Last year, like many others in the HIV community, I was thrilled to learn that a little girl born in Mississippi with HIV may have been cured of HIV infection by the early initiation of antiretroviral treatment. I thought that we were on the cusp of a monumental public policy and humanitarian advance -- not one that required experimental space-age treatments, but one achievable today with the very antiretroviral tools we already have. The enthusiasm that Ms. Mississippi's story generated demonstrates just how urgently we all desire a HIV cure, even if not for all adults, at least for the babies born to HIV-infected mothers. The community cared about her story, and the media cared about her story. Her story was on the front page of the New York Times and the Wall Street Journal alike.
We could cure many of the 300,000 infants born with HIV infection every year. We could eliminate pediatric HIV. Can you imagine it? I did. It wasn't difficult.
Disappointedly, this past week, we learned that the virus, once gone from her bloodstream without antiretroviral treatment, has now returned. She's not cured. She's another HIV-infected child whose health was failed by the weaknesses in our community and health care systems.
It's time to recalibrate. We must go back to the lessons of the recent past to reinvigorate our goals for the future.
We've known for years that testing pregnant women for HIV and by providing antiretroviral treatment (even old antiretroviral treatments) can prevent mother-to-child transmission. Yet, here in the U.S., 20% of positive people don't know their status and another 20% of people who know their status won't seek medical care within the first year of their diagnosis. Around the world, hundreds of thousands of babies will be born this year with HIV. Hundreds of thousands of families will be affected by HIV.
So, where do we go from here?
- We must address the problem in many countries that many women do not access antenatal and postnatal medical care. Hospital care and delivery of babies are critical opportunities for HIV testing and treatment that does prevent transmission. Strengthening antenatal care also reduces general infant and maternal mortality and morbidity, too. Yet, funding for such care is inadequate in many places.
- We must address barriers to HIV testing and engagement in care (such as stigma, discrimination and ignorance) in civil society, communities, religious organizations and medical clinics, for unless positive women know their HIV status and can stay engaged in care, the medical tools we have cannot be effectively used.
- We must address barriers to adequate provider education about HIV and how to create truly nonjudgmental care environments were stigma and discrimination are left outside the door, rather than being roadblocks to staying engaged in essential care.
- We must effectively communicate the idea that ending pediatric HIV is possible. We've largely eliminated pediatric HIV in many high-income countries already. We're reducing rates of pediatric HIV in many low-income countries. It's possible. But we need to know that it's possible. We need to demand that it happen.
Unless we actively insist on doing better, ending pediatric HIV won't happen.
Ending pediatric HIV actually doesn't require Ms. Mississippi to be cured of her HIV. Ending pediatric HIV/AIDS is possible, but requires that we demand that it happen. It requires a renewed commitment to do the things we already know how to do, with the tools that we already have. It requires that pregnant women receive care in well-funded care facilities, with access to nonjudgmental care, adequate diagnostic tools, medications and well-trained medical care providers.