Tomorrow is World AIDS Day. While Cambodia has made remarkable progress in the fight against AIDS, strong and continued investment in HIV programmes is crucial if the Kingdom wants to end the epidemic as a public health threat by 2030, write Dr Vladanka Andreeva, Dr Ly Penh Sun, and Prof Tung Rathavy.
Seven years ago, Navy, a young woman from Phnom Penh learned that she had HIV. She had been feeling sick for a while and a local community-based organization recommended her to get tested for HIV. After knowing her HIV diagnose, she brought her baby child to the clinic where she received devasting news: her child also tested HIV positive. At the time of her pregnancy, Navy did not know her HIV status and gave birth at home with the help of a traditional midwife.
In 2017, an estimated 1.4 million pregnant women were living with HIV globally. In most cases, they are not aware of their HIV status. Untreated, they have a 15 to 45 per cent chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. However, the risk drops to just over 1 per cent if antiretroviral medicines are given to both mothers and children throughout the stages when infection can occur.
On World AIDS Day 2018, HIV testing is being brought into the spotlight. And for good reason. Around the world, 37 million people are living with HIV, the highest number ever, yet a quarter do not know that they have the virus. Knowing your HIV status has many advantages. It is an essential entry point to HIV treatment, prevention, care and support services. People who test positive for HIV should be linked immediately to antiretroviral therapy to keep them alive and well and, when viral load suppression is reached, prevent transmission of the virus. Knowing the HIV status also enables people to make informed decisions about HIV prevention options, including services to prevent children from becoming infected with HIV. A pregnant or breastfeeding woman living with HIV can access a range of options that can ensure that she remains healthy and her baby is born HIV-free and stays HIV-free, but only if she knows her HIV status.
Luckily, as soon as Navy learned about her and her baby’s diagnosis, they were immediately enrolled on
Antiretroviral therapy (ART) and today they are both living healthy and productive lives integrated into their community. Health-care services for mothers living with HIV are integrated into maternal and child health-care programmes in hospitals and are free of charge. Community leadership are ensuring that mothers living with HIV are linked to hospitals and supported throughout their pregnancy.
World AIDS Day is a time to celebrate the progress made and commit to redoubling efforts to achieve the target agreed by Cambodia of ending the AIDS epidemic as a public health threat by 2030. Cambodia has made important achievements over the past two decades. The country has the highest antiretroviral treatment coverage of any country in Asia and the Pacific region, and one of the highest globally. Cambodia’s HIV response has been highly successful, leading the country to be one of seven globally to achieve the 90-90-90 targets becoming a model worldwide. High coverage of prevention of mother-to-child transmission (PMTCT) services at around 81 percent in 2017 has led to significant decline in mother-to-child transmission (MTCT) rate.
Achieving an AIDS free generation is possible in Cambodia, but while the finish line is within site, the last mile is often the hardest. Despite the progress made, there are still barriers with identification, testing and treatment of pregnant women living with HIV and their babies. While 83.5 percent of pregnant women living with HIV were estimated to have received ART in 2015, 17.3 percent remained unidentified and 4 percent were identified only at the time of delivery.
In the country, around 10, 000 people still don’t know their HIV status this year. Services must now be expanded to the most vulnerable people including key populations such as people who inject drugs, sex workers and migrants. Confronting and addressing issues of stigma and discrimination remains an ongoing challenge that may hold some women back from accessing the services they require.
Another challenge is ensuring that newborns are tested for HIV and have immediate access to HIV treatment. Children who acquire HIV through pregnancy, delivery or breastfeeding have a high risk of dying of AIDS-related illnesses within just a few months or years if they do not start treatment immediately. To ensure more children are tested and given access to treatment, testing and the delivery of results need to be linked with prompt initiation of antiretroviral therapy for children found to be living with HIV.
To reach the goal of ending AIDS, a strong and continued investment in HIV programmes is crucial. Over the past years, external financing for Cambodia’s HIV programme has been declining, and recent analysis suggests that such outside financial support will continue to fall in the coming years. Cambodia has worked hard to use funds as efficiently as possible. However, unless the national government and partners increase contributions to the country’s HIV response, the achievements Cambodia has achieved over the past two decades could be at risk.
UN in partnership with the US President’s Emergency Plan for AIDS Relief (PEPFAR) and Clinton Health Access Initiative (CHAI) supported the national maternal and child health and HIV programmes in the development of the Roadmap for Elimination of Mother to Child Transmission of HIV and Syphilis, which is an opportunity to further progress on achieving elimination of HIV transmission from mother to child and end AIDS as public health threat.
The roadmap, that will be launched today, seeks to outline the strategies to be pursued in order to strengthen program delivery, laboratory services, data management and human rights, gender equality and community engagement, ensure sustainability and achieve validation requirements.
Because she was living with HIV, Navy denied herself her dream to have more children. But, with support from local community based organization ARVs Users Association, access to treatment and guidance from the health clinic staff, she decided to have three more children, all of them free from HIV. With Cambodia’s leadership and commitment, this dream can become true for all positive women in the country.
At this unique moment in history, when achieving a future free from AIDS is a possibility, a renewed impetus will make a marked difference to outcomes 7 years down the road. By increasing investment now, by extending the coverage of testing and prevention services, Cambodia, will be on course to end the AIDS epidemic by 2025.
Dr Vladanka Andreeva is country director of UNAIDS Cambodia, Dr Ly Penh Sun is director of the National Centre of HIV/AIDS, Dermatology and STD, and Prof Tung Rathavy is director of the National Maternal and Child Health Centre.