Elimination is important, but it doesn't mean eradication
In 2025, Brazil earned a rare distinction — WHO certification for eliminating mother-to-child HIV transmission — a milestone built on decades of public health commitment. Yet within that achievement lives a quieter truth: infants are still being born into the virus, still acquiring it through breastfeeding, still arriving at the doors of organizations that have never stopped working. A certification marks a threshold, not an ending. The distance between elimination and eradication is measured not in statistics, but in children.
- Brazil's WHO certification declared victory over vertical HIV transmission, but an NGO serving 56 children living with HIV reveals the gap between official milestones and lived reality.
- Infants continue to be infected during breastfeeding — a transmission window that persists because many mothers lack access to timely information and preventive medication.
- PrEP remains widely misunderstood as a tool for LGBTQIA+ communities, leaving pregnant and nursing women in vulnerable situations without a prevention option that is explicitly indicated for them.
- Projeto Criança A.M.A.R., now in its 35th year, continues receiving newly infected infants, offering psychosocial support, coordination with health systems, and the kind of sustained human presence that policy alone cannot provide.
- Closing the remaining transmission gap will require expanding PrEP awareness among women and reinforcing prevention messaging throughout pregnancy and lactation — not as a footnote to success, but as its continuation.
In 2025, the World Health Organization certified Brazil for eliminating mother-to-child HIV transmission — a landmark built over decades of prevention work and treatment access. The country celebrated. And then, quietly, the work continued.
Projeito Criança A.M.A.R. — a nonprofit founded in 1991 — marked its 35th anniversary on June 4th while serving 25 families and 56 children, among them infants and toddlers who acquired HIV from their mothers during pregnancy, birth, or nursing. These children live in the space between a certification and a reality.
Adriana Galvão, who leads the organization, names the paradox plainly: elimination is not eradication. 'We continue receiving infants with HIV,' she says, 'especially in cases tied to maternal infection during breastfeeding.' The organization recently changed its name — from Projeto Criança Aids to Projeto Criança A.M.A.R., an acronym for Embrace, Motivate, Support, Reframe — signaling a shift from fear toward care.
The core challenge, Galvão explains, is reaching sexually active, pregnant, and nursing women with accurate prevention information. PrEP is still widely perceived as a tool for LGBTQIA+ populations, leaving many women unaware that it is indicated for them too, including during pregnancy and breastfeeding. The gap is not in the science — it is in the reach.
Three and a half decades of work have tracked Brazil's full arc with HIV: from years of fear and scarce treatment to a present where children living with the virus can grow up, study, and build families. That transformation is real. But it is unfinished. 'While children are living with HIV and families need support,' Galvão says, 'our work continues.' Brazil holds a certification. It also holds children who need care. Both things remain true.
Brazil crossed a threshold last year that few nations have reached. In 2025, the World Health Organization certified that the country had eliminated mother-to-child HIV transmission—the virus passing from pregnant women to their babies during pregnancy, delivery, or breastfeeding. It was a landmark moment, the culmination of decades of prevention work, treatment access, and public health infrastructure. The country celebrated. And then, quietly, the work continued.
On June 4th, the Projeto Criança A.M.A.R.—a nonprofit that has been walking alongside families affected by HIV since 1991—marked 35 years of operation. The organization serves 25 families, supports 56 children, and reaches roughly 100 people in total. Among them are infants and toddlers living with HIV, all of them infected by their mothers during pregnancy, birth, or nursing. These children exist in the gap between a certification and a reality.
Adrianna Galvão, who leads the organization and founded PalestrAids, speaks about this paradox with clarity. "Elimination is an enormously important achievement," she says, "but it doesn't mean eradication. These children are still here. Our doors prove it. We continue receiving infants with HIV, especially in cases tied to maternal infection during breastfeeding." The organization changed its name last year—from Projeto Criança Aids to Projeto Criança A.M.A.R., standing for Acolher, Motivar, Apoiar, Ressignificar (Embrace, Motivate, Support, Reframe)—to reflect a shift in how it thinks about the virus. Less fear. More care.
The real challenge, Galvão explains, lies in reaching women who are sexually active, pregnant, or nursing with information about prevention. Many people still think of PrEP—the preventive medication—as a tool for LGBTQIA+ populations. It is not. It is a prevention option for anyone at risk, including women. "PrEP is indicated for women during pregnancy and breastfeeding, especially in vulnerable situations," she says. "We need to expand this conversation and make sure more women have access to information, prevention, and proper care." The gap is not in the science. It is in the reach.
The organization's three and a half decades have tracked the arc of Brazil's response to HIV—from the darkest years, when fear and misinformation dominated and treatment was scarce, to now, when children living with the virus can grow up, attend school, work, and build families of their own. That transformation is real. But it is incomplete. The nonprofit provides psychosocial support, education, food, clothing, hygiene items, and counseling from psychologists, social workers, and other specialists. It coordinates with hospitals and referral centers. It holds conversations and cultural activities. It exists because the need exists.
Galvão's final thought carries the weight of someone who has watched this fight for decades: "Reaching 35 years means seeing how far we've come, but also understanding that our mission is still necessary. While children are living with HIV and families need support and information, our work continues." Brazil has a certification. It also has children who need care. Both things are true.
Citações Notáveis
Elimination is an enormously important achievement, but it doesn't mean eradication. These children are still here.— Adriana Galvão, president of Projeto Criança A.M.A.R.
PrEP is indicated for women during pregnancy and breastfeeding, especially in vulnerable situations. We need to expand this conversation.— Adriana Galvão
A Conversa do Hearth Outra perspectiva sobre a história
When Brazil got that WHO certification last year, what did it actually mean on the ground for the families you work with?
It meant the systems worked. The prevention protocols, the treatment access, the prenatal care—they all functioned. But it also meant we had to keep explaining that certification isn't the same as the virus disappearing. We still have infants coming through our doors.
Why are children still being infected if the prevention tools exist?
Access and knowledge aren't the same thing. A woman might not know she's at risk. She might not know PrEP exists for her. She might not have reached prenatal care. The science solved the problem. The reach didn't.
You changed the organization's name last year. Why?
Because we needed to stop leading with fear and start leading with what we actually do—embrace families, motivate them, support them, help them reframe what HIV means in their lives. The old name carried the weight of the epidemic. The new one carries the weight of the work.
What's the biggest misconception you encounter?
That PrEP is only for gay men. It's not. It's for anyone at risk, including pregnant women and nursing mothers. That single misunderstanding keeps women from even asking about it.
If you could change one thing right now, what would it be?
Get information about prevention into the hands of women before they need it. Not after diagnosis. Before. That's where the real elimination happens.