Cuba Bids Adieu to Mother-Child Transmission of HIV and Syphilis

by Monica Joshi

There are currently more than 1.2 million people in the US who are living with the HIV infection and about 35 million worldwide. Of those, globally, an estimated 1.4 million women living with HIV become pregnant each year. Cuba, has become the first country in the world to go ahead and do the impossible: eliminate mother-to-child transmission of HIV. What's more? They've even eliminated mother-to-child transmission of syphilis.

They have even received validation from the World Health Organization (WHO) that they have accomplished this amazing feat.

Dr Margaret Chan, WHO Director-General, commended them on their victory:

“Eliminating transmission of a virus is 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."

Nearly 1 million pregnant women worldwide are infected with syphilis annually. And while HIV is widely talked about, syphilis gets limited global attention. However, the result of women with syphilis giving birth is devasting. It can cause early fetal loss and stillbirth, neonatal death, low-birth-weight infants and serious neonatal infections. However, simple, cost-effective screening and treatment options during pregnancy, such as penicillin, can eliminate most of these complications.

As part of the initiative, the country has worked to ensure early access to prenatal care, HIV and syphilis testing for both pregnant women and their partners. They also provided treatment for women who test positive and their babies, caesarean deliveries and substitution of breastfeeding. These services were provided as part of an equitable, accessible and universal health system in which maternal and child health programs were integrated with programs for HIV and sexually transmitted infections.

Although WHO/PAHO continues to work with partners in Cuba and other countries in the Americas since 2010 to implement a regional initiative to eliminate mother-to-child transmission of HIV and syphilis, their validation process was not a cake-walk for CUBA. WHO's validation process paid particular attention to the upholding of human rights, in order to ensure that services were provided free of coercion and in accordance with human rights principles.

PAHO Director, Dr Carissa F. Etienne, said that:

“Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV. Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis."

Untreated, mothers living with HIV have a 15-45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, that risk drops to just over 1% if antiretroviral medicines are given to both mothers and children throughout the stages when infection can occur. The number of children born annually with HIV has almost halved since 2009 - down from 400 000 in 2009 to 240 000 in 2013. But intensified, efforts will be required to reach the global target of less than 40 000 new child infections per year by 2015.

There have been major efforts in recent years to ensure that women get the treatment they need to keep themselves well and their children free from HIV and syphilis and a number of countries are now equipped and determined to eliminate mother-to-child transmission of both diseases. The process needs to continue. The best solution could be free, prevention health-care options that are provided to those in desperate need of medical care to curb the mother-to-child transmission of both diseases in the US and overseas.

Uzodinma Iweala, author of Our Kind of People, describes how affected people have come to understand HIV/AIDS as something that is "livable, tangible and real."

,