New statistics from the United Nations released on World AIDS day this week have global health experts speculating about the possibility of an AIDS-free generation.
Their hope lies in the cradle.
The number of children who contract the disease at birth from HIV-positive mothers dropped by more than half between 2005 and 2012, from 540,000 to 260,000, according to the report.
The decline in HIV among infants has been dramatic in a number of countries. Namibia cut infection by 58 percent between 2009 and 2012. Zimbabwe, Malawi, Botswana, Zambia and Ethiopia all reported reductions of at least 50 percent.
But “Ghana is the true leader in the fight against AIDS,” wrote Erin Hohlfelder, global health policy director for the nonprofit ONE, in a recent report. In the last four years, mother-to-child transmission of HIV in the country declined by 76 percent.
If Ghana sustains this pace of progress, Hohlfelder wrote, “It will achieve the goal of virtual elimination before 2015.”
So what’s the secret to Ghana’s success?
“This level of success has been made possible by the government’s high level of commitment to fighting AIDS,” Hohlfelder wrote. “Ghana’s highest political leadership continues to be vocal about the epidemic, with President John Dramani Mahama actively promoting the fight against AIDS through published articles, updates to Parliament on the status of Ghana’s AIDS epidemic and speeches to the Ghanaian people.”
As a percentage of its annual budget, Ghana’s domestic health spending is high — and it is rising every year. Between 2009 and 2011, Ghana increased health spending from $754 million to more than $1.1 billion, Hohlfelder reported. In FY2013, the country set aside about $4.8 million for HIV/AIDS.
Ghana’s fight against AIDS is also heavily supported by the Global Fund and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
Ghana has a government arm that is exclusively dedicated to responding to the HIV/AIDS epidemic. For years, the department, called the Ghana AIDS Commission, has been tracking HIV prevalence in different regions of the country so that resources can be dispersed efficiently, said Claudes Kamenga, UNICEF’s regional advisor for HIV/AIDS in west and central Africa.
Between 2005 and 2011, the commission used this data to coordinate an aggressive scale-up of programs designed to prevent mother-to-child transmission of the disease. In six years, the number of clinics equipped to offer the intervention increased eight-fold.
“Ghana has been smart about the way they’ve integrated HIV prevention into maternal and child health services,” Kamenga said. “They have done a lot in terms of informing their interventions with evidence.”
Inside health clinics, Ghana’s plan of attack doesn’t stray far from World Health Organization recommendations, Kamenga said. But the country was one of the first in its region to scale up a plan to prevent mother to child transmission. It launched its initiatives more than a year before global leaders jumped on board in 2011.
Ghana’s infant infection prevention programs, like most in west and central Africa, are multifaceted.
The first line of defense is to protect women of childbearing age from contracting HIV/AIDS, Kamenga said. That means providing education about safe sex, increasing access to condoms and, in some cases, funding income generation projects.
“It’s important that women know about the danger of infection, but it’s also important to empower them to negotiate safe sex,” he said. “When women are economically weak, they may feel obliged to accept what men say or even sell their body to get money.”
Among women who are HIV positive, family planning programs are particularly important, Kamenga said.
“Many women don’t actually want to become pregnant,” he said. “If she does not, she needs to be given the means to prevent that pregnancy. The fewer unwanted pregnancies among HIV-infected women, the fewer children needlessly exposed to infection.”
Ghana’s clinics offer HIV testing to pregnant women and those who test positive are offered anti-retroviral treatment. Women on anti-retrovirals are less likely to transmit an infection to their children during pregnancy.
Care doesn’t stop after the baby is born. World Health Organization guidelines suggest an HIV-positive mother continue anti-retroviral treatment for life — not only for her own health, but also the health of her baby.
“Babies without their mothers don’t thrive,” Kamenga said.
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