1. Global Plan to Eliminate New HIV Infections in Children by and Keep their Mothers Alive and Healthy The Role of Faith-Based Organizations at Regional Conference of Catholic Healthcare Regional Nework “Maternal Health care and Child Care” Johannesburg, 7 April 2014 by Rev. Msgr. Robert J. Vitillo, Caritas Internationalis
These are some of the reasons that the Global Plan is such an important endeavour:
Every child born free of HIV and keeping their mothers alive—this is our hope and it can be our reality.
The world has an unprecedented opportunity to make new HIV infections among children history.

2. Why focus on PMTCT?
90% of children contract HIV from mothers during pregnancy, childbirth and breastfeeding
HIV infection is more aggressive among children than adults, half die by 2 yrs
In highly-endemic areas, children present for care much later, as late as at ages 5-6 years
Mortality for children born to HIV+ mothers higher than children born to HIV- mothers.
Elimination of Mother-to-Child Transmission (MTCT) is feasible.
The Global Plan focuses a great deal on early diagnosis and treatment of women living with HIV. Why? The main aim is to prevent further vertical transmission of HIV from mother to child. Here are some facts to back up this strategy:
90% of children get HIV from mothers during pregnancy, childbirth and breastfeeding
HIV infection is more aggressive among children than adults, half die by 2 yrs
In highly-endemic areas, children present for care much later, as late as at ages 5-6 years
Mortality for children born to HIV+ mothers higher than children born to HIV- mothers.
Elimination of MTCT is feasible.

3. Monitoring Framework for 2015
Reduce the number of new HIV infections among children by 90%
Reduce the number of AIDS-related maternal deaths by 50%
Prong 1 Target
Reduce HIV incidence in women (and 15-24) by 50%
Prong 2 Target
Reduce unmet need for family planning among women living with HIV to 0 (MDG goal)
Prong 3 Targets
Reduce mother-to-child transmission of HIV to 5%
90% of mothers receive perinatal ART or prophylaxis
90% of breastfeeding infant-mother pairs receive ART or prophylaxis
Prong 4 Targets
Provide 90% of pregnant women in need of ART for their own health with livelong ART
These are the four prongs of the Global Plan and the targets to be achieved within each prong:
Reduce HIV incidence in women (and 15-24) by 50%
Reduce unmet need for family planning among women living with HIV to 0 (MDG goal)
3. Reduce mother-to-child transmission of HIV to 5%; 90% of mothers receive perinatal ART or prophylaxis; 90% of breastfeeding infant-mother pairs receive ART or prophylaxis
4. Provide 90% of pregnant women in need of ART for their own health with livelong ART
The overall goals of the plan are t achieve the following by 2015:
a. Reduce the number of new HIV infections among children by 90%
b. Reduce the number of AIDS-related maternal deaths by 50%
Reduce AIDS-related infant deaths by 50%
Additional indicators have been developed for the 22 high burden countries. See the Global Monitoring Framework and Strategy
for the Elimination of new child infections by 2015, UNICEF, WHO.

4. 85% decline needed over 3 years (avg. 74,000 per year) 2012–2015
Responding the first decade: Estimated number of new HIV infections in children (aged 0–14): global trend, annual rates of reduction and projections, 2001–2015
85% decline needed over 3 years (avg. 74,000 per year) 2012–2015
Main Point:
This graph illustrates that there has been a consistent decline in the global number of new HIV infections in children, aged 0 – 14 years, since the mid-2000s.
Although the rate of decline increased in the period between 2009 and 2012 (35% decline over 3 yrs vs. 26% decline over 8 yrs), the rate of decline will need to more than double between 2012 to 2015 in order to reach the Global Plan target of a 90% reduction in new HIV infections in children by 2015 (compared to 2009 baseline data).
Source: UNICEF analysis of UNAIDS modeling, 2013, based on 2012 country estimates.
Global Plan target
Source: UNICEF analysis of UNAIDS 2012 HIV and AIDS estimates.

6. Number of childhood infections averted since 2009 because of ARVs
UNAIDS estimates, 2013

7. Impact: New HIV Infections among children

8. PRONG 3: Maximising returns in South Africa New HIV Infections Among Children
Quality of programs
5% prevalence without prophylaxis can lead to 20K new infections in SA
Need to reach high risk women early
Reduce loss to follow-up
Need to address risk of seroconversion during pregnancy

9. Prong 4: Percent of those eligible receiving ART for their own health, 21 countries, 2012
Source: UNAIDS estimates Oct 2013

10. Paediatric HIV care and treatment

11. Remaining Challenge in 1st decade:
Percentage of ART coverage among eligible adults (aged 15+), children (aged 0–14) and all ages 21 African Global Plan priority countries, 2012
Note: Some numbers do not add up due to rounding. The coverage estimate is based on the estimated unrounded number of children receiving and eligible for ART. Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting.

