In October 2025, the World Health Organization (WHO) officially declared that the Maldives had become the first country in the world to accomplish ‘triple elimination’ of mother-to-child transmission of HIV, syphilis and hepatitis B. As a nation, the Maldives has demonstrated a dedication to targeted, all-encompassing health care, providing a blueprint for the rest of the world to follow in its footsteps towards a collective aim of eliminating preventable disease transmission. This milestone holds the promise of a protected generation born free of infection, making it more than just a medical triumph. The reduction of HIV/AIDS in the Maldives serves as a reminder worldwide that even smaller nations can spearhead global change with the right commitment and focus.

The Meaning of Triple Elimination

Essentially, in global health terms, “triple elimination” marks one of the highest standards a country can achieve: a victory against three life-threatening diseases. It represents an implication that mothers are no longer infecting their offspring with hepatitis B, syphilis or HIV, three diseases that took the lives of countless newborns. Although the diseases have not completely perished, their transmission has dropped to the point that they are no longer a concern to public health. Although these infections still exist, transmission rates fall below strict WHO thresholds. To receive recognition, a country must:

• Test and treat nearly all pregnant women
• Provide prompt newborn interventions, including the hepatitis B birth dose within 24 hours
• Maintain consistent outcomes over several years

Triple elimination fundamentally demonstrates what can be achieved when governmental, medical and scientific efforts come together to provide every baby with an optimal start in life.

Mother-To-Child Transmission on the World Stage

Globally, an estimated 1.3 million women and girls living with HIV become pregnant each year. Congenital syphilis is the second leading cause of preventable stillbirth globally, preceded only by malaria. Hepatitis B, on the other hand, is a liver-attacking virus that can infect a newborn and cause chronic illness in later life. However, early detection, treatment and prompt vaccination—especially the hepatitis B birth dose within 24 hours of delivery—can prevent these diseases.

According to UNICEF, new HIV infections among children under five dropped by 62% between 2010 and 2024. However, to meet the 2030 goals that UNAIDS and its partners established as part of the UNAIDS Global Strategy to End AIDS, progress needs to be made at a much faster rate. To eradicate new infections in children and cut the number of HIV-related deaths among expectant mothers in half, treatment for all pregnant and nursing women living with HIV must be accelerated.

Where Poverty Fits In

Poverty increases vulnerability to mother-to-child transmission because families with low income often face:

• Limited access to antenatal care
• Delayed or missed screening
• Higher rates of untreated infection
• Less access to protection during intercourse
• Difficulty affording transport or follow-up appointments

The Elimination of Mother-To-Child Transmission (EMTCT) Initiative

To assist nations in achieving these objectives, the World Health Organization (WHO) developed the Elimination of Mother-to-Child Transmission (EMTCT) initiative. Numerous countries have made strides with some succeeding in ‘dual elimination’ status for syphilis and HIV. However, no nation had ever successfully eliminated all three at the same time until the HIV/AIDS in the Maldives confirmation this year.

This makes EMTCT efforts essential for reducing inequality across countries, especially in regions with limited health care infrastructure. The Maldives became an active participant in the WHO South-East Asia Regional EMTCT Initiative in 2016. In 2018, due to the regulation provided by the EMTCT initiative, they implemented the ‘Agenda for Integrated Service Delivery’ and started a systematic data collection for HIV, syphilis and hepatitis B. The progress seen with HIV/AIDS in the Maldives highlights how strong public health systems can help overcome poverty-related barriers. 

In the Maldives, poverty and geographic isolation have historically increased the risk of mother-to-child transmission of infections like HIV, syphilis and hepatitis B. Dr Catharina Boehme, Officer-in-Charge at the WHO South-East Asia Regional Office, affirmed the significance of “equitable care across its dispersed islands.” The nation’s numerous outer islands have historically had lower income levels, fewer job prospects, and less access to social services than the capital region. Families in these islands were more likely to miss early screening or timely newborn vaccination due to reduced household income and inadequate health infrastructure, underscoring the connection between health risk and economic disadvantage. Acknowledging these disparities, the government structured its maternal health system on universal access: all islands now offer free testing, treatment and birth-dose vaccination, and the WHO’s EMTCT framework supports this model.

Maldive’s Methods

1. Early and Universal Screening: By the mid-2010s, the Maldives integrated first-trimester HIV, syphilis and hepatitis B screening into routine antenatal care, ensuring that even women in remote islands received early diagnosis.
2. High Antenatal Care Coverage: The government invested heavily in island-level health posts and trained midwives, increasing antenatal care coverage and reducing disparities between wealthier households and families experiencing poverty.
3. Strong Vaccination Systems: The Maldives maintained hepatitis B birth-dose coverage above 95%, a key requirement for EMTCT validation. Skilled birth attendants on smaller islands received training to guarantee newborn vaccination within 24 hours.
4. Free Access to Treatment: All testing and treatment for HIV, syphilis and hepatitis B were free of charge, removing financial barriers that typically disproportionately affect low-income families.
5. Data-Driven Monitoring: Through support from the EMTCT initiative, the Maldives strengthened its data systems, enabling accurate tracking of infections, treatment uptake and birth outcomes.

Looking Ahead

Proving itself a leading agent in maternal and antenatal care, “The Maldives’ triple elimination stands as a powerful example of how sustained investment in health systems, innovation and community-based care can change the trajectory of public health,” said Ms. Payden, WHO Representative to the Maldives. The HIV/AIDS in the Maldives’ progress began more than a decade ago, long before triple elimination was in sight. Because its population is dispersed across more than 1,000 islands, the government prioritized a decentralized, community-based health care system to ensure equal access regardless of income or geography. As stated in the WHO’s South-East Asia update, the Maldives’ feat is credited to long-term, systemic investments that have sustained high antenatal care coverage and integrated first-trimester screening for all three infections across scattered island communities. For the children of the Maldives, the future now begins infection-free.

– Prubleen Bhogal

Prubleen is based in London, UK and focuses on Good News and Politics for The Borgen Project.

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