G8 abandons promise, undermines maternal and child health

published on July 5, 2010 in The Hill Times

Reprinted with permission of The Hill Times.

VANCOUVER, B.C.— The G8 has failed to deliver its 2005 pledge of universal access to care, treatment and prevention of HIV/AIDS by 2010. And, during their recent Muskoka summit, leaders of the world's richest countries watered down their commitment to this life-saving medications program while only 40 per cent of the way toward achieving this important objective. Without universal access to HIV medication, millions more will needlessly suffer and die, disease transmission will increase, and the deadly pandemic will be prolonged.

Meanwhile, the G8's new commitment for maternal and child health already suffers an immense credibility gap. We need to be perfectly clear: There can be no substantial gain in maternal and child health if we fail to deliver universal access to care, treatment and prevention of HIV/AIDS. This is particularly the case in many African countries where HIV prevalence is in the range of 30 per cent among women of reproductive age.

Despite progress in scaling up access to treatment and care, HIV remains the leading global killer of women of reproductive age and one of the leading overall causes of adult and child deaths in low- and middle-income countries. According to UNAIDS, women comprise about half of all people living with HIV worldwide and three quarters of people ages 15-24 living with HIV in sub-Saharan Africa.

The proven benefits of HIV treatment with Highly Active Antiretroviral Therapy (HAART) are real, substantial and growing. HAART has been shown to dramatically reduce progression of the disease and death, in the North and the South of the world. Specifically, HAART decreases mortality in adults by 95 per cent. Moreover, HAART decreased the number of orphans by 93 per cent and decreased mortality among uninfected children by 81 per cent in a recent study in Uganda.

The latter relates to the fact that in this setting "motherless children" are 10 times more likely to die within two years of their mother's death. Additionally, antiretroviral treatment of HIV-infected mothers during pregnancy eliminates HIV transmission to the babies and continued use of HAART after delivery allows for safe breast-feeding, which simultaneously prevents HIV infection in the newborn and diarrhea—a common cause of death in resource-limited settings.

Also, HIV treatment preserves the integrity of the health-care system, as it preserves the health of its workforce. Of note, HIV infection has been estimated to have already claimed 20 per cent of the nursing force in South Africa. The same applies to teachers, social workers and a variety of other professionals that play a key role in supporting the health of mothers and children.

Furthermore, HIV treatment has been shown to dramatically decrease HIV transmission from all routes. A recent study in seven African countries showed greater than 90 per cent reduction of sexual transmission of HIV when the HIV infected member of a heterosexual couple received HIV treatment. Similarly, BC has reduced HIV new infections by greater than 50 per cent among injection drug users in the last three years, as a result of a targeted HAART coverage expansion.

Broad access to HIV treatment has lowered morbidity and mortality among women, reduced vertical transmission and improved the health of infants and children. Yet the estimated four million people receiving HIV treatment in low- and middle-income countries represents less than half of the number of people who urgently need life-saving HIV treatment today.

In Muskoka, G8 leaders "reaffirmed" a commitment to universal access—but severely weakened the pledge by removing the key 2010 time frame. With their resolve in question, G8 countries must provide detailed updates on how they will meet the goal of universal access, prove they are willing to make the necessary political and financial commitments, and commit to a target date.

Failing to deliver on the universal access pledge is morally and ethically wrong. Moreover, the newly demonstrated secondary preventive value of HAART truly represents a game changer, as it transforms what was originally a humanitarian initiative into a highly cost effective investment. Once the preventive value of HAART is considered, its cost effectiveness grows exponentially. Further, today, universal access represents the key to curbing the growth of the pandemic. We must demand better from our political leaders.

Dr. Julio Montaner, the director of the B.C. Centre for Excellence in HIV/AIDS and president of the International AIDS Society, is the leading international expert on HIV/AIDS issues related to maternal and child health.

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Julio Montaner

BC Centre for Excellence in HIV/AIDS

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G8 abandons promise, undermines maternal and child health

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