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The Maldives’ Triple Elimination: A Blueprint for Health

Maldives’ Triple EliminationIn October 2025, the World Health Organization (WHO) announced that the Maldives’ historic triple elimination of mother-to-child transmission of Human Immunodeficiency Virus (HIV), syphilis and hepatitis B had been officially validated. This certification makes the Maldives the first country in the world to successfully eliminate the transmission of all three life-threatening diseases from mother to child simultaneously. The milestone represents a major triumph for maternal health and provides a clear strategy for other low- and middle-income countries (LMICs) to follow.

Understanding Triple Elimination

Triple elimination is a public health standard that ensures the next generation is born free of three specific infections that often cause lifelong health complications or infant mortality. To achieve this, the Maldives had to meet rigorous WHO criteria, including maintaining antenatal care coverage and testing rates above 95%. The nation also proved that its newborn interventions, such as the hepatitis B birth dose, are consistently delivered within 24 hours of birth. Data show that the Maldives recorded zero babies born with HIV or syphilis in both 2022 and 2023. Additionally, a national survey in 2023 confirmed that no young children entering school carried hepatitis B.

A Decentralized Approach to Maternal Care

Progress toward the Maldives’ historic triple elimination was made possible by a decade of systemic reform focused on reaching people in remote areas. Because the population is dispersed across more than 1,000 islands, the government prioritized a decentralized, community-based health care system. In 2018, the nation implemented the “Agenda for Integrated Service Delivery,” which standardized data collection for all three diseases. This ensured that even on the smallest islands, pregnant women could access free testing and treatment. By removing financial barriers, the government addressed a primary cause of health vulnerability among low-income families.

The Role of WHO and United Nations Children’s Fund (UNICEF)

The WHO and UNICEF played essential roles in supporting the Maldives during the validation process. The WHO provided the technical framework and training to ensure that screening and vaccination programs were integrated into routine maternal and child health services. UNICEF South Asia contributed by reviewing and refining national reports to ensure they met global standards for data accuracy. These organizations worked alongside the Indira Gandhi Memorial Hospital, which serves as the national reference laboratory for validating test results. This partnership allowed the Maldives to use digital monitoring tools such as the Electronic Immunization Registry to track children’s health status in real time.

Promoting Equity With the Migrant Health Policy

The path to the Maldives’ historic triple elimination also involved ensuring that no resident was left behind due to background or legal status. The government recently launched a Migrant Health Policy that guarantees equal access to health services for all residents, including migrant populations. This inclusive policy reduced gaps in disease surveillance and ensured that every mother living in the country received the same standard of care. Experts note that including marginalized groups in national health frameworks is a critical factor in achieving disease elimination goals.

A Beacon of Hope for Global Health

The success of the Maldives serves as a beacon of hope for other nations working to eliminate preventable infections. By combining political leadership with a decentralized health system and strong international partnerships, the country has protected future generations from chronic disease. The Maldives’ historic triple elimination demonstrates that geographic isolation and resource constraints are not insurmountable barriers to public health progress. As countries move toward the 2030 global goal for triple elimination, the Maldives shows that equitable, high-quality health care can play a significant role in reducing poverty and improving lives.

– Elena Cárdenas

Elena is based in Monterrey, México and focuses on Global Health and Politics for The Borgen Project.

Photo: Flickr

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Addressing Syphilis, Hepatitis B and HIV/AIDS in the Maldives

HIV/AIDS in MaldivesIn 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.

Photo: Pexels

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Efforts to Stop Mother-to-Child HIV Transmission in Indonesia

Mother-to-Child HIV Transmission in indonesiaIn 2023, about 570,000 people in Indonesia were living with HIV. Recognizing the urgency, the Indonesian government intensified its efforts to support individuals and prevent mother-to-child HIV transmission. Community organizations play a crucial role in this endeavor, providing care and treatment access to those in need.

The Situation in Indonesia

Since 2008, UNICEF has supported the governments of Papua and West Papua in Indonesia in establishing a Prevention of Mother-to-Child Transmission of HIV (PMTCT) program. This program emphasizes HIV prevention, diagnosis and treatment within communities. Providing antiretroviral treatment during pregnancy can significantly reduce the risk of mother-to-child transmission. Ideally, since 2009, HIV testing should be part of antenatal care for pregnant women in Indonesia. However, more than a decade later, 37% of pregnant women still do not receive HIV screening. In 2022, only 18% of mothers with HIV accessed antiretroviral therapy.

Current Action to Prevent HIV Transmission

The National Alliance to End AIDS in Children, established in 2023, unites government, international organizations and civil society to improve access to health services and mental support for women and children living with HIV. The alliance focuses on three primary priorities:

  1. Advocating for the specific needs of adolescent girls and children living with HIV.
  2. Raising awareness by disseminating information about PMTCT (Prevention of Mother-to-Child Transmission), Early Infant Diagnosis and sexual education.
  3. Empowering communities to support children living with HIV effectively.

Importance of the Community

With renewed political commitment, supporting community-based services becomes crucial to providing necessary care and support for women and children living with HIV. Mobilizing community health workers is essential not only to prevent transmission but also to assist those affected by the disease. Organizations like Lentera Anak Pelangi (LAP), operating since 2009, play a vital role in this effort. As Indonesia’s first multidisciplinary service provider focusing on children with HIV, LAP collaborates with volunteers, sponsors and partners to enhance the quality of life for those living with the disease.

