system, because this could significantly lead to the expected decrease mother to child transmission in the region.

Within Cuba, there were three major drivers that broke the infection chain for transmission. First was provision of additional HIV and syphilis testing for pregnant women and their partners. 

Next was the offering of Caesarean deliveries instead of natural deliveries, and, third, provision of suitable breast milk substitutes.

It is accepted that treatment for prevention of mother-to-child-transmission is not 100 percent effective, and elimination of transmission is defined as a reduction of transmission to such a low level that it no longer constitutes a public health problem.

What to be done is simple. Now, Nigeria must work harder to ensure early access to prenatal care, HIV and syphilis testing for both pregnant women and their partners. Treatment for women who test positive and their babies must be assured. Caesarean deliveries and substitution of breastfeeding must not be wanting. 

These services are provided as part of an equitable, accessible and universal health system in which maternal and child health programmes are integrated with programmes for HIV and sexually transmitted infections.

Nigeria must ensure early universal access to free services for antenatal care, HIV and syphilis testing for pregnant women and their partners. It must also provide treatment for women who test positive, and let there be early diagnosis in infants and community engagement.

Ensuring that no baby is born with HIV is an essential step towards achieving an AIDS-free generation. But in Nigeria, far too few pregnant women and their infants have access to this preventive treatment.

Pregnant women must be tested for HIV. PMTCT programmes must be scaled up to include all mothers and babies who need them – no matter how impoverished or geographically isolated they may be. And where prevention of mother-to-child HIV transmission is accessible, it must be delivered consistently and with the most effective drugs available.

Cuba ensured early access to prenatal care, HIV and syphilis testing for pregnant women and their partners.  It also mandated treatment for women who test positive and their babies, Caesarean deliveries and substitution of breastfeeding. The services are provided as part of an equitable, accessible and universal health system in which maternal and child health programmes are integrated with HIV/AIDS and sexually transmitted infections. All these Nigeria must replicate.

The lessons are clear. An equitable, accessible, universal health system in which maternal and child health programmes are integrated with programmes for HIV and sexually transmitted infections are uncontestable.

Nigerians expect that these achievements will inspire their country to seek validation that they have ended mother-to-child transmission of HIV and syphilis. 

It is only by ensuring truly universal access to HIV and syphilis prevention, treatment and care for all, while respecting individual rights, that the HIV and syphilis epidemics in children will be truly eliminated once and for all.