Why focus on PMTCT?

1. Global Plan to Eliminate New HIV Infections in Children by 2015 and Keep their Mothers Alive and HealthyThe Role of Faith-Based Organizationsat Regional Conference of Catholic Healthcare Regional Nework“Maternal Health care and Child Care” Johannesburg, 7 April 2014by Rev. Msgr. Robert J. Vitillo, Caritas Internationalis

2. Why focus on PMTCT? 90% of children contract HIV from mothers during pregnancy, childbirth and breastfeeding HIV infection is more aggressive among children than adults, half die by 2 yrs In highly-endemic areas, children present for care much later, as late as at ages 5-6 years Mortality for children born to HIV+ mothers higher than children born to HIV- mothers. Elimination of Mother-to-Child Transmission (MTCT) is feasible.

3. Monitoring Framework for 2015 Reduce the number of new HIV infections among children by 90% Reduce the number of AIDS-related maternal deaths by 50% • Prong 3 Targets • Reduce mother-to-child transmission of HIV to 5% 90% of mothers receive perinatal ART or prophylaxis 90% of breastfeeding infant-mother pairs receive ART or prophylaxis Prong 4 Targets Provide 90% of pregnant women in need of ART for their own health with livelong ART Prong 1 Target Reduce HIV incidence in women 15-49 (and 15-24) by 50% Prong 2 Target Reduce unmet need for family planning among women living with HIV to 0 (MDG goal) • Additional indicators have been developed for the 22 high burden countries. See the Global Monitoring Framework and Strategy • for the Elimination of new child infections by 2015, UNICEF, WHO.

4. Responding the first decade: Estimated number of new HIV infections in children (aged 0–14): global trend, annual rates of reduction and projections, 2001–2015 85% decline needed over 3 years(avg. 74,000 per year) 2012–2015 Global Plan target Source: UNICEF analysis of UNAIDS 2012 HIV and AIDS estimates.

6. Number of childhood infections averted since 2009 because of ARVs UNAIDS estimates, 2013

7. Impact: New HIV Infections among children

8. PRONG 3: Maximising returns in South Africa New HIV Infections Among Children • Quality of programs • 5% prevalence without prophylaxis can lead to 20K new infections in SA • Need to reach high risk womenearly • Reduce loss to follow-up • Need to address risk of seroconversion during pregnancy

9. Prong 4: Percent of those eligible receiving ART for their own health, 21 countries, 2012 Source: UNAIDS estimates Oct 2013

10. Paediatric HIV care and treatment

11. Remaining Challenge in 1st decade: Percentage of ART coverage among eligible adults (aged 15+), children (aged 0–14) and all ages 21 African Global Plan priority countries, 2012 Note: Some numbers do not add up due to rounding. The coverage estimate is based on the estimated unrounded number of children receiving and eligible for ART.Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting.

12. The Religious Community working toward Zero New Infections among Children • Support women to avoid HIV infection. A mother free from HIV cannot pass on the virus to her children. • Provide information in local faith communities encouraging and supporting couples to go together for HIV testing. • Support access to antenatal care and HIV testing and counselling for pregnant women and provide linkages to related health facilities and care. • Strengthen programmes to prevent new HIV infections in children––in line with national policies and protocols––in religiously affiliated hospitals and medical centres, particularly in rural areas. • Ensure coordination with national health systems addressing HIV prevention and treatment to enable pregnant women living with HIV to access the best possible antiretroviral therapy—for their own health and for their baby’s health.

13. Caritas Internationalis “HAART for Children” Campaign “HAART” = Highly Active Retroviral Treatment but also requires “HEART”

14. “Prescription for Life”: Children taking action on behalf of other children – those living with HIV or with HIV/TB co-infection letter-writing action by children to governments and to a target group of pharmaceutical companies

15. Education/Awareness Raising Campaign for WAD 2010 - Advertisement published in Sydney and Melbourne Newspapers

16. Caritas Internationalis and other Campaign partners promote HAART for children advocacy at various United Nations fora Caritas • In collaboration with other Campaign partners, Caritas seizes every opportunity to link the the HAART for Children Campaign to the child’s “right to health” through oral and written interventions and organization of side events in various UN and other international fora, including meetings of UN Human Rights Council, • World Health  Organization, and UNAIDS

17. Getting to Zero: CRS efforts to Strengthen Male Involvement in PMTCT Through AIDS Relief Programmes, in such countries as Kenya, Zabmia, and Nigeria, Catholic Relief Services, Catholic Medical Mission Board, and other Catholic Church-related organizations, work to increase awareness about the need for male involvement in HIV programming and to attract and retain men in its programming, including PMTCT, by: • Promotion of voluntary medical male circumcision • Formation of support groups specifically for men • Strengthening couple relationships and encouraging testing as a couple (cf., The Faithful House: A couple’s Guide to PMTCT) • Involving men in antenatal care and PMTCT services – including shorter waiting periods to be seen as a couple in clinic, encouraging “love letters” by women patients to invite their husbands to follow-up visits and to communicate information on healthy pregnancies.

18. UNICEF chose a Catholic Church Programme in Papua New Guinea as a Best Practice Model for PMTCT “The Catholic Health Service, and particularly Mingende Rural Hospital in Simbu Province where I work, as well as Catholic Health Service in Mendi, are implementing a very successful programme on Prevention of Parent- to-Child Transmission of HIV (PPTCT), called: ”Born to live”. … “Since the beginning of the ‘Born to live’ project in October 2003, and up to l December 2009, we tested 6867 mothers with an average prevalence rate of 1.1%. 66 HIV-positive mothers delivered their babies in our facility. 14 babies died during the first years of the programme, while we were administering only single-dose Nevirapine to the mothers and their babies.. “ Gradually, we started using 2 ART drugs and since 2009, we use triple ART therapy for all HIV-positive mothers who are past 28 weeks of gestation. We continue the treatment during labour and the breastfeeding period. Since then, all our babies born to HIV-positive mothers have tested negative. Since last year, we are able to use DNA PCR testing of infants at the age of 6 weeks, and we are all happy with the babies BORN TO LIVE and free of the HIV.” Sr. Kinga Czerwonka, Catholic Health Service, Simbu, Papua New Guinea

19. Cardinal Bertone, Secretary of State to His Holiness Pope Benedict XVI appeals for Universal Access • What more effective image of love is there than the relationship between the mother and the child? Whoever saves the mother and child saves the future of the world, it could be said! • In the presence of so many authoritative Ministers and persons in charge of health care, I would like to address an appeal to the International Community, to States and to donors: … May universal access to treatment be agreed! • Let us do so beginning with the mothers and children. • In this See, in the name of the Holy Father, I make myself the voice of the many who are suffering, of so many patients who do not have a voice. • Let us not waste time and invest all the resources necessary!”