Key Focuses of LAP

  • Improving the Quality of Health and Nutrition. LAP offers health and nutrition assessments, family counseling and support during child hospitalizations. The organization also educates on sanitation and hygiene. Additionally, LAP provides monthly free medical checkups, non-BPJS laboratory testing and financial support for medications.
  • Advocating for ARV treatment. Its program raises public awareness about treatment options and conditions through training, social media campaigns and mass media efforts. It also extends its outreach to schools by educating both staff and students.
  • Ensuring the psychosocial well-being of children and their families. The program teaches children life skills and includes a school that monitors their development. It offers vocational training tailored to each child’s talents and interests. Additionally, the organization facilitates peer support groups for parents.

Providing a Community

A mother describes how her daughter’s confidence has grown since joining LAP, highlighting the friendships they have both formed with others in similar situations. Another parent comments on the bonds her son has created and the benefits he has received from LAP’s educational and nutritional support. Despite the stigma in Indonesia, where 33.5% of adults believe children with HIV should not attend school with uninfected children, programs like LAP play a crucial role. They counter isolation and stigma while ensuring families receive necessary support and help prevent the disease’s spread.

– Amelia Short

Amelia is based in Bradford, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr

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HIV and Syphilis: Mother-to-Child Transmission in Belize

Belize Eliminates Mother-to-Child HIV and Syphilis TransmissionIn May 2024, Belize achieved certification from the World Health Organization (WHO) for eliminating mother-to-child transmission of HIV and syphilis. Over the past 20 years, in collaboration with the Pan American Health Association (PAHO), health care workers in Belize have dedicated themselves to enhancing medical services, ensuring a generation free from these diseases.

Improving Medical Services in Belize

Since the early 2000s, Belize’s health care services, in collaboration with the Pan American Health Organization (PAHO), have been following the organization’s Plan of Action for the Prevention and Control of HIV and Sexually Transmitted Infections. This initiative has improved and promoted access to prenatal HIV and syphilis testing. Health care providers now screen every pregnant woman for these viruses two to three times during pregnancy, at delivery and at 18 months postpartum.

The vastly improved testing services have reduced mother-to-child transmission in Belize, of HIV and syphilis by 81% from 2007 to 2023, achieving eradication by 2024. This success depended on effective treatments administered to pregnant women who tested positive for these diseases. For syphilis, health professionals administer three consecutive weeks of penicillin injections; HIV-positive mothers receive daily antiretrovirals along with prenatal vitamins. These treatments effectively prevent the transmission of HIV and syphilis to their children. To further ensure children are born virus-free, nurses follow up with mothers a week after treatment completion to verify the full course was administered and to identify any potential complications.

Encouraging Mothers to Seek Testing and Treatment

Throughout Belize’s collaboration with PAHO under its Plan of Action, the country has enhanced the research capabilities and capacity of its health care services, enabling more pregnant women to be tested earlier and more accurately for both HIV and syphilis. The percentage of women attending health clinics in their first trimester has risen to 90%, allowing for earlier and more effective administration of preventative treatments. When mothers test positive for these diseases, health care providers also encourage their partners to get tested, fostering community awareness and enabling more individuals to know their statuses and receive necessary treatment. As of 2022, 81% of people living with HIV in Belize are aware of their status.

Screenings and treatments in these clinics are free, ensuring that all women in Belize can access life-saving treatments for themselves and their unborn children. This accessibility has been crucial in eradicating the viruses and underscores the relentless efforts of Belizean health care workers. Additionally, if a mother misses an appointment, a nurse visits her home to conduct a follow-up check.

Nurses Maintaining the Transmission Rates

The critical roles of nurses in eliminating mother-to-child transmission of HIV and syphilis in Belize, particularly in remote areas like San Lazaro, are pivotal. The Belize Ministry of Health facilitates mobile health services that allow nurses to travel between villages to conduct screenings and treatments. This commitment underscores the dedication of health care workers to achieving the certification for eradicating HIV and syphilis transmission from mothers to their children.

Health care services in Belize actively educate and promote awareness of HIV and syphilis, encouraging mothers to seek regular testing. During prenatal checkups at clinics, health care workers emphasize the importance of screenings for both the women and their unborn children. This approach normalizes early testing upon pregnancy, increasing awareness and helping more women know their health status.

Testimonies from Belizean health care workers emphasize that their diligence, research and efforts are crucial for sustaining the elimination of mother-to-child transmission of HIV and syphilis. The Minister of Health and Wellness of Belize, Hon. Kevin Bernard, notes that cooperation and teamwork between health care workers and the communities they serve are essential for delivering optimal services and effectively preventing the spread of the disease.

Looking Ahead

The WHO certification confirming the elimination of mother-to-child transmission of HIV and syphilis in Belize highlights the success of the country’s health care workers and medical services. According to Dr. Natalia Largaespada Beer, this achievement not only ensures a new generation free of these diseases but also represents an opportunity to strengthen the health care system. The enhancement of services and nationwide access to life-saving treatments promise a bright future for Belize in sustaining this elimination, ensuring every child has the right to be born free from these diseases.

– Ben Kane

Ben is based in London, UK and focuses on Global Health for The Borgen Project.

Photo: Flickr