Committee on the rights of the child

Figure 54

Cases of HIV/AIDS by category of transmission (1991–2005)

Sexual transmission

Unknown

Vertical transmission

Intravenous drugs

Blood transfusion

188. 
     Over the period studied, sexual transmission (heterosexual, homosexual and bisexual) was the main type of exposure, accounting for 85% (13,876) of all forms of transmission. Vertical (mother-child) transmission accounts for 7%.
     
189. 
     According to the National STD/HIV/AIDS Control and Prevention Programme,³³ the annual rate of incidence gradually increased up to 2003, for both HIV (seropositives) and cases of AIDS. This rate grew especially from the year 2000, at an average of 765 new cases of HIV and 779 of AIDS a year, which may be the result of improvements in the epidemiological monitoring system and greater availability of free HIV testing nationwide, although it might also indicate a sustained – and more recently more acute – increase in the level of risk in the country.³⁴
     
190. 
     However, it is important to mention that from 2003 and 2004, national efforts have succeeded in reducing the rate of incidence of HIV by 3 percentage points, from 20 in 2004 to 17.3 in 2005; the rate of AIDS was also reduced from 10.2 in 2004 to 6.2 in 2005. Therefore, if the current dynamic continues, the country can probably hold the disease in check.
     
191. 
     One of the major achievements in combating HIV/AIDS in the country is the reduction of cases of HIV and AIDS in babies under one year old up to 2005, down from 92 in the year 2000 to 20 in 2005.³⁵
     

192. 
     Mother-to-child transmission of HIV accounts for over 90% of infections in children under 15 worldwide. In El Salvador significant progress has been made using a strategy of national action to prevent HIV infection by mother-to-child transmission.
     
193. 
     This national action to prevent mother-to-child transmission of HIV began in 2001, as a priority in the National STD/HIV/AIDS work programme of the Ministry of Public Health and Social Welfare (MSPAS), and consists of the four main phases: a) research, b) training, c) supply, d) monitoring and assessment.
     
194. 
     The main activities and tasks of the previous phases were as follows:
     
     1. 
        Training of key players (health personnel and midwives);
        
     2. 
        Free and voluntary testing nationwide for pregnant women, with counselling before and after HIV testing;
        
     3. 
        Incentive through provision of baby clothing for pregnant women undergoing testing for detecting HIV antibodies;
        
     4. 
        Prophylactic anti-retroviral treatment for HIV-positive pregnant women (with AZT, Niverapine or triple therapy schemes);
        
     5. 
        Elective caesarean for HIV-positive pregnant women;
        
     6. 
        Counselling on infant nutrition;
        
     7. 
        Provision of breastmilk substitutes for HIV-positive mothers, consisting of eight tins of milk a year;
        
     8. 
        Monitoring of children of HIV-positive mothers at the Centre of Excellence for Immunodeficient Children;
        
     9. 
        Inclusion in the Basic Food Hamper Programme, to foster continuation of the treatment.
        
195. 
     From 2003, voluntary and free HIV testing has been offered to all pregnant women nationwide, together with an promotion item of baby clothing as an incentive for taking the HIV test; similarly, the Ministry of Health offers seropositive pregnant women specialist ante-natal care, counselling, administration of antiretroviral drugs, safe birthing care, post-natal care and the necessary food (breastmilk substitutes) free of charge for proper feeding and nutrition of the child up the age of 18 months.
     
196. 
     In the year 2000 the clinic for immunodeficient children opened at the Benjamín Bloom National Children’s Hospital, and a significant increase in the number of new infections was recorded, due mainly to the work carried out on active detection of new cases and comprehensive management offered to that population, with a subsequent strengthening of the “Initiative for the Prevention of Mother-to-Child Transmission of HIV-AIDS” at national level through the National Programme with the taking of free tests nationwide in health centres equipped with a laboratory, associated with training of all operational levels of the Ministry of Health: Public and Social Assistance and an intense educational campaign on the media.
     
197. 
     The success of the measure was clearly seen from 2004, when there were more than 100 cases of children infected with HIV a year, whereas over the past three years there were fewer than 20 cases a year, thanks to the prevention and comprehensive care measures put in place.
     
198. 
     The most outstanding achievements of National Action for the Prevention of Mother-to-Child Transmission include:
     

1. 
   An 88% reduction in the number of cases of children born with HIV;
   
2. 
   A 60% reduction in the level of HIV/AIDS positivity during pregnancy, from 0.33% in 2002 to 0.08% in 2006;
   
3. 
   An increase of over 100% in the number of HIV tests carried out from 2001 to 2006;
   
4. 
   Decentralization and extension of cover of third-level care centres for the prevention programme, from one hospital in 2001 to 13 centres in 2006.
   

199. 
     In the field of education, a number of strategies have been promoted to prevent HIV transmission, with the aim of reducing new infections among the population. Using these strategies a number of different messages have been designed that encourage people to adopt the various ways of preventing infection, and provide information on the ways in which HIV can and cannot be transmitted.
     
200. 
     Note that ignorance of the ways in which HIV is transmitted is a determining factor for stigma and discrimination in various environments such as the family, the community, the workplace and health establishments.
     
