Despite progress in reducing HIV infections and AIDS-related deaths among children, a new report released today by the Global Alliance to End Paediatric AIDS by 2030 shows that an urgent scale-up of HIV services in countries hardest hit by the pandemic is needed to end AIDS by 2030.
The report, Transforming Vision into Reality, shows that programmes targeting vertical transmission of HIV have averted 4 million infections among children aged 0–14 years since 2000. Globally, new HIV infections among children aged 0–14 years have declined by 38% since 2015 and AIDS-related deaths have declined by 43%.
Among the twelve member countries of the Global Alliance, several have achieved high coverage of lifelong antiretroviral therapy among pregnant and breastfeeding women living with HIV, with Uganda approaching 100%, the United Republic of Tanzania at 98% and South Africa at 97%. Mozambique has achieved 90% coverage, Zambia at 90%, Angola at 89%, Kenya at 89%, Zimbabwe at 88% and Côte d’Ivoire at 84%.
“I applaud the progress that many countries have made in scaling up HIV services to keep young women healthy and protect babies and children from HIV,” said UNAIDS Executive Director Winnie Byanyima. “With the medicines and science available today, we can ensure that all babies are born – and stay – HIV-free, and that all children living with HIV are on and remain on treatment. Treatment and prevention services must be scaled up immediately to ensure they reach every child everywhere. We cannot rest on our laurels. The death of a child from AIDS-related causes is not only a tragedy, it is a scandal. Where I come from, all children are our children. The world can and must deliver on its promise to end childhood AIDS by 2030.”
Global Alliance countries are innovating to overcome obstacles and accelerate progress toward ending AIDS among children. However, despite the progress made, neither the world nor Global Alliance countries are currently on track to meet their commitments to address HIV among children and adolescents. Moreover, the pace of progress in preventing new HIV infections and AIDS-related deaths among children has slowed in recent years.
“Accelerating the delivery and uptake of HIV services for children and adolescents is a moral obligation and a political choice,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Twelve countries are demonstrating that they have made this choice, but significant challenges remain. While we have made progress in improving access to testing and treatment for pregnant women to prevent vertical transmission of HIV, we are still far from closing the paediatric treatment gap. We must further strengthen the collaboration and reach of the Global Alliance, and we must do this work with determination and solidarity with all affected mothers, children and adolescents.”
In 2023, approximately 120,000 children aged 0–14 years were infected with HIV, including approximately 77,000 in Global Alliance countries. AIDS-related deaths among children aged 0–14 years were 76,000 globally, including 49,000 in Global Alliance countries. Vertical transmission rates remain extremely high in some settings, including West and Central Africa, with rates exceeding 20% in countries such as Nigeria and the Democratic Republic of the Congo.
“In the fight against HIV, we must do much better for children,” said Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which funds HIV programs in more than 100 countries through a country partnership model. “To support national programs, we have purchased the latest pediatric dolutegravir regimens at negotiated prices. Our investments in laboratory systems help ensure that exposed infants are rapidly tested and those who test positive are rapidly started on age-appropriate antiretroviral therapy. Differentiated approaches to testing and treatment help close the diagnostic gap and ensure more child-centered service delivery.”
It is worrying that the treatment gap between adults and children continues to widen.
“Only 57 per cent of children living with HIV are receiving life-saving treatment, compared to 77 per cent of adults,” said Anurita Bains, UNICEF Deputy Director for HIV/AIDS. “Without early and effective testing and treatment, HIV remains a persistent threat to the health and well-being of children and adolescents and puts them at risk of death. To close the treatment gap, we must support governments to scale up innovative testing approaches and ensure that children and adolescents living with HIV receive the treatment and support they need.”
In 2023, there will be 210,000 new infections among young women and girls aged 15 to 24 years globally (130,000 in Global Alliance countries), four times the target of 50,000 by 2025. Preventing new infections in this age group is essential both to protect the health and well-being of young women and to reduce the risk of new infections among children.
Gender inequalities and human rights violations increase women’s vulnerability to HIV and reduce their ability to access essential services. Globally, nearly one in three women has experienced some form of violence in her lifetime, with adolescent girls and young women disproportionately affected by intimate partner violence. In the four Global Alliance countries with available data, countries are not currently on track to meet the target of ensuring that by 2025, less than 10 per cent of women, key populations and people living with HIV experience gender-based inequalities and gender-based violence.
“It is remarkable how many more children’s lives can be saved when all stakeholders and partners come together to commit to ending pediatric AIDS. While much progress has been made, including the successful introduction of pediatric dolutegravir, large gaps remain in the pediatric cascade and we must recommit with determination and innovation to deliver on the promises we have made by 2025 and beyond,” said Ambassador John N. Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy.
The Global Alliance to End Paediatric AIDS by 2030 was launched in 2022 by WHO, UNICEF and UNAIDS to reinvigorate the paediatric HIV agenda. It has now grown and, in addition to UN agencies, the alliance includes civil society movements, including the Global Network of People Living with HIV, national governments of the highest-burden countries and international partners, including PEPFAR and the Global Fund. Twelve countries are members: Angola, Cameroon, Côte d’Ivoire, Democratic Republic of Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Uganda, United Republic of Tanzania, Zambia and Zimbabwe.