Cuba is first country to eliminate mother to child HIV transmissionBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3607 (Published 02 July 2015) Cite this as: BMJ 2015;351:h3607
Cuba has become the first country to receive validation from the World Health Organization for having eliminated mother to child transmission of HIV and syphilis.
In 2010 all countries of the Americas, including the United States and Canada, committed to eliminating mother to child transmission of these two diseases by 2020. Cuba has been the first to officially achieve that goal, but another 30 countries in the region are close, said Carissa Etienne, director of the Pan American Health Organization, at a press conference to announce Cuba’s success.
To achieve official recognition Cuba had to show for at least one year that new infections from mother to child transmission of HIV had fallen below 50 cases in 100 000 live births and that the rate was less than 5% in breastfeeding populations and less than 2% in non-breastfeeding populations. The country also had to demonstrate that rates of mother to child transmission of syphilis were lower than 50 cases in 100 000 live births.
Other indicators for recognition included: 95% of pregnant women knowing their HIV status; 95% of HIV positive pregnant women receiving antiretroviral drugs; and over 95% of pregnant women with syphilis receiving treatment. In 2013 Cuba saw only two babies born with HIV and only five born with syphilis.
Cuba’s public health minister, Roberto Morales Ojeda, said that his country’s achievement showed the success of its healthcare system, which is “free, accessible, universal and whose main strength is primary healthcare.”
Etienne added, “If you have a resilient healthcare system, based on primary healthcare and universal health coverage, then you can confront any challenge, be it natural disasters, emerging infectious diseases or re-emerging infectious diseases.”
She said that Cuba’s success proved that “vertical” top-down healthcare systems were not the way to manage and treat diseases such as HIV. “Health systems based on primary healthcare and universal access to health are the best and most sustainable way for any country to ensure the health and wellbeing of its people,” she added.
Although the Joint United Nations Programme on HIV/AIDS (UNAIDS) and WHO target of eliminating mother to child transmission of HIV globally by 2015 will not be met, eight of the 22 countries, which account for 90% of new HIV infections, have reduced their infection rate by over 50%. The countries that have requested official validation of zero mother to child infections include Bulgaria, Cambodia, Moldova, Oman, Sri Lanka, and Turkmenistan.
Luiz Loures, deputy executive director of UNAIDS, said that Cuba’s success was not due to its geography, in that it is an island with a small, contained population. For example, Russia, in which around 10 000 babies were born with HIV from 2002 to 2004, said that it is on target to eliminate mother to child transmission of HIV by the end of this year.
Loures said, “I don’t think Cuba is the only country that can achieve this. Without a doubt the Cuban experience can be adopted by all the countries—the combination of a working healthcare system, mobilising the people and, the most important thing, political will and action can work in any country.”
Mickey Chopra, chief of health at Unicef, said that even South Africa, the country with the largest HIV population in the world, had mother to child HIV transmission rates of under 5%. “The key feature that changed the landscape was the empowerment of women and communities to demand the treatment and preventive services,” he said.
However, he added that children still lag behind adults in treatment terms: 34% of children who needed antiretroviral drugs received them in 2012, compared with 64% of adults.1
Cite this as: BMJ 2015;351:h3607