12. The Religious Community working toward Zero New Infections among Children
Support women to avoid HIV infection. A mother free from HIV cannot pass on the virus to her children.
Provide information in local faith communities encouraging and supporting couples to go together for HIV testing.
Support access to antenatal care and HIV testing and counselling for pregnant women and provide linkages to related health facilities and care.
Strengthen programmes to prevent new HIV infections in children––in line with national policies and protocols––in religiously affiliated hospitals and medical centres, particularly in rural areas.
Ensure coordination with national health systems addressing HIV prevention and treatment to enable pregnant women living with HIV to access the best possible antiretroviral therapy—for their own health and for their baby’s health.
These are the recommendations of UNAIDS for strengthening engagement of the religious community in the UNAIDS/PEPFAR Global Plan to Eliminate New HIV infections among Children by 2015 and to Keep their Mothers Healthy. They were presented to Pope Benedict XVI when he granted an audience to UNAIDS Executive Director, Mr. Michel Sidibé; they Holy Father expressed strong encouragement for this initiative.
The Catholic HIV/AIDS Network has done a study of the challenges faced by Catholic Church-related organizations and of additional contributions they can make toward achievement of the Global Plan. For more complete information, come to the Report Launch in the Faith Zone of the Global Village, later today at hours.

13. Caritas Internationalis “HAART for Children” Campaign
TO SCALE UP PMTCT
TO INCREASE DEVELOPMENT AND ACCESS OF PEDIATRIC TESTING FOR BOTH HIV AND TB
TO INCREASE DEVELOPMENT AND ACCESS OF PEDIATRIC TREATMENT FOR HIV AND HIV/TB CO-INFECTION
On 08 March 2009, Caritas Internationalis launched its HAART for Children Campaign to promote early diagnosis and treatment of HIV+ women and their children as well as greater uptake of Prevention of Mother-to-Child Transmission Programmes.
The Campaign is built on three pillars:
Promote the development of a simple, affordable diagnostic test for infants that can be carried out at local point of service (including rural health clinics, or even at home);
Advocate for Access for all pregnant women to voluntary HIV testing and for all HIV-positive pregnant women to prevention of mother-to-child interventions together with ongoing antiretroviral treatment - combined with elective caesarean surgery, where advisable, and alternatives to breast-feeding, when appropriate;
Urge pharmaceutical companies and regulatory authorities to speed up the processes of registration and development of new, affordable, child-friendly formulations and dosages for antiretroviral medications.
Caritas Internationalis “HAART for Children” Campaign
“HAART” = Highly Active Retroviral Treatment but also requires “HEART”

14. “Prescription for Life”: Children taking action on behalf of other children – those living with HIV or with HIV/TB co-infection
letter-writing action by children to governments and to a target group of pharmaceutical companies
Caritas invites all Campaign Participants to promote the “Children’s Letter Writing Action” – under the theme of Prescription for Life – by encouraging students and children to write to governments health officials and to a target group of pharmaceutical companies asking them to improve diagnostic tools and treatment for children living with HIV.
We have prepared an action guide for use by teachers and schools, parents and families, faith leaders and their communities, and all who play a vital role in making young people more aware of the world in which they live and empowering them to take action on behalf of, and in solidarity with, others. Ideas also are given for students and youth groups to raise awareness of these issues in local newspapers and other media.  
Caritas pursues this initiative with the Ecumenical Advocacy Alliance (EAA), a broad ecumenical network that does advocacy work on AIDS and food security.
To date, some 1800 letters have been written through the help of Campaign partners in various parts of the world, including the Christian Brothers, International Young Catholic Students, and Caritas organizations in Slovakia, Slovenia, Austria, Vietnam, and , India.

