SIXTEEN babies were infected with human immunodeficiency virus (HIV) in 2017, derailing Jamaica’s efforts to achieve World Health Organization (WHO) validation as having eliminated mother-to-child transmission of the virus and syphilis.

That number fell to seven in 2018, according to the health and wellness ministry’s senior medical officer for the National HIV/STI Programme, Dr Nicola Skyers, but Jamaica still has work to do if it intends to join the seven Caribbean countries that have so far been validated by WHO.

“So we did have a spike in 2017, but the numbers have come down in 2018,” Dr Skyers told the Jamaica Observer in an interview ahead of World AIDS Day, which is being commemorated today.

According to the WHO, mother-to-child transmission is the transmission of HIV from an HIV-positive mother to her child during pregnancy, labour, delivery, or breastfeeding.

In order to be validated by the specialised agency of the United Nations that is concerned with international public health, Jamaica must be certified as having met the regional goal, which is a less that two per cent transmission rate for two consecutive years.

In an e-mailed response to a query by the Observer at the end of 2017, Pan American Health Organization (PAHO) — which serves as the regional office for the Americas of the World Health Organization — explained that in the region, PAHO only accepts applications from countries and territories for the dual elimination of mother-to-child transmission (EMTCT) of HIV and syphilis, as per its resolution.

At the global level, WHO accepts applications and validates countries separately for elimination of mother-to-child transmission (EMTCT) of HIV and/or syphilis, PAHO said.

“The validation process takes more than a year, and involves interviews with many different actors in each country and territory and in-depth examination of data, programmes, and laboratory networks. In addition, EMTCT has to be achieved in accordance to human rights,” PAHO told the Observer then.

Cuba was the first country to be validated in 2015, and according to the latest report on the Caribbean, entitled ‘Communities at the Centre — The response to HIV in the Caribbean and published last Thursday by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Spanish-speaking country has since been re-certified.

The other six countries — Anguilla, Antigua and Barbuda, Bermuda, the Cayman Islands, Montserrat, and St Kitts and Nevis — reached that target in 2017.

In 2015, then Minister of Health Dr Fenton Ferguson told the Observer that Jamaica was on track to being among the first English-speaking countries in the region to achieve the target. Fast-forward to 2019, Jamaica has still not been certified.

“When you look at the [mother-to-child transmission] cases, it comes back to the social issues — stigma and discrimination,” the senior medical officer explained. “So persons, they don’t want to disclose [their HIV status]; they haven’t disclosed to their family [and when they] come in for delivery, they don’t tell the staff.

“Some of these women haven’t been able to say to their partner that they’re HIV-positive…there are a whole host of social issues around HIV and women living with HIV, and it is usually those who are less socially empowered who will have transmission to their infant,” Dr Skyers explained.

The senior medical officer said that the issue then becomes, “how do we try to provide that support, to try to get them to stay on their medication so that they can have HIV-negative babies?”

She reiterated that the social issues are very real.

Dr Skyers emphasised, too, that meeting the target requires the elimination of both HIV and syphilis.

While expressing disappointment that Jamaica is yet to achieve validation as having eliminated mother-to-child transmission of HIV, a representative of a global partner in the fight to end the AIDS epidemic by 2030 has also weighed in on the dual link with syphilis.

Dr Kevin Harvey, AIDS Healthcare Foundation Caribbean regional director, said in a recent interview that syphilis is a big problem.

“The fall-off in mother-to-child transmission is disappointing, very disappointing. In fact I started the programme for the prevention of mother-to-child transmission with Professor Celia Christie at University Hospital of the West Indies. We started that programme, I wrote the manual to train the physicians, I rolled it out and we were doing extremely well, but somehow it got derailed,” he told the Sunday Observer.

“We still have not achieved elimination in Jamaica. I think what happened is when they twinned it with syphilis, so you have to eliminate syphilis and HIV and then syphilis is a broader issue,” he continued. “Syphilis is actually on the rise, big time; we have hundreds and hundreds of patients.

“It is a major problem not just in Jamaica, but worldwide,” said Dr Harvey, whose foundation is responsible for providing HIV prevention services, testing, and health are for HIV patients.

Dr Harvey is responsible for the countries in the Caribbean region.

In the meantime, the UNAIDS report on the Caribbean published last Thursday said the rate of mother-to-child transmission of HIV was 14 per cent in 2018.

The proportion of pregnant women living with HIV in 2018 receiving antiretroviral medicines to prevent vertical transmission of HIV and protect their own health was 86 per cent. Coverage of early infant diagnosis in 2018 was 47 per cent, it said.

“Early infant diagnosis coverage varies considerably between countries. Antigua and Barbuda, which has been validated as having eliminated mother-to-child transmission of HIV, achieved 100 per cent coverage of infants receiving HIV testing in the first four to six weeks of life, as did Dominica and Grenada. Elsewhere, rates vary, ranging between 46 per cent and 71 per cent,” the UNAIDS report said.

It continued: “Eliminating mother-to-child transmission region-wide will require countries to develop strategies to reach all pregnant women living with HIV and their children with health and social services, including HIV and syphilis diagnosis and treatment.”