Richard Amenyah, Ian Stein, Olga Isaza | Region achieves elimination of mother-to-child HIV transmission

Belize, Jamaica, and St Vincent and the Grenadines are being recognised for the remarkable achievement of having eliminated mother-to-child transmission (EMTCT) of HIV and syphilis, which is one of the greatest global public health achievements of the last decade.

This milestone follows a global push to eliminate mother-to-child transmission with Cuba being the first in 2015. Now, over 20 countries have been certified, with a significant number from the Caribbean.

The whole world joins in the celebration of the addition of Belize, Jamaica, and St Vincent and the Grenadines as part of the 20 prestigious achiever countries to be certified. This success is not just a testament to the relentless efforts of these nations but demonstrates strong government commitment, collaboration between healthcare providers and the unwavering support from international organisations like PAHO/WHO, UNAIDS, and UNICEF. These organisations offered guidance on best practices to ensure that no child starts life with HIV. The invaluable contribution of communities of persons living with HIV must also be underscored.

The scale up of HIV prevention services in these countries has also prioritised the elimination of hepatitis B and syphilis. Untreated maternal syphilis results in congenital syphilis in over half of affected pregnancies and can lead to early foetal loss, premature birth, stillbirth, low birthweight and newborn deaths.

In the absence of any intervention, mother-to-child transmission rates of HIV range from 15 to 45 per cent. This rate can be reduced to below five per cent with effective interventions during the periods of pregnancy, labour, delivery and breastfeeding, especially with the use of antiretroviral drugs for both mother and baby.

These nations faced challenges in their journey, including stigma and access to care and the process has provided valuable lessons for other countries striving for EMTCT certification.

Strong political and public health commitment was paramount to developing and sustaining resilient health systems, which provide continuous and unrestricted access to services that were people centred.

Now in place are high-quality primary prevention, diagnosis and treatment services for women and girls in the reproductive age as well as to their newborns. There are also robust surveillance systems which identify and monitor those at risk of infection and their health outcomes. High standards of laboratory services are maintained with timely release of results and case reporting to ensure the efficacy, effectiveness and reliability of their EMTCT programmes.

Respect and protection of their human rights and gender equality are now ensured and in communities, there is active engagement and meaningful involvement which is free from violence.

Communities of women and people living with HIV in these countries managed to challenge stigma and discrimination associated with HIV and were encouraged by their peers, including mother-to-mother support groups, to continuously access the critical healthcare services they needed. The active participation of communities ensured that the programmes were culturally sensitive and widely accepted.

Maintaining EMTCT status requires continuous monitoring, adaptation, and resilient healthcare and community systems.

The certification of Belize, Jamaica, and St Vincent and the Grenadines inspires hope for an AIDS-free generation in the Caribbean and empowers other countries to follow suit. Let us celebrate their success and encourage them to maintain this crucial fight to protect future generations and that no child starts life with HIV.

– Contributed by Richard Amenyah (UNAIDS), Ian Stein (PAHO/WHO) and Olga Isaza (UNICEF)