A Global Plan to End HIV Among Children and Keep Mothers Alive

Through the collective efforts of donors, the U.S. government, and U.N. agencies, we're close to beating an epidemic that has claimed millions


Busiswa was 25 when her first baby, a boy, died of AIDS. He shouldn't have died. But in 2005, when he was born, South Africa was living in the Dark Ages of "denialism"; a time when the country's president, Thabo Mbeki, and minister of health, Manto Tshabalala-Msimang, ignored interventions that could prevent babies from being born with HIV and therapies that could keep people with AIDS alive. Had Busiswa been living in the United States, her son could have been born HIV negative. But Busiswa lived in a small town outside of Johannesburg; and there, rather than getting for the duration of her pregnancy a potent three-drug cocktail that prevents HIV transmission from mother to child, she received only a single dose of a single drug at delivery. About 100 babies are born HIV positive in the U.S. each year and about 1,000 babies are born HIV positive in Africa every day.

An infection that was once almost universally lethal, now responds to a single pill each day.

The HIV epidemic has been with us for 30 years now. During that time, 30 million people have died from the infection and its complications. Today, 33 million people are infected with the virus, and of these, two-thirds are living in sub-Saharan Africa. By 2009 World Health Organization guidelines, 16 million people today are entitled to life- and health-sustaining medication, but to date only six million people are receiving them. In 2009, 2.6 million people were newly infected with HIV; 1.8 million people died from the infection; and 1.2 million people were started on anti-retroviral therapy (ARVs). Twice as many people get infected -- and half again as many people die -- as are started on HIV/AIDS treatment each year. Clearly, we're falling behind.

But much has changed for the better in 30 years. An infection that was once almost universally lethal, now responds very favorably to an ARV regimen that may be as simple as a single pill each day. And therapy that once cost $10,000 a year, essentially unaffordable in all but the most affluent countries, can now be had for $100 a year. And this cost reduction is essential, for what we do know is that once treatment starts it must continue for life. From where will this money come? Since 2003, the United States' PEPFAR program has contributed billions of dollars to make medicines accessible to those in need. But these funds are now threatened as Capitol Hill legislators deliberate over budget cuts in humanitarian aid that represent less than one percent of the U.S. budget, but account for millions of lives saved across the African continent.

This is a time when we can be optimistic about preventing mother-to-child transmission of HIV (PMTCT). Without HIV testing in pregnancy and the interventions provided to mothers who are HIV positive, 40 percent of babies will be infected during pregnancy, delivery, and with breast feeding. But in the last decade we've learned how to keep babies from getting infected. In Africa, where 90 percent of the 1.4 million pregnant women with HIV each year reside, new initiatives are striving to drive transmission rates to less than five percent.

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In 2001, Mitch Besser, a Harvard-trained obstetrician and gynecologist, founded mothers2mothers, a peer mentorship program dedicated to educating and supporting pregnant women and new mothers living with HIV.

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