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Caribbean public health authorities propose to eliminate vertical transmission of HIV and syphilis by 2015

Mexico City, August 7, 2008—Public health authorities, HIV and Maternal and Child Health experts concluded that it is feasible to eliminate the vertical transmission of HIV and syphilis in the Caribbean by 2015. The conclusion was reached after a technical meeting convened by the Pan American Health Organization-World Health Organization (PAHO-WHO) and the United Nations Fund for Children (UNICEF) during the XVII International AIDS Conference.

The experts proposed criteria to certify countries that achieve elimination of vertical transmission of HIV and syphilis as public health problems. The transmission of both infections from mother to child can be reduced to very low levels with simple and affordable interventions, but zero transmission rates are not possible at the moment.

According to the proposal, Caribbean countries with incidence rates of less than 2 HIV cases per 100 infected mothers could be certified as having eliminated vertical transmission of HIV as a public health problem, while countries with incidence rates of 0.5 or lower of syphilis cases for 1,000 live births could be certified as having eliminated vertical transmission of syphilis.

In 1995, the Pan American Health Organization (PAHO) began a regional initiative for the elimination of congenital syphilis in the Americas. However, it is the first time that a developing region proposes also the elimination of vertical transmission of HIV. "The Caribbean has been pioneer in other areas, and we can be a pioneer in this one too. This is a target we can definitely reach," said the Minister of Health and the Environment of St. Vincent and the Grenadines, Hon. Douglas W. Slater.

The discussions in Mexico involved several public health officials from most countries of the region. For Carol Jacobs, chairperson of the National HIV/AIDS Commission of Barbados, the proposal is feasible but it will require "strengthening the surveillance and the monitoring and evaluation systems of the region." The regional organisms were represented by the Assistant Secretary-General of the Caribbean Community (CARICOM), Edward Greene, and the Deputy Program Manager of Pan Caribbean Partnership Against HIV/AIDS (PANCAP), Morris Edwards. Also attended the meeting representatives of the United Nations Population Fund (UNFPA), the Caribbean Network of people living with HIV (CRN+), the Caribbean Vulnerable Communities Coalition (CVC) and the Centers for Disease Control and Prevention (CDC).

"PAHO and UNICEF believe this proposal will contribute to address two public health problems that affect our women and children, HIV and Syphilis, in a comprehensive and integrated manner, " said the PAHO director Mirta Roses. The Caribbean Initiative for Elimination of Vertical Transmission of HIV and Syphilis will be formally launched in 2009, after a series of regional consultations, announced the PAHO HIV Caribbean Office (PHCO).

Country reports indicate significant progress in addressing vertical transmission of HIV and syphilis. In Trinidad and Tobago the syphilis sero-reactivity rate for infants declined from 31% in 2002 to 9% in 2005. Antiretroviral treatment to reduce the vertical transmission of HIV is available to 100% of pregnant women with the virus in Cuba, Dominica, St. Kits and Nevis, and St. Vincent and the Grenadines, and to 86% in The Bahamas.

However, the elimination of vertical transmission by 2015 presents challenges. Some countries have low coverage of syphilis screening and treatment. Antiretroviral coverage for pregnant women with HIV is below 50% in several countries including Haiti, the Dominican Republic, Suriname and the Turks and Caicos Islands. Available data from 2000 to 2005 indicates that 0.5% to 4% of pregnant women in the Caribbean had syphilis. Mother to Child transmission of HIV constitutes an estimated 8% to 10% of all transmissions in the region in 2007.

According to the Caribbean experts present in the Mexico City AIDS Conference, key elements of the elimination initiative include scaling-up services of primary prevention of HIV and syphilis and strengthening of health systems, in particular maternal and child health services, surveillance, monitoring and evaluation. This was first time that the AIDS Conference took place in Latin America and the Caribbean.

PAHO, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It also serves as the Regional Office for the Americas of the World Health Organization (WHO).

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