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The UN’s Pursuit of an AIDS Goal Puts Women and Children at Risk


A set of reports issued by UN agencies in time for World AIDS Day 2010 announced advances in programs aimed at “preventing mother-to-child transmission of HIV (PMTCT).” But the assertions of progress for women set out in the UNAIDS Report on the Global AIDS Epidemic 2010 and UNICEF’s Children and AIDS: 5th Stocktaking Report do not hold up under scrutiny. And claiming that full success can be achieved by 2015 is as misleading as the program’s very name, which points a finger of blame at infected mothers. One simple step toward respect for mothers’ rights would be a change of names, to “prevention of vertical transmission.” Other steps are far more urgently required.

The UN announced this week that “53 per cent of women in need received antiretrovirals for PMTCT.” Relying on partial data that make true comparisons across years nearly impossible, the reports compared the 2010 percentage with a 15 percent marker reached in 2005. Media packets did not mention that this year’s total included women who were prescribed only single-dose nevirapine. That quick fix is no longer recommended by the World Health Organization (WHO) because it falls so short of acceptable standards of care, but worse, because it puts mothers and babies at risk.

About a third of women who are given a single dose of nevirapine during childbirth will develop resistance to that class of drugs. Later, when their HIV disease progresses and they need treatment to stay alive, the antiretroviral regimens used in most developing countries may not work. Over 50 percent of the babies exposed to single-dose nevirapine will also develop drug-resistant HIV.

Even the pharmaceutical company that patented nevirapine has since discouraged its use in single doses to prevent vertical transmission. But it was still prescribed to many program beneficiaries, and that was still described by the UN as a 2010 success story. Of the four countries in sub-Saharan Africa applauded for achieving the UN’s 80 percent coverage goal, three — Namibia, South Africa and Swaziland — reached the target in part by prescribing single-dose nevirapine; in Namibia, 48 percent of women enrolled in the program received it. In Ethiopia and India, single-dose nevirapine was prescribed to all the women treated, and yet both countries earned a tick on the UN ledger that marks progress toward “virtual elimination of mother-to-child transmission.”

AIDS-Free World’s own stocktaking leads us to conclusions starkly at odds with the UN’s assessment. The truth can be found by poring over this week’s and other recent UN reports, and cobbling together pieces of fact scattered across hundreds of inside pages. They tell a different story than the one presented this week, about a program with five characteristics that the public, the media and HIV-positive women should know:

First, in the UN reports, progress toward ending mother-to-child transmission is not measured by counting the babies protected from HIV. It is estimated by counting the women given drugs to prevent transmission, and then calculating the likelihood that the drugs succeeded. So far, no real data exists that establishes how many infant lives have actually been saved. The claim that an “HIV-free generation” is within reach is based on guesswork, not evidence.

Second, the figures said to represent beneficiaries of “PMTCT” services include not only pregnant positive women who received appropriate antiretroviral drugs (ARVs) and infant feeding counseling and support, but also women who were given nothing more than single-dose nevirapine. Since that drug application is known to endanger the lives of women and children, it should be discontinued, not counted as an achievement.

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