Fifteen years of HIV and syphilis outcomes among a prevention of mother-to-child transmission program in Haiti: from monotherapy to Option B.

OBJECTIVE: To evaluate mother and infant outcomes in the largest prevention of mother-to-child-transmission (PMTCT) programme in Haiti in order to identify gaps towards elimination of HIV and syphilis. METHODS: Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999 to 2014, we assessed maternal enrolment in PMTCT, receipt of antiretrovirals before delivery, maternal retention through delivery as well as infant enrolment in PMTCT, HIV testing and HIV infection. Four PMTCT programme periods were compared: period 1 (1999-2004, mono ARV), period 2 (2005-2009, dual ARV), period 3 (2010-2012, Option B) and period 4 (Oct 2012-2014, Option B+). Kaplan-Meier methods were used to assess retention in PMTCT care. RESULTS: Among 4665 pregnancies, median age was 27 years and median CD4+ was 494 cells/µl (IQR 328-691). A total of 75% of women received antiretrovirals before delivery, and 73% were retained in care through delivery. Twenty-two percent of women were lost before delivery, <1% died and 6% had stillbirths or abortions. Ninety-four percent of infants who were born alive enrolled in PMTCT, of whom 92% had complete HIV testing. One hundred and sixty-one infants were HIV+, giving a 5.4% HIV transmission rate (9.8%, 4.6%, 5.8% and 3.6% in periods 1-4). Retention among women through 12 months after PMTCT enrolment did not significantly differ across periods. However, among women who received antiretrovirals at the time of enrolment, retention 12 months later was lower in the Option B+ period (83%) than in periods 2 and 3 (94% and 93%) (P < 0.001). Syphilis infection among women decreased from 16% in period 1 to 8% in period 4, whereas syphilis testing of infants increased from 17% to 91%. CONCLUSION: Despite dramatic reductions in MTCT in Haiti, interventions are needed to improve retention to achieve MTCT elimination of HIV and syphilis.

Los experimentos de Sífilis y otras infecciones de transmisión Sexual en Guatemala, 1946-1948, ¿un dilema ético y político para Guatemala y el mundo? / The experiments of Syphilis and other sexually transmitted infections in Guatemala, 1946-1948, an ethical and political dilemma for Guatemala and the world?

En Guatemala se llevaron a cabo experimentos por entidades de salud de Estados Unidos de Norte América, inoculando infecciones de transmisión sexual (gonorrea, sífilis y cancroide) a poblaciones vulnerables con el objetivo de generar un modelo humano para estudio de este tipo de enfermedades. Estos experimentos permanecieron ocultos durante 64 años, cuando la Dra. Susan Reverby los descubrió al revisar los archivos de quien fuera el investigador de los mismos, Dr. John C. Cutler. Fueron inoculados 1308 personas y reportadas fallecidas 83. Al hacerse pública esta nefasta noticia, se condenaron los hechos acontecidos entre 1946-1948 por múltiples organizaciones y el gobierno, nombrándose una Comisión Presidencial en Guatemala y por su parte el gobierno de Estados Unidos también conformó una Comisión Presidencial. Los informes y dictámenes de ambas Comisiones coinciden en que se violaron los principios éticos y morales, que la desigualdad social y racismo existente en esa época fueron condicionantes muy importantes, que lo acontecido puede ser catalogado como crímenes de lesa humanidad y que las personas que planificaron, aprobaron, condujeron, facilitaron y financiaron estos experimentos son moralmente culpables. A la fecha no se ha otorgado ningún resarcimiento a los afectados o familiares, ni compensación alguna a Guatemala...(AU)

In Guatemala, experiments were carried out by health entities in the United States of America, inoculating sexually transmitted infections (gonorrhea, syphilis and canker) into vulnerable populations with the aim of generating a human model for the study of this type of disease. These experiments remained hidden for 64 years, when Dr. Susan Reverby discovered them by reviewing the files of whoever was their researcher, Dr. John C. Cutler. 1308 people were inoculated and 83 were reported deceased. When this ominous news was made public, the events occurred between 1946-1948 by multiple organizations and the government were condemned, a Presidential Commission was appointed in Guatemala and for its part the government of the United States also formed a Presidential Commission. The reports and opinions of both Commissions agree that ethical and moral principles were violated, that the social inequality and racism that existed at that time were very important conditions, that what happened can be classified as crimes against humanity and that the people who planned , approved, conducted, facilitated and financed these experiments are morally culpable. To date no compensation has been granted to those affected or relatives, nor any compensation to Guatemala ... (AU)