The WHO Regional Director for Southeast Asia, or someone writing under his name, has published an op ed consisting of drivel in the Bangkok Post on the occasion of World AIDS Day.
Prevention of mother to child transmission, even in his home country of Thailand that he says 'shows the way', prevents only a few infections a year. Other prevention activities prevent many more infections. He has wasted an opportunity to show how HIV incidence is falling in the region and why it is falling: safer injecting and safer sex.
BTW, he calls Myanmar by the name of Burma in the second paragraph of his op ed. Has WHO begun to call the country by that name again?
[him] moderator
++++++++++++++++++++
Preventing HIV: Thailand shows the way
Dr Samlee Plianbangchang
Bangkok Post
1 December 2010
Despite great achievements in prevention and treatment, World Aids Day today reminds us that HIV/Aids remains a serious public health problem globally.
In the 11 countries that comprise the World Health Organisation's Southeast Asia Region, the latest data suggest a downward trend in new HIV infections. But still, 3.5 million people in the region are living with HIV, mainly in India, Indonesia, Burma, Nepal and Thailand.
In 2009, there were an estimated 220,000 new HIV infections and 230,000 people died due to Aids-related illnesses in the region. People most at risk of HIV infection are female sex workers, men who have sex with men, transgender persons and people who inject drugs.
The most vulnerable face of this disease are the HIV-positive children. As long as a new generation continues to get the virus from HIV-positive mothers, the battle against HIV/Aids cannot be won. Protecting these children against HIV infection and safeguarding their mothers' health is a priority for WHO.
The HIV threat to children highlights the need to strengthen health systems, particularly primary health care and to address issues of gender and stigma.
The estimated number of children living with HIV in Southeast Asia increased from 89,000 in 2001 to 130,000 in 2009. Almost half of HIV-positive children in the region have access to treatment, compared to about a quarter globally.
Women constitute 37% of the 3.5 million people living with HIV/Aids in the region. Barely 34% of the estimated 58 000 HIV-positive pregnant women who need anti-retroviral prophylaxis are receiving it. Without any intervention, 15-45% of their infants will become infected during pregnancy, delivery or breastfeeding. Effective intervention to prevent children from getting the virus exists, and there is good evidence that earlier and more effective treatment can prevent nearly all mother-to-child transmissions. "Prevention of mother to child transmission" (PMTCT) of HIV is a priority, and the elimination of such transmission by 2015 is possible.
In 2010, WHO released new guidelines on the prevention of mother to child transmission of HIV based on recent evidence that recommended earlier initiation of anti-retroviral prophylaxis in pregnancy (as early as 14 weeks of gestation) to prevent mother-to child transmission of HIV, and the provision of life-long anti-retroviral treatment to all HIV-infected pregnant women in need of treatment. Widespread implementation of these guidelines could reduce the risk of mother-to-child transmission to less than 5% or even lower and would increase maternal and child survival.
Effective antenatal care services at the primary health care level is key to safeguarding the health of mothers and children. A more comprehensive approach for preventing HIV in children must include preventing women of child-bearing age from becoming HIV-infected in the first place, as well as meeting their needs for family planning.
Thailand has achieved universal access to effective prevention of mother to child transmission of HIV services, and this provides a valuable lesson for other countries. Early in this decade, Thailand was the first country in the region to integrate PMTCT interventions into its existing infrastructure of antenatal care. The programme had many important components, including confidential voluntary HIV counselling and testing at all health care facilities for all pregnant women, as well as PMTCT services for pregnant HIV-positive women.
An estimated 20,000 children have been protected from HIV infection in Thailand since the launch of the programme at the beginning of the decade. Moreover, new laboratory methods are being scaled up for earlier determination of a child's HIV status, which will allow for better protection of the child's health and well-being. Strong political commitment and the implementation of evidence-based policies within a system already based on a strong primary health care foundation have been key factors in Thailand's success.
Ultimately, the epidemic of HIV/Aids cannot be dealt with in isolation. Experience from countries such as Thailand that have had the greatest success in controlling the epidemic suggests that measures to prevent and control HIV/Aids have to be an intrinsic part of primary health care services. Removing stigma and building stronger health systems are crucial, as are improving the education and status of women. Barriers to accessing PMTCT services must be removed, and appropriate care and social support for the affected child, mother and family must be ensured.
In this way we can ensure that HIV/Aids does not destroy the lives of young children even before they have begun.
Dr Samlee Plianbangchang is WHO Regional Director for Southeast Asia.
http://www.bangkokpost.com/news/local/208926/preventing-hiv-thailand-shows-the-way
