June 7, 2016; U.S. News & World Report
Last week, the World Health Organization (WHO) announced that Thailand had become the first Asian country to eliminate mother-to-child transmission of HIV and syphilis. WHO defines the benchmarks for elimination as less than 2% transmission from mother to child and an infection rate of less than 50 in 100,000 live births. Thailand achieved this validation by making use of clinical trials, having trained and knowledgeable healthcare workers, launching a national HIV education program, and promoting 100% condom use. In addition, pilot programs were used for testing and treatment, and a policy was implemented that required government hospitals to test and treat pregnant women for HIV and syphilis.
Thailand now joins Cuba, which received its validation for elimination of mother-to-child transmission of HIV during the summer of 2015. Cuba was the first country to go through the WHO monitoring and validation program. WHO launched the initiative to reduce the spread of HIV through mother to child transmission in 2011 as part of the Global Plan towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive. In addition to achieving a transmission rate of less than 2%, a country must provide two years of data. Members of WHO must also be allowed to visit all areas of the country to assess the level of care provided to receive validation. Of particular concern to WHO is the access to and quality of care in more rural areas and with underserved populations. Cuba was able to achieve validation from WHO by:
Increasing the likelihood that a woman knows she has HIV by having a system for testing and treatment.
When infected women become pregnant, they are immediately put on an antiretroviral drug, which has a 98% success rate.
Encouraging HIV positive women to agree to a caesarean section, which has also been shown to be an effective way of reducing the spread of HIV.
Once an HIV positive woman gives birth, she refrains from breastfeeding and the infant is placed on an anti-retroviral for 4-6 weeks.
It should be noted that Cuba offers universal health care, in which services are free to patients. Also, healthcare is delivered outside of hospital walls, making it more accessible to people who live in more remote areas.
The WHO validation for Thailand is considered big news due as the country has been battling an HIV epidemic. While eliminating the transmission of the disease through birth is a considerable step in the right direction, the death rate from AIDS in Thailand remains steady at an estimated 200,000 people per year. The information used by WHO to provide the validation did not include data on migrant women. Pregnant women from neighboring Myanmar and Cambodia do not receive prenatal care or HIV testing while working in Thailand. There is an estimated migrant workforce in Thailand of about 2.7 million. Migrant workers are fearful of getting tested because they don’t want to lose their jobs.
Armenia also received validation from WHO for eliminating mother-to-child transmission of HIV, and Moldova received validation for eliminating syphilis. While the United States has achieved a transmission rate of less than 2%, it has not received WHO validation for eliminating the spread of HIV through mother-to-child transmission due to access to care issues found in many rural and remote areas. Also, there is a considerable disparity in transmission rates between ethnicities thought to be due to disparities in access to prevention, education and care. While the transmission rates are below 2% for whites and Hispanics, the transmission rate for African-Americans is nearly 10%.—Kelley Malcolm