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Born Free: Delivering On The Promise Of The Global Plan Towards Elimination Of Mother To Child Transmission Of AIDS

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By Sally Osberg and Mitch Besser

Sarah walks hours through the heat and dust to a small South African clinic that offers medicine and hope -- medicine to reduce the risk of her HIV infecting her unborn child, and hope that her baby's life can be different.

The good news? Her visit won't justify her fears: an hour-long wait followed by minutes of incomprehensible care from overwhelmed staff with neither medicine nor time. That's because for Sarah and more than one million mothers like her, times are changing. Her long walk and wait will be worth it: she can, in fact, give birth to a healthy baby, free of the HIV virus, because tests and medicines available in the United States and Europe are now increasingly available to her and millions of pregnant African women.

Health systems are embracing programs like mothers2mothers (m2m), in which the Skoll Foundation has just invested a $2.5 million grant. m2m educates and emotionally supports pregnant women and mothers. m2m supplements doctors and nurses and helps encourage mothers to commit and adhere to the care needed for them to live longer and ensure disease-free babies.

This week, as more than 20,000 delegates from the scientific, policy-making, donor and activist sectors gather for the International AIDS Conference in Washington D.C., attention is on the breakthroughs -- especially progress for an AIDS vaccine and newer research to find a cure.

But big wins also beckon in the near term -- wins that leverage the enormous headway made against AIDS over the last 30 years. Once a death sentence, the infection now can be controlled by anti-retroviral (ARV) drug regimens. A yearlong treatment that once cost thousands of dollars is now $100. And more ARVs than ever are sent to sub-Saharan Africa, where the epidemic continues to rage, where two-thirds of the 34 million infected with the virus live, work and raise their families.

Over the past year, a group of U.N. agencies, together with the U.S. government, civil society organizations, donors and others got serious about delivering one of those big wins. In June 2011, the group launched a plan that is both ambitious and achievable: the United Nations' Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive. Its targets are to cut by 90 percent new HIV infections in children, to double the numbers of mothers kept alive -- and to do so in just over three years.

We believe this is the right plan at the right time for all the right reasons: The right people created the Global Plan; 22 sub-Saharan African countries have signed on and are now building out their implementation programs; and we know what works. Plans can get us moving, but delivering results is what matters. In this case, it's delivering HIV-free babies and keeping their mothers alive. We simply can't conceive (sorry!) of results more important.

We think of innovations as new technologies, but in healthcare, innovations are often as simple as a pregnant woman with HIV talking with a similarly-affected peer who has successfully navigated the treatment process. m2m employs mothers living with HIV in hospitals and clinics. Called Mentor Mothers, they assist overburdened doctors and nurses with education and psychosocial support, ensuring that pregnant women and new mothers understand how to care for themselves and their babies. Mentor Mothers promote adherence to medical treatment, birth control, vaccination schedules for babies and breastfeeding. As employed women living with HIV, Mentor Mothers are role models who help overcome the stigma of an HIV diagnosis.

m2m started in a single hospital in Cape Town, South Africa in 2001. Today it employs 1,500 HIV positive mothers in 600 health facilities in seven countries -- where more than three million m2m mentoring sessions occurred in 2001.

Now it's time to take this learning and embed it in healthcare systems. At m2m and the Skoll Foundation, we're doubling down on Mentor Mothers -- an innovation that works, that can help deliver the Global Plan's promise -- hundreds of thousands of lives saved today, tomorrow and over the next three years. mothers2mothers has rededicated itself to build capacity in government health systems and teach local partners to provide Mentor Mother services to all pregnant women exposed to and living with HIV in each of the Global Plan's 22 countries.

Can philanthropy and the work of a relatively small NGO help achieve the Global Plan's goals? And is philanthropic investment and any NGO's work meaningful when we consider the billions invested by global players like the Presidents Emergency Plan for AIDS Relief (PEPFAR), the Global Fund and others who have led the way in making antiretroviral drug prophylaxis available to populations who could not otherwise afford them? "Of the estimated 6.6 million individuals in low- and middle-income countries who currently receive treatment, in fact, nearly 5.6 million receive support through PEPFAR bilateral programs, the Global Fund, or both."

But mothers2mothers is an example of how an elegant, cost-effective innovation like Mentor Mothers can leverage even investment at this scale, literally accounting for tens of thousands of babies born free of the HIV virus and mothers able to care for them, with multiples on that achievement now within sight. As a global community, we can and must invest in the research and development needed for new therapies, but all the life-saving drugs in the world won't get us where we want to be without human beings who choose to take them and sustain requisite treatment regimens.

Nearly 1.5 million HIV positive mothers will have babies this year. All can be born free of this viscious virus. We have the medicines. We can strengthen country health systems. We can engage and enroll communities. We can ensure every precious invested dollar delivers the most value for the most in need. Sarah and mothers like her can dream of a time when HIV will not threaten their lives or their children's futures. And we can help make that dream come true.