WHO validates Brazil for eliminating mother-to-child transmission of HIV

The World Health Organization (WHO) has validated Brazil for the elimination of mother-to-child transmission (EMTCT) of HIV, making it the most populous country in the Americas to achieve this historic milestone. This accomplishment reflects Brazil’s long-standing commitment to universal and free access to health services through its Unified Health System (SUS), anchored in a strong primary health-care system and respect for human rights.

“Eliminating mother-to-child transmission of HIV is a major public health achievement for any country, especially for a country as large and complex as Brazil,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Brazil has shown that with sustained political commitment and equitable access to quality health services, every country can ensure that every child is born free of HIV and every mother receives the care she deserves.”

The milestone was marked during a ceremony in Brasília, attended by President Luiz Inácio Lula da Silva, Brazil’s Minister of Health Alexandre Padilha, and the Director of the Pan American Health Organization (PAHO) Dr Jarbas Barbosa, along with representatives from UNAIDS.

Meeting validation criteria

Brazil met all the criteria for EMTCT validation, including reducing vertical transmission of HIV to below 2% and achieving over 95% coverage for prenatal care, routine HIV testing, and timely treatment for pregnant women living with HIV. In addition to meeting the targets of the validation, Brazil demonstrated the delivery of quality services for mothers and their infants, robust data and laboratory systems, and a strong commitment to human rights, gender equality and community engagement.

The country implemented a progressive, subnational approach by first certifying states and municipalities with over 100 000 inhabitants, adapting the PAHO/WHO validation methodology to its national context while maintaining coherence across the country.

The evaluation, supported by PAHO, was conducted by independent experts who reviewed data, documentation, and health facility operations. Findings were then assessed by WHO’s Global Validation Advisory Committee, which formally recommended Brazil’s validation for elimination.

“This achievement shows that eliminating vertical transmission of HIV is possible when pregnant women know their HIV status, receive timely treatment, and have access to maternal health services and safe delivery,” said Dr Jarbas Barbosa, Director of PAHO. “It is also the result of the tireless dedication of thousands of health professionals, community health workers, and civil society organizations. Every day, they sustain the continuity of care, identify obstacles, and work to overcome them, ensuring that even the most vulnerable populations can access essential health services."

Part of a broader initiative

Over the past decade (2015-2024), more than 50 000 pediatric HIV infections have been averted in the Region of the Americas as a result of the implementation of the initiative to eliminate mother-to-child transmission of HIV.

Brazil’s success is part of the broader EMTCT Plus Initiative, which seeks to eliminate mother-to-child transmission of HIV, syphilis, hepatitis B, and congenital Chagas, in collaboration with UNICEF and UNAIDS. It is embedded within PAHO’s Elimination Initiative, a regional effort to eliminate more than 30 communicable diseases and related conditions in the Americas by 2030.

"I am delighted that Brazil has just been certified by WHO/PAHO for eliminating vertical transmission – the first country of more than 100 million people to do so,” said Winnie Byanyima, UNAIDS Executive Director. “And they did it by doing what we know works –prioritizing universal health care, tackling the social determinants that drive the epidemic, protecting human rights, and even – when necessary – breaking monopolies to secure access to medicines."

Global context

Brazil is one of 19 countries and territories worldwide that have been validated by WHO for EMTCT. Twelve of these are in the Region of the Americas. In 2015, Cuba became the first country in the world to be validated for EMTCT of HIV and the elimination of congenital syphilis. Other countries in the Region include Anguilla, Antigua and Barbuda, Bermuda, Cayman Islands, Montserrat, and Saint Kitts and Nevis in 2017; Dominica in 2020; Belize in 2023; and Jamaica and Saint Vincent and the Grenadines in 2024.

Outside the Americas, countries validated for EMTCT of HIV include Armenia, Belarus, Malaysia, Maldives, Oman, Sri Lanka, and Thailand.

The World Health Organization (WHO) has validated Brazil for the elimination of mother-to-child transmission (EMTCT) of HIV, making it the most populous country in the Americas to achieve this historic milestone. This accomplishment reflects Brazil’s long-standing commitment to universal and free access to health services through its Unified Health System (SUS), anchored in a strong primary health-care system and respect for human rights.

“Eliminating mother-to-child transmission of HIV is a major public health achievement for any country, especially for a country as large and complex as Brazil,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Brazil has shown that with sustained political commitment and equitable access to quality health services, every country can ensure that every child is born free of HIV and every mother receives the care she deserves.”

The milestone was marked during a ceremony in Brasília, attended by President Luiz Inácio Lula da Silva, Brazil’s Minister of Health Alexandre Padilha, and the Director of the Pan American Health Organization (PAHO) Dr Jarbas Barbosa, along with representatives from UNAIDS.

Brazil met all the criteria for EMTCT validation, including reducing vertical transmission of HIV to below 2% and achieving over 95% coverage for prenatal care, routine HIV testing, and timely treatment for pregnant women living with HIV. In addition to meeting the targets of the validation, Brazil demonstrated the delivery of quality services for mothers and their infants, robust data and laboratory systems, and a strong commitment to human rights, gender equality and community engagement.

The country implemented a progressive, subnational approach by first certifying states and municipalities with over 100 000 inhabitants, adapting the PAHO/WHO validation methodology to its national context while maintaining coherence across the country.

In 2019, Pan American Health Organization Member States approved the Disease Elimination Initiative: A Policy for an Integrated Sustainable Approach to Communicable Diseases in the Americas committing to eliminating more than 30 communicable diseases and related conditions by 2030.

