2013 Progress Report on the Global Plan

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The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) was launched in July 2011 at the United Nations General Assembly High Level Meeting on AIDS. This report presents the interim progress made by 20 countries in sub-Saharan Africa and some of the challenges they face in meeting the agreed targets for 2015. Of the 22 Global Plan priority countries, data from India were not available at the time this report was written. Only provisional data were available from Uganda at the time of publication. The preliminary results for

Uganda are included in the aggregated values, but no country-specific data are presented here.

Antiretroviral therapy coverage among pregnant women living with HIV has increased but remains low

The number of pregnant women living with HIV receiving antiretroviral therapy for their own health has increased since 2009. In Botswana, Ghana, Malawi, Namibia, South Africa, Swaziland and Zambia, more than 75% of the pregnant women eligible according to 2010 WHO criteria – a CD4 count <350 cells/mm3 – receive antiretroviral therapy versus 50–75% in Kenya, Lesotho, the United Republic of Tanzania and Zimbabwe. Increasing access to antiretroviral therapy for pregnant women living with HIV for their own health is critical to saving the lives of women and their children. In many places where HIV treatment is available, women living with HIV have reported that stigma and discrimination, especially in health care settings, continue to be a barrier to accessing adequate information and services.

Malawi, with its policy of providing antiretroviral therapy to all pregnant and breastfeeding women (irrespective of CD4 count), increased the coverage of women from 13% in 2009 to 86% in 2012. Malawi has been able to increase antiretroviral therapy coverage during both pregnancy and the breastfeeding period by decentralizing treatment services and offering lifelong HIV treatment to all pregnant and breastfeeding women as the central tenet of its national programme to stop the mother-to-child transmission of HIV.

The numbers of women requiring services for preventing mother-to-child transmission continue to be stable but at unacceptably high levels

The number of women becoming newly infected with HIV between 2009 and 2012 remains stable in most of the 20 countries. Only Ghana (44%) and South Africa (28%) have substantial declines in the number of women acquiring HIV infection.

The lack of decrease in new HIV infections among women in most of the priority countries of the Global Plan is a worrying trend, since it is detrimental to women’s own health and well-being and can also potentially increase the need for antiretroviral medicines for preventing mother-to-child transmission and increase the number of children newly infected. This also underscores that reducing the overall incidence of HIV in all adults, both men and women, by combination HIV prevention methods – safer sexual behaviour, voluntary medical male circumcision and use of antiretroviral therapy among discordant couples – is critical to reaching the Global Plan targets.

Reducing unmet need for family planning will reduce new HIV infections among children and improve maternal health. Increasing access to voluntary and noncoercive family planning services for all women, including women living with HIV, can avoid unintended pregnancies. Family planning enables women to choose

Percentage of eligible pregnant women living with HIV receiving antiretroviral therapy for their own health, 2012 the number and spacing of their children, thereby improving their health and wellbeing. Coercion for family planning and forced sterilization of women living with HIV are completely unacceptable under any circumstances and violations of human rights.