The Legacy of Courageous Mothers in Africa

By Ambassador Deborah L. Birx, M.D.

April 6, 2016

Two decades ago, long before antiretroviral treatment (ART) became widely and freely available in Africa, I met hundreds of pregnant women living with HIV/AIDS who’d walked many miles to the clinic to help their babies be born HIV-free. At that time, we had little to offer them beyond the hope that their child could start his or her life without this burden. And yet these women came, day after day – risking expulsion from their homes, violence by their partners, and stigma and discrimination in their communities on account of disclosing their HIV-positive status. Many of them arrived with the knowledge that, lacking access to ART for their own health, they wouldn’t live long enough to watch their children grow up. It was heartening and heartbreaking.

Back then, the tools we had to prevent mother-to-child transmission of HIV focused primarily on the child. With a single dose of Nevirapine or a short course of AZT, pregnant women living with HIV/AIDS could significantly reduce the risk of transmission to their babies. These early interventions were not perfect, but knowing they could help save their baby’s life, women chose to disclose their HIV status and face the attendant risks. As a mother of two daughters, I was humbled and awed by their extraordinary courage.

Thankfully, today, we have even better tools to protect and promote both the health of mothers and children. The World Health Organization now recommends that all pregnant and breastfeeding women living with HIV/AIDS should receive ART for life, a policy called Option B+. When implemented properly, Option B+ both dramatically reduces the risk of HIV transmission from mother-to-child and keeps mothers alive.

Despite this incredible progress in preventing HIV infections among children, we are falling short in keeping adolescent girls and young women HIV-free.

In 2015 alone, with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), more than 831,500 pregnant women living with HIV/AIDS received ART to protect their babies and improve their own health. This enabled 267,000 babies who would have otherwise been infected to be born HIV-free. To date, PEPFAR support has enabled more than 1.5 million babies to have this start. And this has contributed to the 58 percent global decline in new HIV infections among children since 2000.

Despite this incredible progress in preventing HIV infections among children, we are falling short in keeping adolescent girls and young women HIV-free. Globally, AIDS remains the leading cause of death for women of reproductive age. Every year, 380,000 adolescent girls and young women become newly infected with HIV – more than 1,000 every day.

Through an ambitious $385 million DREAMS partnership, PEPFAR and several private sector partners, including Johnson & Johnson, are committed to change this by supporting girls and women to become Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. Our goal is to reduce new HIV infections among adolescent girls and young women living in the highest-burden areas of 10 African countries by 40 percent by the end of 2017. Through DREAMS, we are working to break down the structural barriers that put girls and women at greater risk, and empower them to protect their health and the health of their future families.

Every mother deserves the chance to thrive and to watch her children do the same. Two decades ago, in much of Africa, this wasn’t possible for many mothers living with HIV/AIDS. But today it is. We owe it to the courageous mothers I met then in Kenya, Tanzania, and Uganda – and the many adolescent girls and young women I see in Africa today – to deliver on the promise of an AIDS-free generation.

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