A turning point for children: creating an AIDS-free generation

Fforty years after the the first cases of AIDS have been reported, the harsh reality is that deep inequalities continue to exist in the global response to HIV and AIDS, with gaps in rights and services preventing real progress.

And while it’s painful to admit, one of the most overlooked segments of the population have been children.

As the “End inequalities, end AIDS” The strategy proposed by the Joint United Nations Program on HIV and AIDS (UNAIDS) clearly states: “One of the most glaring disparities in the response to HIV is the failure to meet the needs of children living with HIV. or at risk.

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the final progress report on the “Start for free, stay free, without AIDS” initiative just published by our organizations, UNAIDS (BW), and the Elizabeth Glaser Pediatric AIDS Foundation (CL), and its partners, offer a dark look at HIV and children. About 1.7 million children are currently living with HIV. Every week, nearly 2,000 of them die and 5,900 children and adolescents are newly infected with the virus. Only 54% of children living with HIV have access to lifesaving treatment. Although children made up only 5% of people living with HIV in 2020, they accounted for 15% of all AIDS-related deaths. Almost 90% of all children living with HIV in the world are in Africa.

Without a voice in the response, children have an unequal chance to ask for solutions to their needs. The Covid-19 has further intensified existing inequalities, diverting funds and other resources from essential health services.

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Yet even before Covid-19 took hold, the picture was troubling. New pediatric HIV infections have been on the rise in a handful of African countries, pediatric treatment coverage had stalled and the global community had failed to identify and reach nearly half of children living with HIV. None of the “Start free, stay free, AIDS free” targets set for 2020 have been met and have in fact been largely missed.

World leaders gathered in June for the United Nations High Level Meeting on HIV and AIDS to chart the future direction of the global AIDS response. As leaders of organizations committed to ending HIV and AIDS, we have been encouraged by the inclusion of a new global commitment in the political statement eliminate mother-to-child transmission of HIV and end pediatric AIDS by 2025.

Commitments have no meaning without action. As world, national and community leaders strive to develop a framework for action, we call on them to scale up their efforts for children in real and meaningful ways, catalyzing the momentum to achieve the first AIDS-free generation. , with a focus on four key areas:

Find the children. Improving efforts to “find” and diagnose children of all ages living with HIV is a key gateway to increasing the number of children with access to drugs and ensuring viral load suppression. The effectiveness of early infant diagnosis at the point of care is a well-documented game changer, but the adoption and scale-up of this strategy has stalled and needs to be scaled up to countries around the world.

Help children access life-saving treatment. Without treatment, one in two HIV-positive babies die before their second birthday. Children living with HIV need formulations that are age appropriate, effective and accessible. Yet children in low- and middle-income countries often wait years to have access to the same drugs as adults, eroding their health and even leading to preventable deaths. The development and uptake of optimal, child-friendly HIV treatment lags far behind such work in adults, leading to poorer health outcomes in younger patients. Recent UNAIDS data indicates that 800,000 children living with HIV went without drugs in 2020, a deeply concerning reversal from recent progress. A rapid transition to better pediatric formulations, in combination with better HIV diagnosis for children is desperately needed.

Focus on prevention. Rates of mother-to-child transmission of HIV have been cut in two during the last decade. But this success capped disturbingly. Ending mother-to-child transmission requires HIV testing and support for adolescent girls and young women which includes the prevention of unintended pregnancies and the intensification of primary prevention efforts for pregnant and breastfeeding women – including pre-exposure prophylaxis (PrEP) – as the global community seeks to move forward President Biden’s appeal to “restore a government-wide focus on educating women and girls around the world.”

Address structural barriers for women at the community level. A range of socio-economic and structural factors that include unequal power dynamics and gender norms, gender-based violence, poverty, stigma and discrimination compromise the ability of many women to access and remain engaged in clinical services and psychosocial support. The needs of women must be at the center of all efforts. Stakeholders need to recognize barriers to treatment adherence or regular clinic visits and respond with improved options and support at the community level.

To end AIDS in children, governments, civil society and other stakeholders must act urgently, following up the political declaration with concrete actions that live up to its aspirations. It means providing resources and services to protect the unique rights, needs and perspectives of children and young women – and doing so with a clear focus on human rights and equity.

Ending pediatric AIDS is both ambitious and achievable. Let’s make 2021 another turning point in the history of ending AIDS – and in doing so, let’s create the first AIDS-free generation.

Winnie Byanyima is Executive Director of UNAIDS and Under Secretary-General of the United Nations. Chip Lyons is the CEO of the Elizabeth Glaser Pediatric AIDS Foundation.