About 90 per cent of HIV infections in infants and children are vertically transmitted from mother to child during pregnancy, delivery or breastfeeding. Vertical transmission of HIV can be sharply reduced if antiretroviral drugs are administered to a woman during pregnancy and delivery and to her baby shortly after birth. Without any intervention, between 15 per cent and 45 per cent of babies born to HIV-positive mothers will become infected. And half of all infants infected with HIV will die before their second birthday if they do not receive treatment.
In 2011, the UN Secretary-General launched a new Global Plan to reduce HIV infections in children by 90 per cent by 2015 and to increase survival rates of pregnant women and mothers who are HIV-positive. While service uptake is increasing, and new HIV infections among newborns are declining rapidly, progress must accelerate to meet the 2015 deadline.
PREVALENCE OF PREGNANT WOMEN WHO ARE HIV-POSITIVE
In 2012, an estimated 1.5 million pregnant women in low- and middle-income countries were living with HIV. Over 70 per cent of these women are concentrated in 10 sub-Saharan African countries: Nigeria, South Africa, the United Republic of Tanzania, Kenya, Uganda, Zimbabwe, Mozambique, Malawi, Ethiopia and Zambia.
Reducing vertical transmission of HIV requires a range of interventions, beginning with voluntary and confidential counselling and testing for pregnant and breastfeeding women. This should be followed by lifelong antiretroviral treatment for pregnant and breastfeeding women with HIV and the administration of antiretroviral drugs to their newborns as a preventive measure. Safe delivery practices must also be followed, and new mothers should receive guidance in selecting a suitable infant-feeding option.
A GLOBAL PLAN
In June 2010, under the leadership of UNICEF, UNAIDS and WHO, United Nations organizations and key global partners committed to work together to eliminate new HIV infections among children. One year later, at the UN General Assembly High-level Meeting on AIDS, the UN Secretary-General launched a Global Plan to reduce new HIV infections among children by 90 per cent by 2015. By the same date, the plan seeks to reduce HIV-related maternal deaths by 50 per cent. The plan outlines specific, time-bound targets at the global level, which have been adapted by countries to support this goal. It also identifies 22 priority countries that are receiving intensified support.
Expanding HIV testing and counselling among pregnant women is critical for identifying those in need of follow-up care and increasing coverage of subsequent interventions. This is especially important since too few pregnant women are aware of their HIV status. In 2012, an estimated 40 per cent of pregnant women in low- and middle-income countries received an HIV test, up from 30 per cent in 2010 and 8 per cent in 2005.
Many countries are also making progress in treating pregnant women found to be infected. In 2012, 62 per cent of pregnant women living with HIV in low- and middle-income countries were on an effective antiretroviral drug regimen, an increase from 48 per cent in 2010.
Among regions, Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS) has the highest coverage (95 per cent) of antiretroviral drugs among pregnant women who are HIV-positive. This is followed by Latin America and the Caribbean (88 per cent) and Eastern and Southern Africa (75 per cent). All other regions have coverage of under 50 per cent: East Asia and the Pacific (43 per cent), West and Central Africa (30 per cent), the Middle East and North Africa (10 per cent) and South Asia (less than 1 per cent).
* Coverage values for 2005–2009 are not comparable to those for 2010–2012 because they are based on previous WHO treatment guidelines and include single-dose nevirapine.
** CEE/CIS: Central and Eastern Europe and the Commonwealth of Independent States.
Note: The bars indicate uncertainty ranges around the estimates.
Sources: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting, and UNAIDS 2012 HIV and AIDS estimates.
Dramatic declines have been observed in the number of infants newly infected with HIV, and progress is accelerating, largely because of increased access to related services. Still, faster progress is needed to reach the 2015 Global Plan target of a 90 per cent reduction in new HIV infections in children between 2009 and 2015.
Source: UNICEF analysis of UNAIDS 2012 HIV and AIDS estimates.
World Health Organization (WHO) guidelines recommend that all infants born to HIV-positive mothers should receive antiretroviral drugs preventively. Coverage of antiretroviral prophylaxis among infants was still lower than treatment coverage among mothers in 2012. However, that year, an estimated 52 per cent of the 1.5 million infants born to mothers living with HIV received prophylactic medicine.
Data show that the use of services related to the prevention of vertical transmission of HIV is expanding. Still, formidable challenges must be overcome before Global Plan targets can be met. Poor service delivery in hard-to-reach areas, aggravated by weak health systems, and the fear, stigma and denial that discourage women from being tested for HIV are significant barriers to wider uptake of services.
For more data and analysis on HIV and AIDS in children, see UNICEF’s Children and AIDS: Sixth stocktaking report by clicking here.
UNAIDS, Report on the Global AIDS Epidemic, UNAIDS, Geneva, 2013.
UNICEF, Children and AIDS: Sixth stocktaking report, UNICEF, New York, 2013.
UNICEF, Progress for Children: A report card on adolescents, No. 10, UNICEF New York, 2012.
UNICEF, Progress for Children: Achieving the MDGs with equity, No. 9, UNICEF New York, 2010.
UNICEF, The State of the World’s Children 2014 in Numbers: Every child counts – Revealing disparities, advancing children’s rights, UNICEF, New York, 2014.
UNICEF, The State of the World’s Children 2013: Children with disabilities, UNICEF, New York, 2013.
UNICEF, UNAIDS, UNESCO, UNFPA, ILO, WHO and The World Bank, Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood, UNICEF, New York, 2011.
WHO, Global Update on HIV Treatment 2013: Results, impact and opportunities, WHO, Geneva, 2013.
WHO, UNAIDS and UNICEF, Global HIV/AIDS Response: Epidemic update and health sector progress towards universal access – Progress report 2011, UNAIDS, Geneva, 2011.
 Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia and Zimbabwe.
An AIDS-free generation means a generation in which all children are born free of HIV and remain so for the first two decades of life, from birth through adolescence.
GLOBAL AIDS RESPONSE PROGRESS REPORTING/UNIVERSAL ACCESS
In an effort to harmonize data collection and minimize the reporting burden on countries, UNAIDS, WHO and UNICEF have developed a joint reporting tool. The tool, which has been translated into several UN languages, combines the Global AIDS Response Progress Reporting and Universal Access reporting on the health sector response to HIV/AIDS. Countries that have not yet begun using the tool are advised to download the latest version. Accompanying guidelines support countries in using the tool and provide detailed descriptions of the indicators used.
- For more information, click here.
- For Global AIDS Response Progress Reporting/Universal Access reporting guidelines, click here.
- To view the latest version of the reporting tool, click here.
- To view a list of indicators, click here.
SPECTRUM/EPP ESTIMATE MODELLING
UNAIDS, WHO and UNICEF are using Futures Institute's modelling software, Spectrum/EPP, to generate estimates, which support policy decisions concerning public health. Spectrum includes modules for HIV estimates and projectors.
NATIONALLY REPRESENTATIVE SURVEYS
Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), AIDS Indicator Surveys (AIS), reproductive health surveys, sexual behaviour surveys and other nationally representative surveys are currently used to collect data on HIV and AIDS.