A Candid Conversation among Funders about Eliminating Vertical Transmission
International AIDS Conference, Vienna – July 20, 2010
BACKGROUND: Global efforts to eliminate vertical transmission of HIV from mother to child are gaining
momentum. Bilateral and multilateral funding institutions are reprioritizing funds to achieve the elimination of mother
to child transmission by 2015. Key stakeholders, including global agencies, governments in high-burden countries, and
implementing partners from civil society, are committed to this goal. In addition, philanthropic institutions and the
private sector are engaging in this global movement. These funders can play a critical role in identifying gaps and
funding unmet needs to eliminate vertical transmission.
PURPOSE: Johnson & Johnson hosted a meeting co-partnered by UNAIDS, Funders Concerned About AIDS
(FCAA), the Global Business Coalition on HIV/AIDS, Tuberculosis, and Malaria (GBC), and the European HIV/AIDS
Funders Group (EFG) to galvanize funders – both foundations and corporations – to join the global effort to eliminate
vertical transmission of HIV. In addition to discussing the role that funders can play to support unmet needs through
financial and non-financial contributions, the meeting also sought to strengthen and align the responses of foundations
and corporations already committed to this effort. Over 70 people from private foundations and corporations, funder
affinity groups, implementing organizations, and the United Nations participated.
KEYNOTE SPEECH: Jan Beagle, Deputy Executive Director of UNAIDS, highlighted several key points. With HIV
as the leading cause of death among women of reproductive age, nearly 16 million women living with HIV, and 1.4
million pregnant women who risk passing HIV to their child each year, Beagle urged that this is a time to scale up the
response to HIV/AIDS. Although mother-to-child transmission of HIV has been almost eliminated in high-income
countries, it has not yet been eliminated globally. However, with the current investment, substantial progress has been
made in access to PMTCT services. Funders and corporations can provide not only financial resources, but also nonfinancial contributions such as PMTCT and family planning commodities, skills and platforms to reach out and
empower community empowerment, and programs to ensure delivery and uptake of services.
PANEL DISCUSSION: VOICES FROM THE FIELD: A moderated panel discussion highlighted the status of
PMTCT and the highest-impact ways that funders can engage. Daniel Lee, Executive Director of the Levi Strauss
Foundation, served as the moderator. Panellists represented both pioneering community service providers and
acknowledged thought leaders: Dr. Mitch Besser, founder of mothers2mothers; Dr. Shaffiq Essajee, Medical Officer
for Pediatric AIDS Care and Treatment at the World Health Organization; Dr. Christian Pittner, Director of the
Elizabeth Glaser Pediatric AIDS Foundation’s Global Technical Policy Unit, and Ms. Morolake Odetoyinbo, Founder
of Campaign to End Pediatric AIDS Nigeria and Project Director of Positive Action for Treatment Access.
Panellists discussed opportunities for support at both the national government and the grassroots level. Overall, many
of these suggestions encouraged linkages between Millennium Development Goals 4 (Reducing Child Mortality), 5
(Improving Maternal Health), and 6 (Combating HIV/AIDS, Malaria and Other Diseases). On a national scale,
panellists suggested engaging national governments in order to reach scale with successful programs. Panellists also
highlighted a need to conduct a review to identify countries that have had difficulty scaling up, and to determine the
political or technical reasons for these challenges. On a local scale, outreach to women at the community level,
advocacy for community mobilization, and civil society and family planning strengthening were all seen as
opportunities. Although current policy focuses on pregnant women and reproductive health, there is a gap in access to
treatment for children. Panellists also stressed a need to focus on cultural and religious issues to address stigma while
supporting evaluation to determine what works.
Innovative approaches to MTCT include empowering HIV-positive women to work in health services and impart their
knowledge, using mobile technology for follow-up on treatment and care. Furthermore, panellists felt that creating
gender empowerment through educating girls and focusing on a women-centred approach is instrumental, while
increasing the use of dry blood testing for early infants may help reach more mothers and children. Additionally,
UNICEF’s mother-baby pack, which will initially be piloted in Cameroon, Kenya, Lesotho and Zambia, may help with
scaling up PMTCT service delivery.
Philanthropic institutions and the private sector can bolster PMTCT program support. Private funding, particularly in
the areas of monitoring and evaluation (M&E) and treatment-based paediatric programs, has been instrumental.
Donors want to fund initiatives that are sustainable, have clearly defined milestones, and focus on PMTCT service
delivery. Lastly, the panel highlighted that, since PMTCT strategies are available at the country level, but not all will
be costed or targeted, funders should consider investing more directly in communities and people who do the work.
GROUP WORK: There was also an opportunity for funders to break into working groups for more focused discussions. The groups were segmented by funder entry point:
scale and measurement, advocacy and community involvement, task shifting and sharing, and integration. Within each working group, discussion surrounded three key
questions related to funding for PMTCT. The highlights of the working group discussions are outlined below.
Funder Entry
Point
Scale and
Measurement
Advocacy and
Community
involvement
Task Shifting
and Sharing
Integration
Questions
Why should a funder who is new to the PMTCT space
focus their resources on your sub-area?
What are three approaches/strategies would you
recommend as being best practice approaches?
Measurement
-Shows what we are doing
-Develops and strengthens government structures and
performance capacity
-Captures benefit
Measurement
1) Use qualitative and quantitative data
2) Do sentinel surveillance and operations research to
identify geographic areas and gaps in scale-up
3) Have a sense of thoughtful urgency
Scale
-Helps countries adopt WHO guidelines
-Helps attain government will
-Provides mothers and babies with access to treatment
Scale
1) Be conscious not to lose quality while scaling
2) Implement the comprehensive IATT PMTCT
guidelines, then have the WHO 2009 guidelines
3) Strengthen government will and leadership
1) Provide core support (build capacity of organizations
and individuals)
2) Adopt a women-centred approach
3) Engage new technology
1) Fund models that have shown that tasks can be shifted
in a sustainable way
2) Identify training and programming needs in the field
and listen rather than imposing donor desires
3) Get away from silo mentality and recognize that
integrated services are ultimately more cost-effective
-Strengthens sustainability
-Helps with mobilization and outreach to communities
-Engages program staff to provide quality services
-Involves different voices and groups
-Can try innovative ideas until there is a proof-of-concept
for scaling
-Supports staffing to support integrated health systems
-Funds models that show that cost-effectiveness
-Supports programs that identify HIV-positive women
-Supports programs that empower HIV-positive women,
which fights stigma by creating role models
-Meets women’s needs
-Is cost-effective and efficient
-Is great for those interested in building capacity and
strengthening a continuum of care
-Can support a range of services from family planning
through the first 24 months of a baby’s life
-Addresses stigma and discrimination
1) Link antenatal care with HIV services
2) Create a strong referral system across a range of
services
3) Have cultural sensitivity that allows flexibility in
meeting women’s needs
What do you need from each
other as you develop and
execute your funding
strategies?
-Serve as resources for each
other
-Share best practices
-Share indicators and synthesize
metrics
-Communicate about what we
are funding and identify gaps
-Communicate more frequently
-Identify alliances in-country
and mechanisms for
coordination
-Select 2-3 projects that all
funders can work on and see
what can be accomplished
within one year
-Support innovative, technologybased programs