PMTCT – almost at a standstill

Around 200 000 children are infected with HIV in the womb or at birth every year. While there are multiple challenges to implementation of treatment strategy, the preventive methods are well known and affordable.

The transmission of the HIV virus from mother to child during pregnancy or childbirth is the main reason why 200 000 children are infected with the virus annually. Yet only one in ten of these HIV positive women have access to treatment to prevent virus transmission to their children.

Prevention of mother-to-child transmission of HIV (PMTCT) should be possible: the information is readily available, the necessary medicine has been developed, and the price is relatively low. A double dose of nevirapine given to both mother and child reduces the chance for infection down to five percent, whilst cost less than US one dollar. Even so, there is little progress regarding prevention of mother-to-child transmission of HIV.

The obstacles

There are multiple challenges in developing and implementing a comprehensive counseling, care and treatment plan for all pregnant HIV positive women and mothers. One lies in the difficulties of coordinating and implementing a robust programme. There are also huge challenges with regards to inequality, discrimination and women's sexual and reproductive rights.

The systemic challenges for drug supply and availability are recurring themes in development contexts. Encouraging behavior change to get HIV positive mothers to breastfeed their newborns is not done overnight. Added to that is the huge impact of insufficient health systems and health personnel.

In the area of HIV and AIDS programming, PMTCT is left as a particular challenge in most countries, and there is little improvement to be observed. In this area of PMTCT there is a great potential for collaboration between HIV and AIDS and maternal and child health stakeholders - be it governments, NGOs, donors, global funds and the UN.

Channels for PMTCT

The Global Fund to fight AIDS, Tuberculosis and Malaria which again supports the Malawi National Response to HIV/AIDS through two-pool funding mechanism with the Government of Malawi and other donors, including Norway. In the latter part of the programme support, an increased consideration has been placed on inter alia Voluntary Counselling and testing as well as PMTCT.

The effects have been remarkable. The baseline coverage rose from seven percent of all health facilities offering PMTCT in 2005 to 55 percent as of December 2007. Although the data is limited as to how many women receive these services, the fact that 300 out of 545 centers offer PMTCT services indicates a positive improvement. This has led to an increase in pregnant women receiving the treatment and hence fewer infants run the risk of being HIV infected in the womb or at birth.

Norway also funds PMTCT in Eritrea through a joint UNICEF/UNFPA programme where PMTCT is one of several components, and through the Clinton Global Initiative in Tanzania.

The Norwegian policy

Norway's HIV and AIDS policy from November 2006 states that Norway will:

  • request that PMTCT is included in national AIDS programmes and health sector efforts;
  • cooperate with UNICEF in these efforts;
  • help to make the issue of mother-to-child transmission more visible in global, regional and national discussions of HIV and AIDS, for example through the use of indicators, reports, funding and research.