15. Education/Awareness Raising Campaign for WAD Advertisement published in Sydney and Melbourne Newspapers
Awareness raising campaign by Caritas Australia
- Post card mailed to 2,000 monthly donors (Hopegivers) and handed out at concerts and exhibits, training sessions, and placed in school bags
Caritas Publications (100,000 newsletters) + Be More, Ozspirit, and Website
Advertisements placed in Sydney and Melbourne Newspapers
- Target Roche Pharmaceutical Company to enourage development of paediatric ARV medication (i.e., Fuzeon) in a formulation that could be used in low-resource, low-technology

16. Caritas Internationalis and other Campaign partners
promote HAART for children advocacy
at various United Nations fora
Caritas
In collaboration with other Campaign partners, Caritas seizes every opportunity to link the the HAART for Children Campaign to the child’s “right to health” through oral and written interventions and organization of side events in various UN and other international fora, including meetings of UN Human Rights Council,
World Health  Organization, and UNAIDS
In collaboration with other Campaign partners, Caritas seizes every opportunity to link the the HAART for Children Campaign to the child’s “right to health” through oral and written interventions and organization of side events in various UN and other international fora, including meetings of UN Human Rights Council, World Health  Organization, and UNAIDS

17. Getting to Zero: CRS efforts to Strengthen Male Involvement in PMTCT
Through AIDS Relief Programmes, in such countries as Kenya, Zabmia, and Nigeria, Catholic Relief Services, Catholic Medical Mission Board, and other Catholic Church-related organizations, work to increase awareness about the need for male involvement in HIV programming and to attract and retain men in its programming, including PMTCT, by:
Promotion of voluntary medical male circumcision
Formation of support groups specifically for men
Strengthening couple relationships and encouraging testing as a couple (cf., The Faithful House: A couple’s Guide to PMTCT)
Involving men in antenatal care and PMTCT services – including shorter waiting periods to be seen as a couple in clinic, encouraging “love letters” by women patients to invite their husbands to follow-up visits and to communicate information on healthy pregnancies.
Through AIDS Relief Programmes, in such countries as Kenya, Zabmia, and Nigeria, Catholic Relief Services, Catholic Medical Mission Board, and other Catholic Church-related organizations, work to increase awareness about the need for male involvement in HIV programming and to attract and retain men in its programming, including PMTCT.

18. UNICEF chose a Catholic Church Programme in Papua New Guinea as a Best Practice Model for PMTCT
“The Catholic Health Service, and particularly Mingende Rural Hospital in Simbu Province where I work, as well as Catholic Health Service in Mendi, are implementing a very successful programme on Prevention of Parent- to-Child Transmission of HIV (PPTCT), called: ”Born to live”. …
“Since the beginning of the ‘Born to live’ project in October 2003, and up to l December 2009, we tested 6867 mothers with an average prevalence rate of 1.1%. 66 HIV-positive mothers delivered their babies in our facility. 14 babies died during the first years of the programme, while we were administering only single-dose Nevirapine to the mothers and their babies..
“ Gradually, we started using 2 ART drugs and since 2009, we use triple ART therapy for all HIV-positive mothers who are past 28 weeks of gestation. We continue the treatment during labour and the breastfeeding period. Since then, all our babies born to HIV-positive mothers have tested negative. Since last year, we are able to use DNA PCR testing of infants at the age of 6 weeks, and we are all happy with the babies BORN TO LIVE and free of the HIV.”
Sr. Kinga Czerwonka, Catholic Health Service, Simbu, Papua New Guinea
UNICEF chose a Catholic Church Programme, sponsored by the Sisters of the Holy Spirit and associated with the National Catholic AIDS Office in Papua New Guinea, as a Best Practice Model for PMTCT. The Sisters reported amazing progress as a result of early testing of mothers and babies and of early treatment for HIV+ mothers and, when necessary, of their chldren.

19. Cardinal Bertone, Secretary of State to His Holiness Pope Benedict XVI appeals for Universal Access
What more effective image of love is there than the relationship between the mother and the child? Whoever saves the mother and child saves the future of the world, it could be said!
In the presence of so many authoritative Ministers and persons in charge of health care, I would like to address an appeal to the International Community, to States and to donors: … May universal access to treatment be agreed!
Let us do so beginning with the mothers and children.
In this See, in the name of the Holy Father, I make myself the voice of the many who are suffering, of so many patients who do not have a voice.
Let us not waste time and invest all the resources necessary!”
In an address to African Ministers of Health convened by the Comunità Sant’ Egidio in Rome, the Secretary of State to Pope Benedict XVI, Cardinal Tarcisio Bertone, passionately appealed for Universal Access to early diagnosis and treatment for mothers living with HIV in order to keep them healthy and to prevent vertical transmission of the virus to their children:
“What more effective image of love is there than the relationship between the mother and the child? Whoever saves the mother and child saves the future of the world …
I would like to address an appeal to the International Community, to States and to donors: … May universal access to treatment be agreed!
Let us do so beginning with the mothers and children.
Source: ZE ,