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Erica Penfold
Cuba has officially become the first country in the world to eliminate the transmission of HIV and syphilis from mother to child. Margaret Chan, director-general for the World Health Organisation (WHO), described the small Caribbean island’s achievement as: … “one of the greatest public health achievements possible”.

Cuba’s success is the first step in a potential victory in the fight against HIV and Aids. Its milestone is important on several fronts in the global health governance work towards an Aids-free generation.

It also resonates in the Millennium Development Goals to reduce child mortality, combat HIV/Aids, malaria and other diseases as well as in the sustainable development goals to reduce the global threat of HIV and Aids.

What lies behind Cuba’s success?

Cuba’s health system is described as being a model for the world, despite a lack of resources and financial assistance. It provides access to health care for its entire population of more than 11 million and provides assistance, including provision of doctors, to other developing nations.

The healthcare system is linked to research and development, providing constant innovation in treatment and care. It is based on preventive medicine, instead of a curative model, which is more costly and less effective.

The main drivers in eliminating mother-to-child transmission were:

• the combined efforts of the Cuban government;
• its political tenacity in working to stop the halt of the virus; and
• the efforts of Pan-American Health Organisation in ensuring Cuba adhered to its programmes to stop the progression of transmission.

Their success story is partly as a result of the Pan American Health Organisation’s access to medicines programme which increases mothers’ access to anti-retroviral drugs in the region.

In partnership with the WHO the organisation implemented two strategies: the Global Elimination of Congenital Syphilis strategy towards the elimination of new HIV infections among mothers and children.

These effectively increased governments’ political will to engage with HIV-positive citizens.

These regional initiatives controlled the spread of the disease. It showed success and consistency in their approach to stem risky behaviour which could increase transmission.

Within the country there were three major drivers that broke the infection chain for transmission.

A decision was taken to provide additional HIV and syphilis testing for pregnant women and their partners; women were offered caesarean deliveries instead of natural deliveries; and breastfeeding was substituted.

Cuba also initiated a nationwide HIV screening programme during 1985 and 1986. HIV screening is still required for expectant mothers. Voluntary screening is also encouraged. As a result, over 23 million HIV tests have been performed. HIV-positive females receive AZT as a matter of priority from 14 weeks of gestation.

The global picture
Each year about 1.4 million infected women across the globe fall pregnant. Without anti-retrovirals, these women have a 15 percent to 45 percent risk rate of transmitting HIV, either during pregnancy, labour or breastfeeding. If anti-retrovirals are provided, the risk drops to 1 percent of transmission.

Currently seven of the 10 pregnant women across the globe have access to anti-retrovirals to prevent viral transmission. This is an increase in access to anti-retroviral medication in low and middle income countries and should result in increased prevention of transmission of the virus.

Of the 22 countries which account for 90 percent of the new HIV infections, eight have reduced new infections by more than 50 percent since 2009, with an additional four creeping closer towards this milestone.

Lessons southern Africa can learn What Cuba’s success story means is two-fold.

First, it is possible to eliminate mother to child transmissions, within measure. Second, the intervention and assistance of a regional organisation is effective in reducing transmission and providing access to anti-retrovirals.

Southern Africa, which has the highest rate of HIV/Aids in the world, should take heed.

The spread of the disease remains at the forefront of the development agenda for the heads of state in the Southern African Development Community (Sadc).

If the Sadc could mimic or adopt the same level of success that the Pan American Health Organisation has, this could significantly decrease mother to child transmission in the region.

The Sadc secretariat should facilitate and coordinate regional issues and health care. But it is only mandated to assist with policy making that is approved by member states.

The secretariat has a HIV and Aids unit, which assisted with a strategic framework. And most member states have adopted national policies or strategic development plans to address the country specific problems.

But coordination of policy is only executed once the Sadc member states agree to implement the policy.

A separate plan, the Pharmaceutical Business Plan, which was developed to address the need for regional provision and management of medication, has not been renewed.

Despite significant policy attention and the development of a regional cross border HIV and Aids initiative, it remains to be seen how the region will fare in its struggle to reduce the epidemic.

Efforts to increase access to anti-retrovirals are continually hampered with problems of stock outs, limited political will and logistical difficulties.

South Africa and Zambia, two prominent countries in the region, have experienced medication stock-outs. The need for a strengthened regional presence is evident.

However, countries like Zimbabwe are also doing well in terms of reduction of mother to child transmittion of HIV.

The National Aids Council (Nac) reports that the number of HIV-positive women giving birth to infected babies has been on the wane.

According to Nac Zimbabwe Aids Progress Report for 2014, the number of women receiving anti-retroviral (ARV) treatment to reduce the risk of mother-to-child transmission has been on the rise, from 22 percent in 2007 to 93 percent in 2013.

This had a knock–on effect on the number of infected children born to HIV-positive mothers, which decreased from 31 percent in 2009 to 9,61 percent in 2013.

“Zimbabwe adopted Option B+ in order to enable what it referred to as ‘the elimination agenda’. The recent national estimates reviewed that the mother-to-child transmission rate has reduced from 18 percent in 2011 to 9,61 percent in 2013,” says the report.

“High quality, comprehensive PMTCT services are currently provided in 95 percent of the 1,560 health facilities in Zimbabwe. PMTCT is one of the programmes that has achieved universal access (93 percent in 2013).”

The PMTCT programme in Zimbabwe was funded to the tune of $38,391,095 between 2013 and 2014 by a variety of local and international partners.

The country also developed and adopted the national strategic plan for eliminating new HIV infections in children and keeping mothers and families alive (2011-2015).

The elimination strategy aims to contribute to the attainment of Millennium Development Goals (MDGs) four (reduce child mortality), five (improve maternal health, and six (combat HIV and Aids, malaria and other diseases) by 2015. — The Conversation Africa/ Features Writer

Erica Penfold is a Research Fellow in the , South African Institute of International Affairs