A World Where No Child Is Born With HIV

The 30th anniversary of the discovery of AIDS this week has sparked a series of retrospective conversations about how radically the landscape of this modern epidemic has changed -- for the better -- and what kind of changes we can expect next for the world's most vulnerable populations.

The changes we have witnessed have been profound. As a young physician training in the early '90s in New Haven, CT, I vividly remember our feeble attempts to ease the pain and suffering of those infected with HIV, of overflowing hospital floors, of discussions to open hospices so our patients could die with dignity. Just a few years later, I would be standing in the same place, looking at empty beds and a deserted floor as patients crammed into a tiny outpatient clinic, regaining their health and their lives through new safe and effective treatments.

I still can't shake the déjà-vu I experienced in 2003 while visiting corrugated metal shacks in Soweto, South Africa, and holding the hands of men and women dying from HIV -- living in a world where the previous decade of scientific and medical advances was beyond their reach. And I am still awed, as I was last month, by seeing the impact of changing our approach to foreign aid to make funding for AIDS treatment a priority, allowing organizations and agencies like the Global Fund and PEPFAR to bring lifesaving resources to parts of the world where access to a health worker is scarce.

Equally transformational, but less well-known, is the story of pediatric HIV. Two decades ago, an expectant mother living with HIV had a very high risk of infecting her baby during pregnancy, birth, and breastfeeding. Studies showing that transmission from a mother to her child could be halted were celebrated.

The global community set very ambitious goals that 80% of pregnant women living with HIV would have access to life-saving medications by 2010. Quickly, countries like the U.S. with strong health care systems began providing these safe and effective medications to pregnant women and virtually eliminated new pediatric infections. The vast majority of pregnant women living with HIV, however, tragically continued to give birth to infected children -- infections that were entirely preventable. In 2004, only 10% of pregnant women living with HIV had access to services to prevent transmission.

In 2003, I was asked to identify areas in HIV/AIDS where Johnson & Johnson could make an impact through its philanthropic programs. We chose to embrace prevention of mother-to-child transmission of HIV- - not because we had a test or a drug that could be used -- in fact we had neither at the time. We did have the belief that no mother should give birth to an HIV-infected child when she can have a healthy baby. Our vision of a world where no baby is born with AIDS was shared by our partners, the Elizabeth Glaser Pediatric AIDS Foundation and mothers2mothers.

Since then, Johnson & Johnson has committed $20 million to scaling up services for HIV positive mothers to have healthy babies and access life-saving medications for themselves. Our support, in combination with that of others such as PEPFAR, has resulted in over 2 million pregnant women receiving HIV testing and nearly a quarter of a million expectant and new mothers with HIV receiving care and services. The latest global figures from 2009 reveal a jump from 15% to over 50% of pregnant women receiving medications to prevent transmission.

Still, today, a baby is born with HIV every 90 seconds and half of all children with the virus die before age 2 (see video below). This is simply unacceptable, especially when we have the knowledge and ability for every mother with HIV to have a healthy baby.

Conversations among global health advocates, world leaders, and affected communities have produced perhaps the most compelling changes yet to the way we think about AIDS: a shift from prevention to elimination and a deadline to save the youngest lives.

Today in a joint announcement, UNAIDS and PEPFAR released a new global plan to eliminate new HIV infections among children by 2015 and keep their mothers alive. At the United Nations, governments, foundations, and corporations, including Johnson & Johnson, made financial pledges to realize the goals of the plan. Our $15 million pledge over the next four years from 2012 to 2015 brings our total commitment to $35 MM towards eliminating vertical transmission -- an issue we have been focused on since 2003. It is a continuation of our long-standing commitment to support achievement of the Millennium Development Goals, and reflects our enduring dedication to closing the world's most glaring gaps in maternal and child health.

Two components of the global plan are truly remarkable "firsts" for the global AIDS community. We collectively are making the virtual elimination of these new infections in children an achievable goal, deliberately using the word "eliminate" -- not just "prevent." Equally amazing is that for the first time, we are making the mothers a focus, ensuring they are kept alive and linked to care. By changing the way we frame this issue, we affirm that the next generation has the right to be born free from HIV, and acknowledge that we have a responsibility to make the lifesaving medications -- already in reach for many pregnant women living with HIV -- available to ALL, reducing the deaths of these expectant and new mothers and ending the hundreds of thousands of needless infections in children every year.