201. 
     Information, education and communication (IEC) programmes have reached all spheres through the use of various channels of the mass media, interpersonal and group communication media. The media have played a determining role in recent years, by contributing to the whole process of involving this profession in awareness-raising education campaigns about HIV/AIDS. As part of this process, the “Journalism Prize” strategy is being implemented, that rewards publications and reports on AIDS on radio, in the press and on television.
     
202. 
     To support all the measures set out above, various printed materials have been designed (leaflets, flyers, brochures, posters and flipcharts that focus on the prevention message). The various educational campaigns are also based on epidemiology, which identifies the target groups for our action, thereby avoiding increased numbers of cases in groups such as adolescents, homosexual males, sex workers, pregnant women and the general population.
     

203. 
     The increase in pregnancies and HIV infections among adolescents, where the risks make this group more vulnerable, has prompted a number of measures in this group, which was broken up into two main segments, adolescents aged 10-12 in 4^th to 6^th grade and those aged 12-19. This situation indicates that delaying the start of sexual relations among adolescents is a 100% safe alternative for preventing HIV/AIDS in this group.
     
204. 
     The campaign is an initiative of the National STD/HIV/AIDS Programme of the Ministry of Health and Social Welfare, in coordination with the “Education for Life” programme which is the fruit of the combined efforts of the Health Ministry, the National Secretariat for the Family and the Ministry of Education. All this was made possible by the support and coordination of the Pan-American Health Organization (PAHO) and private enterprise.
     
205. 
     The main goal of the campaign is to make adolescents think about responsible sexuality; the slogan “Decide to Wait” is a phrase that covers many questions, and which at the same time sends a clear message to adolescents about postponing the start of sexual relations. We believe that that message needs to be strengthened, so as to make a positive change towards responsible behaviour on the part of young Salvadorans. Furthermore, adolescents learn about other prevention options and are educated to reduce the stigma and discrimination against persons living with or affected by HIV/AIDS.
     
206. 
     One of the campaigns promoted during 2005 offers a response to the challenges raised by the FESAL study in 2005 which, on the basis of the 2002-2003 national family health survey, indicated the perception of personal risk of catching HIV, and the stigma and discrimination that infected persons can experience. This campaign was carried out in two stages, the first, called “Win the Battle against AIDS”, aims to reduce the situations of risk among the population. While the second, “Unite against Discrimination”, is designed to reduce levels of stigma and discrimination against persons living with HIV. The exposure of both campaigns in the mass media was the largest investment in the country’s history in HIV/AIDS prevention campaigns, costing more than one million dollars.
     

207. 
     This campaign comes in response to the increase in cases among the country’s young population, and disseminates images in various environments where young people spend their daily lives; the central messages are directed at a proper perception of the risk of HIV and recommending effective means of prevention against the epidemic, such as delaying the first sexual relations, mutual fidelity among couples, and thoughtful self-control in a healthy and responsible sex life.
     
208. 
     Messages were spread by placing them on street billboards, in public transport buses, and in places most frequented by these groups, such as cinemas, restaurants and bars, with a launch in September 2005 by the Ministry of Health through the National HIV/AIDS Programme with the support of the National Aids Commision (Conasida) and private enterprise.
     

209. 
     During the various publicity campaigns under the National STD/HIV/AIDS Programme, campaigns were run aimed at high-risk groups such as homosexual men, sex workers and the general public, for which a variety of educational materials about the disease were prepared, laying emphasis on specific aspects such as the means of transmission and prevention, and ways of preventing transmission.
     
210. 
     These groups were also received in health establishments for interviews, educational talks and counselling. At the same time, monthly meetings were held with groups of sex workers who were given guidance on looking after their own health, sexual health topics and HIV/AIDS.
     
211. 
     Like other campaigns of the Ministry of Public Health and Social Welfare, this one was backed up using mobile testing units for detecting HIV antibodies, which travel to various places in order to offer this service wherever required.
     

212. 
     As a tribute to those who have died of AIDS and as a wake-up call to the general public on the importance of HIV prevention, a “Solidarity Garden” was built. This commemorative garden is designed with paths, green spaces and sunlight, covering a total area of 2,500 metres, to send the message “we human beings move along the path of life recognizing that we must show solidarity with persons living with HIV”; they are also human beings who hope to live a normal and harmonious life.
     
213. 
     The National AIDS Commission (Conasida) was the driving force behind this project, which was the main action in the country to commemorate World AIDS Day, held on 1 December each year all over the world, with the aim of recognizing progress in the fight against the epidemic, and drawing attention to the remaining challenges.
     
214. 
     In 2007 the central theme was “Stop AIDS. Keep the promise”, a pledge to be shared with anyone concerned to help from a personal standpoint, through leadership. This personal pledge consists of stepping up measures for prevention, treatment and care for HIV with support and dignity.
     
215. 
     Note that the epidemiological report, up to December 2007, shows that important progress has been made against AIDS in El Salvador, thanks to a significant improvement in political commitment, coordination between institutions through Conasida with public policies and a unified plan, to ensure effective prevention, HIV/AIDS treatment, detection tests, and technical advice, along with other effective action.