‘The prevailing discourse on ending AIDS has bred a dangerous complacency and may have hastened the weakening of global resolve to combat HIV.’ This alarming soundbite reverberated around the HIV, public health, and international development communities in July this year, when a special International AIDS Society/Lancet Expert Commission released key findings.
It is right that the Commission sounded the alarm. AIDS is not over. Despite significant progress, too many individuals either do not know they contracted HIV, if they are HIV-positive they are not on antiretroviral treatment (ART), and/or if they are on ART, they are not ‘virally suppressed’ (where the level of HIV in the bloodstream is very low, meaning they are likely healthy and incapable of transmitting the virus). Moreover, other worrying trends are emerging in many areas that could see a resurgence.
At mothers2mothers (m2m), an organisation born to prevent mother-to-child transmission of HIV, we are particularly concerned about the toll the pandemic continues to take on children. According to UNAIDS, 180,000 children contracted HIV in 2017. While this is a dramatic drop from 550,000 per annum in 2001 (the year of our founding), it is deeply worrying given that globally, agreement was that this number could, and should, have been zero by 2018. What is more, it is an absolute failure that in 2017 only half of all HIV-positive children under 15 were on treatment.
As m2m is now 17 years old, we also have a particular interest in adolescents and youth—since the very first children born HIV-free through our programme are now entering these vulnerable years. Here too, the numbers document a worrying reality. Over 7,000 adolescent girls and young women are infected each week, the majority of whom live in sub-Saharan Africa.
The Global Goal is to end AIDS by 2030. If we are to make this a reality, resources, further investments, are critical. We need urgent action to close the current 20 per cent funding gap. If we don’t close the gap, human costs will be real—a million preventable deaths and 2.1 million new HIV infections by 2030. We cannot treat our way out of this epidemic. But we can prevent new infections and help those who are HIV-positive to reach viral suppression.
While there are many reasons to be concerned, there are also many reasons to be optimistic. The global HIV response has united diverse communities like nothing before it. Now is the time to seize this once-in-a-generation opportunity and end AIDS. We believe a key success factor will be to unleash an army of women working as paid, professionalised peers to ensure that women, infants, children, adolescents, and men—individuals and families—get access to life-saving treatment.
Our work over the past 17 years has led us to know that this is completely possible. m2m employs HIV-positive women as frontline health workers, called Mentor Mothers. Mentor Mothers are based both in health facilities and in surrounding communities. Through a mix of service delivery, education, and psychosocial support, Mentor Mothers ensure HIV-positive individuals access care, start treatment, remain adherent, and live positively…while ensuring that HIV-negative clients remain that way.
The impact of this model has been nothing short of remarkable. In 2017, 91 per cent of HIV-negative pregnant women and new mothers we served in Eswatini, Lesotho, and Uganda had at least one HIV test during their enrollment with m2m— most have had three. Ninety-nine percent of HIV-positive pregnant women and new mothers we served directly were initiated on treatment; 90 per cent are alive and remain in care after a year (seven per cent higher than the East and Southern Africa benchmark). These efforts are working—89 per cent of our clients with a recorded viral load test result were virally suppressed. The model has also been delivering benefits to keep new infections under control. We achieved virtual elimination of mother-to-child transmission of HIV among our enrolled clients in 2017 with a rate of just 1.6 per cent —far below the UN’s five per cent benchmark. Moreover, just 0.07 per cent of women who were HIV-negative at enrollment into the m2m programme acquired HIV—far lower than the 2014 pan-African rate of 3.6 per cent.
We know our model is one of several innovative solutions that has emerged from the HIV/AIDS response. Exciting advances are being made in treatment, testing, and vaccines, and collaboration—across countries, sectors, and communities—is happening like never before. So yes, let us guard against the dangerous complacency the IAS/Lancet Commission warns of, but let us also seize on the opportunity that lies in front of us, and end AIDS once and for all. We owe it to ourselves to finish the job, to those living with HIV and AIDS to live healthy lives, and to our children to create an HIV-free generation.
Frank Beadle de Palomo is President and CEO at mothers2mothers