The UN’s Pursuit of an AIDS Goal Puts Women and Children at Risk
December 3, 2010
FOR IMMEDIATE RELEASE
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.
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.
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.”
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
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.
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.