Making an AIDS-free generation a reality is possible, according to the Children and AIDS, Fifth Stocktaking Report: a renewed call to action issued today in New York by UNICEF, in partnership with the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO) and the United Nations Population Fund (UNFPA).
The international community must redouble their efforts to reach the most vulnerable and marginalised members of society to make this happen, note the authors.
“To achieve an AIDS-free generation we need to do more to reach the hardest hit communities. Every day, nearly 1,000 babies in sub-Saharan Africa are infected with HIV through mother-to-child transmission,” said Anthony Lake, UNICEF’s Executive Director. “Our Fifth Stocktaking Report on children and AIDS highlights innovations like the Mother-Baby Pack that can bring life-saving antiretroviral treatment to more mothers and their babies than ever before,” said Lake.
While progress continues to be made in HIV prevention, treatment and social protection, much remains to be done.
“The elimination of new HIV-infections and AIDS-related deaths in children is possible, but it will require vision, leadership and system-wide improvements in health-care delivery, as well as deep-seated social change and continued implementation of best practices,” stress the authors.
Thirty years into the epidemic and children are now central to the HIV response. Investments on behalf of children have made a significant difference. Improved evidence has led to new guidance for women and children in the global HIV response and increased action means “the story of how the AIDS epidemic is affecting children is being rewritten”.
Yet millions of women and children continue to fall through the cracks. Progress is uneven, revealing gaps in service coverage as well as inequities rooted in gender, economic status, geographical location, education level and social status.
Without addressing these barriers universal access to knowledge, care, protection and prevention of mother-to-child (PMTCT) transmission for all women and children will be difficult to achieve, note the authors.
Funding continues to lag behind what is needed to scale-up evidence-based strategies. Reaching the goal of an AIDS-free generation can only happen when this scale-up is part of a “rights-based, results-focused drive to reach all those in need.”
In 2005, UNICEF, UNAIDS and other partners launched Unite for Children, Unite against AIDS to focus attention and resources dedicated to putting children at the heart of the global response.
This is the fifth in the series of annual stocktaking reports published by the partnership, examining progress toward the goal of universal access to prevention, treatment and care.
The report looks at progress made in the global response for children in four programme areas known as the ‘Four Ps’:
Preventing mother-to-child transmission
Paediatric HIV care and treatment
Preventing HIV infection among adolescents and young people
Protecting and supporting children affected by HIV and AIDS.
Prevention of mother-to-child HIV transmission
In 2009, 53% of HIV-positive women received antiretroviral drugs to prevent transmission of the virus to their children - a number that has more than doubled since 2006, yet only 26% of the estimated pregnant women living in low- and middle-income countries were tested for HIV in 2009, a 5% increase from 2008.
In Eastern and Southern Africa 68% of HIV-positive pregnant women received antiretrovirals in 2009, a 10% increase from 2008.
In North Africa and the Middle East the number is a scant 3%, up from 2% in 2008. This contrasts sharply to the Eastern Europe and Central Asia region where an estimated 94% of HIV-positive pregnant women received antiretrovirals to prevent mother-to-child transmission.
Twenty-seven low- and middle income countries (of 192 United Nations member states) reached the United Nations General Assembly Special Session on HIV/AIDS goal of reaching 80% of HIV testing and counselling of all pregnant women, up from 19 countries in 2008.
Paediatric HIV care and treatment
An estimated 2.5 million children under the age of 15 are living with HIV.
Only 28% of the estimated 1.27 million children in need of treatment (according to the revised WHO treatment guidelines) are getting treatment. Without treatment, approximately 50% will die before their second birthday.
Evidence suggests that AIDS-related deaths are at their highest at two to three months of age. While much is being done to implement and scale up early infant diagnosis, testing does not mean getting children onto treatment and keeping them in care.
Preventing Infection among adolescents and young people
In 2009, an estimated five million young people between the ages of 15 and 24 were living with HIV.
UNAIDS reported a decrease of more than 25% in HIV prevalence among those aged 15 to 24 between 2001 and 2008; the number of new infections in most parts of the world is falling or stabilising, according to UNAIDS .
In 2009 there were 890,000 new infections among 15 to 24 year olds.
Girls and women represent over 60% of all young people living with HIV globally, whereas in sub-Saharan Africa it is close to 70%.
“We need to address gender inequalities, including those that place women and girls at disproportionate risk to HIV and other adverse sexual and reproductive health outcomes,” said Irina Bokova, Director General of UNESCO. “While we are encouraged by a decline in HIV incidence among young people of more than 25%, we must do everything possible to sustain and increase such positive trends in order to achieve universal access to prevention, treatment, care and support.”
In nine countries in Southern Africa, it is estimated that at least one in 20 people aged 15 to 24 is living with HIV; in Botswana, Lesotho and Swaziland over one in 10 is.
The report stresses the need to recognise and address the realities of new infections in young people – sex, sexuality and injecting drug use.
Legal and policy barriers mean that adolescents may need parental consent before testing, so delaying or preventing testing and timely treatment.
Protection, care and support for children affected by HIV and AIDS
A median of 11% of households caring for orphans and vulnerable children between 2005 and 2009 received any kind of external support. The continuing poor economic climate adds to the additional stresses that poverty brings to the wellbeing of children affected by HIV.
The report highlights how child-sensitive social protection is a key and cost-effective intervention in reaching children affected by HIV; this can include:
social transfers (cash and in-kind transfers and vouchers)
improved school attendance
stregthening of community systems
investment in national monitoring and evaluation.
“We must increase investments in young people’s education and health, including sexual and reproductive health, to prevent HIV infections and advance social protection,” Thoraya Ahmed Obaid, Executive Director of UNFPA, said. “Reaching marginalized young people, including vulnerable adolescent girls and those who are not in school, must remain a priority.”
Call to action
Change the PMTCT focus from coverage of ARV prophylaxis to the health of mothers and the HIV-free survival of children.
Make exclusive breastfeeding safe and sustainable.
Identify HIV-positive newborns, children and young people without delay and provide rapid access to ART for those eligible.
Make children and adolescents central to the development and implementation of promising new prevention initiatives.
Redress low levels of knowledge about HIV.
Increase access of children and adolescents living on the margins of society to health, education and social welfare services.
Provide economic support to poor and vulnerable women, children and adolescents.
Prevent violence and abuse of women and girls and enforce laws against it.
Further information
The Fifth Stocktaking Report can be downloaded at www.uniteforchildren.org