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Congressional Briefing
Rayburn House Office Building
September 25, 2002
Good afternoon. Thank you to Representatives Millender-McDonald, Leach, Morella and McDermott for hosting this important briefing.
One of the tragic consequences of the HIV/AIDS epidemic is mother-to-child transmission of HIV. Transmission can occur during pregnancy, at the time of delivery, or through breastfeeding. Worldwide, more than 4 million children are estimated to have died from AIDS, primarily contracted from their mothers. Globally, approximately 800,000 babies become infected with HIV every year, and Africa bears the greatest burden.
As you have heard from the earlier speakers, preventing mother-to-child-transmission of HIV is a critical tool in our arsenal in the fight against AIDS. The AIDS epidemic is continuing to spread from high-risk populations to epidemics that encompass the general population. As that happens, we will see more mother-to-child transmission of HIV, and more children dying of AIDS. Harder even than watching adults suffer and die of a preventable disease is seeing a child suffer and die.
The President cares very much about this and in June announced the new International Mother and Child HIV Prevention Initiative. USAID and the Department of Health and Human Services are working together to implement the President's goals. The President's plan bridges what we call the "prevention to care continuum", preventing HIV infection of the baby, while setting in place the capacity to treat and manage the mother's HIV. As President Bush said, "When the lives of babies and mothers are at stake, the only measure of compassion is real results."
We have already seen results. With all the dire predictions about AIDS, it is important to emphasize that we have success stories in our overall prevention programs. The U.S. Agency for International Development has a comprehensive AIDS response that begins with strong prevention programs, and has grown to encompass many other areas of need, education, orphan care, and treatment for sexually transmitted diseases, tuberculosis, and other opportunistic infections. We have been working on preventing mother-to-child transmission of HIV since 1999, and currently have programs in 11 countries. USAID's mother-to-child transmission prevention programs now reach 50,000 people annually, and this number will dramatically increase over the next few years.
USAID has a three-pronged approach to preventing HIV transmission from mother to child: first, preventing HIV infection in women of reproductive age; second, giving HIV positive women the family planning tools to choose whether or not to become pregnant; and third, preventing vertical HIV transmission during pregnancy, delivery, and infant feeding. Following that, we must also be ready to address the long-term care and support to the mother, the infant, and her family.
The core of the President's initiative is the third prong, the clinic-based pregnancy, delivery and infant feeding interventions. While on the surface this appears easy - you just give a dose of medicine to the mother and later to the child; in reality, this simple program is fraught with cultural and logistical complexities we are just learning now to address. That's why gathering here today to discuss these issues is a wonderful opportunity. We have seen very successful pilot programs with high acceptance, while other programs pull in few women and HIV transmission continues despite the availability of the program.
First, pregnant women must know about, want, and have access to voluntary and confidential counseling and testing services. If you do not know who is HIV positive, you cannot know who needs additional services. But willingness to be tested or treated is not automatic. The threat of stigma or domestic violence all too often hinder women from agreeing to be tested. USAID funds have established testing centers, trained counselors, and supported community outreach workers to promote voluntary counseling and testing and community acceptance of HIV/AIDS activities. Bringing HIV testing into antenatal settings is recent, but there was an obvious need. In Zambia, USAID developed an innovative mother-to-child transmission prevention program that offers a full package of antenatal services including voluntary counseling and testing for HIV, as well as syphilis testing and treatment.
Second, short, affordable courses of medication, given to HIV-infected pregnant women, can reduce HIV transmission to newborn babies by 20 to 50 percent. Because the drug treatment needs to be provided around the time of delivery, accessible quality antenatal, delivery, and postpartum services are necessary in order for mothers and babies to benefit from these interventions.
In Romania, USAID is supporting an HIV treatment center and health professional training academy. The center serves as a focal point in Romania for health professional and community education on how women can prevent transmitting HIV to their infants. In Ghana, USAID is providing mother-to-child transmission prevention services as part of a larger antiretroviral therapy program. In the first few months, approximately 2,000 pregnant women have already received services.
We can also reduce risk of transmission during delivery through safe obstetrical practices. In Malawi, USAID provides training to improve birthing to reduce mothers' transmission of HIV to their infants.
Finally, while not large, there is the real possibility, of HIV transmission during breastfeeding. Because breastfeeding plays a critical role in protecting children's health and saves lives, this is one of the most complex aspects of preventing mother-to-child transmission. Mothers need counseling on safe infant feeding choices. In Haiti, USAID provides community support to pregnant and lactating women with AIDS. The delicate balance of savings versus risking lives during breastfeeding is a complex and controversial part of preventing mother-to-child transmission.
We have come a long way in just a few years toward improving our mother-to-child transmission prevention services, and increasing the numbers of pregnant women who access these services. However, in order to take the next steps, there is critical research - both biomedical and operations - that needs to be done.
As we do research, we need to apply the research and constantly be improving access, so that all pregnant women can benefit from what we already know. This will be a really big job. I look forward to working with all of you as we work to ensure that in the future no baby is born HIV positive.
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