The Elimination Initiative involves a wide range of communicable diseases, including:

a. Diseases preventable by vaccination. It is necessary to protect the achievement of elimination of measles, rubella, congenital rubella syndrome, poliomyelitis and neonatal tetanus, and accelerate the elimination of bacterial meningitis.

b. Neglected infectious diseases and zoonoses: Chagas disease, leprosy, trachoma, schistosomiasis, intestinal parasites, lymphatic filariasis, human rabies transmitted by dogs and hydatidosis affect marginalized populations that do not have sufficient access to integrated health services . There are effective tools to eliminate them.

c. Vector-borne diseases: Malaria affects thousands of people and can be eliminated with proven effective interventions. Yellow fever epidemics can also be eliminated.

d. Sexually transmitted infections and viral hepatitis: HIV, syphilis and other STIs as well as viral hepatitis can move towards elimination if actions to achieve this are accelerated.

e. Diseases transmitted from mother to child: HIV, hepatitis B, syphilis, hepatitis B and Chagas disease can be eliminated and no longer affect pregnant women and newborns.

f. Other priority diseases and conditions: cervical cancer caused by human papillomavirus, cholera, tuberculosis and environmental factors such as open defecation and the use of polluting fuels in homes can be eliminated.

Our steadfast commitment has a profound impact across the entire Region

The results of this initiative are milestones that have significantly improved the quality of life for individuals and communities. The commitment of countries, communities, partners, donors, allies, and PAHO is reflected in these achievements.

Elimination of the lymphatic filariasis as a public health problem

Countries certified as malaria-free in the Americas

Countries certified free of mother-to-child transmission of HIV and syphilis

Countries validated as free of trachoma in the Americas

Countries certified as free of onchocerciasis in the Americas

Countries certified as free of human rabies in the Americas

50% reduction of bacterial meningitis cases.70% reduction of deaths due to bacterial meningitis.

0% (alloctonous vectors); <=1% (autochthonous vectors) households with intra and peridomiciliary vector infestation of T.cruzi sustained for at least five (5) years in the entire territory and by all vectors.0% (alloctonous vectors); <=1% (autochthonous vectors) households with intra and peridomiciliary vector infestation of T.cruzi either by territory or by vector in a given period.

Absence of community transmission of epidemic Vibrio cholerae for at least three (3) consecutive years.

≥90% of newborns with T. cruzi infection, cured.

≤ than 0.5 new cases of mother-to-child transmission of syphilis per 1,000 live births.

Zero (0) cases in people <15 years old per 100,000 people <15 years old.

≤5% of cases of fascioliasis in humans detected by coprology (sustained over time).Zero (0) cases cases of fascioliasis in children aged 5-14 years with ≥ 400 eggs per gram of feces.

<2% Prevalence of moderate and severe infection due to A. lumbricoides, T. trichiura and hookworms in school-age children (5 to 14 years).

90% reduction in the incidence of hepatitis B compared to 2015.<4 per 100,000 inhabitants (65% reduction in mortality from hepatitis B compared to 2015).

<5 per 100,000 inhabitants (90% reduction in the incidence of chronic hepatitis C compared to 2015)<2 per 100,000 inhabitants for hepatitis (65% reduction in mortality from hepatitis C compared to 2015).

≤0.1% prevalence of HBsAg in children aged 4 to 6 years.

≤2% incidence rate of mother-to-child transmission per 100 live births of women with HIV.

90% reduction in annual HIV-related deaths compared to 2010 values.<0.02 new infections per 1000 inhabitants per year (90% reduction since 2010).

Zero (0) human deaths from dog-transmitted rabies for five (5) consecutive years.

Zero (0) new autochthonous cases for at least three (3) consecutive years AFTER reaching interruption of transmission among children <15 years (indicator of disease elimination).Zero (0) new autochthonous cases of leprosy for at least five (5) consecutive years (indicator of interruption of transmission).

Prevalence of microfilaremia <1% or prevalence of antigenemia <2% in persons => 5 years of age sustained for at least 4 years after stopping mass drug administration.

Zero (0) new autochthonous cases for three (3) consecutive years.

< 0.1% prevalence of infective flies and Seroprevalence of onchocerciasis in children under 10 years of age.

90% reduction in new syphilis and gonorrhea infections compared to 2020.

<1% proportion of high-intensity Schistosoma mansoni infections in school-aged children (5 to 14 years).

<5% of trachomatous inflammation-follicular in children aged 1-9 years.<0.2% of trachomatous trichiasis in people aged 15 years and above.

Pre-elimination of tuberculosis: <1 cases per 100,000 inhabitants; elimination of tuberculosis as a public health problem: <0.1 case per 100,000 inhabitants.

95% reduction in the number of people practicing open defecation (2030 vs. 2020).

<5% percentage of population that depends on the use of polluting fuels in the household.

Zero (0) endemic cases of congenital rubella syndrome in 12 months in any defined geographical area.

Zero (0) endemic cases of measles in 12 months in any defined geographical area.

<1 new confirmed cases of neonatal tetanus per 1,000 live births in each district (or equivalent administrative unit) of a country in a year.

Zero (0) cases of poliomyelitis due to wild poliovirus or circulating vaccine-derived poliovirus in children younger than 15 years in 12 months in any defined geographical area.

Zero (0) endemic cases of rubella in 12 months in any defined geographical area.

Zero (0) cases of urban yellow fever due to transmission by Aedes aegypti.

Zero (0) cases in the absence of vaccination in countries free of foot-and-mouth disease.

Absence of cases verified by PCR Zero (0) new serologically confirmed autochthonous cases for three (3) consecutive years