Necessity: Mother of Prevention
Born Free Africa Counts Down to Zero Mother-to-Child Transmission
by Stevie St. John
At its heart, it’s a simple problem with an elegantly simple solution.
An HIV-positive pregnant woman with access to care and medication can greatly diminish the chance that she will pass HIV on to her child during pregnancy, during childbirth or while breastfeeding. All she has to do is take one pill a day.
For that to happen, though, several pieces must fall into place. First, the expectant woman must have access to medical care, including HIV testing. Only if she knows that she is HIV-positive can she get the care she needs. Her healthcare providers must be trained in providing HIV testing and offering care for those who are positive. They must have access to testing equipment and, of course, to the antiretroviral meds themselves.
Without treatment, the risk of mother-to-child (or perinatal) transmission is some thirty-five to forty-five percent—compared to just less than one percent for those who get the needed care. And those children who are born HIV-positive face a fifty-percent chance of death before the age of two if they do not receive treatment.
Just one pill a day, taken by the expectant mother, would prevent the vast majority of these tragedies.
“HIV is a huge issue globally,” says John Megrue, founder and chair of Born Free Africa. “Having newborn babies born HIV-positive is really a huge challenge.” And the objective of a new generation being born HIV-free, he says, was “something that I thought was central to success” in the fight against HIV/AIDS.
Born Free Africa is a private sector-led initiative that partners with governments, donors, and nonprofits to provide funding, training and policy analysis in order to eliminate mother-to-child HIV transmissions in some of the most affected African countries such as Kenya, Uganda, South Africa, and Nigeria.
Megrue called Born Free Africa “a quite broad constituency thinking about it and trying to make a difference.”
The Problem of Perinatal Transmissions
In affluent countries, mother-to-child HIV transmissions have become quite rare. The Centers for Disease Control and Prevention says that perinatal transmissions in the U.S. have dropped by more than ninety percent since the mid-1990s, even though the number of HIV-positive women giving birth has increased dramatically.
But there are still many countries, the vast majority of which are located in Africa, where such transmissions remain a serious issue.
According to Born Free Africa:
• Worldwide, mother-to-child transmissions peaked in 2003 and have declined more than fifty percent in subsequent years
• 260,000 children were infected in 2012—an average of more than 700 per day
• In children, more than ninety percent of new HIV infections are the result of transmission via pregnancy, childbirth, or breastfeeding
• Nigeria accounts for more than one-quarter of newly infected children each year
• Twenty-two countries account for more than eighty percent of cases.
“It’s a systems problem,” Megrue says, referring to the barriers that must be overcome in order to halt mother-to-child transmissions. “We’re all working together to solve these challenges.”
Countdown to Zero Transmissions
The Born Free Africa Web site features a prominent countdown clock: the “countdown to zero transmission.” As of May 29, it stood at 581 days, with the green and white hours, minutes and seconds all marking progress toward December 31, 2015.
The specificity of the clock reflects an ambitious goal: halting mother-to-child HIV transmissions by the end of next year.
Why 2015? The deadline came out of Millennium Development Goals set by UNAIDS. Among ten “targets and elimination commitments” set by UNAIDS is the goal to “eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths,” according to the 2011 United Nations General Assembly Political Declaration on HIV/AIDS.
The Millennium Development Goals were set in 2000, Megrue notes, with enormous strides made in subsequent years. In fact, Born Free Africa says that new HIV infections in children have declined by fifty percent between 2003 and 2012.
But there are still more than 200,000 annual transmissions worldwide, says Born Free Africa, with ninety-eight percent of those being completely preventable. But there are persistent challenges—funding issues, for one thing—that must be met before a generation born free can be achieved.
Navigating those challenges, Megrue shares, called for high-speed, fast-paced decision making—“and that plays to the private sector’s strengths.”
That’s where Megrue, chief executive officer of the private equity advisory firm Apax Partners, came in.
In 2011, the U.N. tapped Megrue, a longtime philanthropist with experience working in Africa (largely on issues related to poverty), to get involved. As a result, Born Free Africa was formed. In addition to Megrue, the organization’s advisory board includes CEOs and other power players from companies such as Chevron, NBCUniversal, J.P. Morgan, Johnson & Johnson, and GE Healthcare.
“Being part of something that the private sector can have such an influence in has been incredibly joyful,” Megrue says.
Making Prevention Fashionable
In Africa, Born Free Africa does work such as hiring talent and providing training for healthcare professionals. The organization also hosts visits from governmental and other leaders who come to see how mother-to-child transmissions are being combated.
In addition to its on-the-ground work, Born Free Africa puts its resources to work to raise awareness. For example, Megrue partnered with Vogue, Diane von Fürstenberg, Claire Danes, Liya Kebede and Wangechi Mutu to host a Mother’s Day Carnival in support of Born Free Africa; he called the event “a real crescendo of consumer awareness.”
Held in New York, the event featured performances by Ariana Grande and Idina Menzel. It also included family-oriented activities such as family portraits, cookie decorating, yoga, arts and crafts, face painting with M•A•C makeup artists, soccer with the New York Red Bulls, and basketball with the New York Giants.
There were many high-profile guests in the crowd, including actor Matt Bomer and designers Ivanka Trump, Vera Wang and Donna Karan.
Trump, Wang and Karan were also all part of a Born Free Africa initiative to raise awareness through a partnership with the fashion industry. Earlier this year, they and nineteen other prominent designers—all of them mothers—designed items for a limited edition Born Free Collection, sold via ShopBop.com. The collection’s array of tees, scarves, bags, pants, blouses, skirts and other items are based on the work of New York-based visual artist Wangechi Mutu, who was born in Kenya. Proceeds from sales of the Born Free Collection items benefit Born Free Africa, with a M•A•C AIDS Fund matching grant for up to $500,000.
“As a mother and as a fashion designer, Born Free is everything I believe in—taking care of mothers so they can take care of their children, which takes care of the world. That I could do all this through creativity was perfection,” Karan tells A&U via e-mail. “When you think about the vulnerability of new mothers and their babies, you’ll do anything to eradicate the transfer of HIV from one to the other.”
Karan says she was “completely inspired” by the Born Free campaign.
“Whenever you have a creative avenue to fight a real threat, it brings out the best in everyone,” she says.
By bringing out the best in everyone—from fashion designers to government leaders and private sector CEOs—perhaps Born Free Africa can build the awareness and support needed to reach its ambitious goal of wiping out perinatal transmissions of HIV.
For more info, visit: http://bornfreeafrica.org.
Stevie St. John is a freelance writer in Los Angeles, where she serves on the board of the local chapter of the National Lesbian & Gay Journalists Association (NLGJA-LA).