prevention among women and girls of childbearing age (Prong 1) and in reducing unmet need for family planning by women living with HIV (Prong 2) has not been as impressive. In the Global Plan priority countries in Africa, the number of women becoming newly infected declined 10 per cent between 2009 and 2012. Ghana reported the greatest decline, at 44 per cent, during the same period, and South Africa reported a 21 per cent decline.58 This trend highlights the need for innovation in following up with pregnant women who test HIV-negative at their first antenatal visit and the importance of broader primary prevention (outside of antenatal settings) among women and girls to achieving the goal of an AIDS-free generation. Unmet need for family planning services among women living with HIV continues to undermine efforts to eliminate new infections among children.59 For women in low- and middle-income countries, unmet need for family planning declined only slightly, from 15 per cent in 1990 to 12 per cent in 2010.60 UNAIDS reports that in East Africa and West Africa, the unmet need for family planning services for more than 20 per cent of women did not change between 1990 and 2010.61 This means that more than one in five women in stable relationships expressing the desire to delay or stop childbearing were not using contraception. Renewed commitment and resources for family planning from the global community, including through the Family Planning 2020 initiative, are
260,000
new HIV infections occurred among children (0–14 years) in low- and middle-income countries in 2012.
one third
welcome.62 Family planning services for women living with HIV must be voluntary and non-coercive. Reports of forced sterilization and other coercive attempts to prevent women living with HIV from having children underscore the importance of a human rights–based approach, including for family planning services.63
NEW PARADIGMS, OPPORTUNITIES AND INNOVATIONS The WHO guidelines on ARVs released in 201364 provide important opportunities to simplify and further scale up interventions among children and their mothers. They include recommendations in the following six areas:
•
Offering ART to all pregnant and breastfeeding women living with HIV, regardless of CD4 count, to protect their health, protect their babies from HIV and protect their sexual partners from HIV. This approach emphasizes the importance of pregnant and breastfeeding women living with HIV beginning treatment without delay. It also reduces the risk of HIV transmission during breastfeeding as long as mothers continue to take ART. Simplifying ART for pregnant and breastfeeding women through the use of a standardized one-pill-daily, fixed-dose combination of three ARVs should also facilitate further decentralization and integration of HIV services to the primary-care level, including maternal and child health services.
62%
of pregnant women living with HIV in 22 Global Plan priority countries received ARVs to prevent mother-to-child transmission in 2012.
Without treatment, of infants living with HIV will die before their first birthday, and half will die before their second birthday.
34%
of children (0–14 years) received the life-saving ART they needed in 2012 versus
64%
of adults.
15