Protecting Children from AIDS (Part 1 of 2)

It would have been natural for Gladys Mukaratirwa to feel a little out of place within the majestic marble and glass building in Geneva that is the UN headquarters for the fight against AIDS.  But if she was, she didn’t let on.  She was there on a mission – to represent grassroots organizations and their important role in the fight against AIDS. Firelight had proposed that Gladys, the head of the Chiedza Community-Based Orphan Welfare Organization, should make a presentation on her group’s efforts to fight the transmission of HIV at birth, known as “mother-to-child transmission” or “vertical transmission” at this meeting.

Firelight is the chair of a collaborative of funders and technical experts called the Coalition on Children Affected by AIDS.  CCABA, in partnership with UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNICEF, was convening a meeting on the vital need for good collaboration between health services and community organizations to end vertical transmission by the year 2015.  Gladys provided the first-person perspective about community and grassroots efforts.

Ending vertical transmission is probably the most mobilizing, compelling issue in the AIDS world today.  The world knows how to prevent transmission at birth – evidence for this is the simple fact that there have been virtually no cases of such transmission in the US or in Europe in the last fifteen years.  Think about it: you probably know people living with AIDS, but do you know a child living with AIDS?  Probably not, if you live in the North.  For years we’ve had the knowledge, the drugs, the financing, the health systems, and the patient awareness to end vertical transmission, and thus also to virtually end pediatric AIDS.

This is not yet true in the developing world.  An estimated 400,000 children became infected with HIV at birth in 2009, and 90% of them were in Africa.

Over the last year, global consensus has grown that this disparity is unacceptable, and that we must all work to bring the same rates of protection to children in Africa and Asia as in the industrialized North.  Multilaterals, donors, national governments, and civil society organizations have all come together around the goal of ending vertical transmission by December 31, 2015.  The overall plan for this goal has been sketched out in a WHO publication, PMTCT Strategic Vision 2010-2015.

This plan revolves around the administration of an effective set of drugs during pregnant women’s labor and delivery.  But the catch is that in many countries, women do not deliver in hospitals and clinics where such drugs can be efficiently administered, but rather at home.  And this is the main reason that community-based organizations are so important to the fight against vertical transmission – they form a sort of bridge between health services and expectant mothers. They inform all women and men in their areas of the importance of preventing vertical transmission, they encourage expectant women to go to the clinic for prenatal care, and they try to ensure that those women who can’t or won’t go to the clinic to deliver have access at home to the drugs, and know how to use them.

That at least is the ideal, but there are many aspects that need strengthening, on both the government and community sides.  How to do this strengthening was the focus of the meeting this month in Geneva that Gladys Mukaratirwa was attending.

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This article is published in two parts.  Next week, we’ll tell you about Chiedza, an organization named after the Shona word for “light.”  They work in the Mutare District of northeastern Zimbabwe.  Gladys Mukaratirwa tells about her efforts to incite communities and individuals to think of preventing transmission at birth as part of their everyday values, norms, and expectations and encouraging expectant women to make use of PMTCT services provided at clinics and hospitals.