Children

Faith communities and faith-based organizations have a long history of caring for children and adolescents living with and affected by HIV. However, these efforts have not been well documented and hence their contributions have not been well understood nor resourced. Until now.

UNAIDS and PEPFAR have co-published the Compendium of Promising Practices on the Role of African Faith Community Interventions to End Paediatric and Adolescent HIV which goes a long way to addressing this dearth of information. The Compendium documents 41 promising practices that provide evidence of the core roles that faith communities have played in identifying undiagnosed children living with HIV, improving continuity of treatment, supporting adolescents to access psychosocial support, care and treatment, and enabling peer support groups to empower children and adolescents living with HIV. It also documents how faith leaders have driven advocacy to tackle stigma and discrimination and pushed governments for targets to be achieved. Some specific promising practices include:

• In Zambia, by expanding integrated health service delivery through Health Posts within places of worship, more children were identified when tested for HIV in faith community sites compared with those tested in non-faith community sites, averaging 15% and 7%, respectively, for the semi-annual period in the 2021 Financial Year.
• In Nigeria, a congregation-based approach to HIV testing in pregnant women, using Baby Showers, found the intervention improved HIV testing among pregnant women (with 93% linkage) and their male partners, who were 12 times more likely to know their status, compared with partners of women giving birth who had not participated in the intervention.
• Religious leaders and faith-based organizations in several countries have enrolled as Faith Paediatric Champions and have strengthened community engagement through teams sometimes - Christian and Muslim - including religious leaders, youth leaders, as well as men’s and women’s group leaders. Faith Paediatric Champions have advocated to governments and community members for all children and adolescents to be supported to access HIV care and treatment.

The Compendium showcases the transformative impact of faith-based approaches, highlighting innovative strategies, programmes, and interventions that have saved lives and nurtured the well-being of young individuals. By combining the power of faith with evidence-based interventions, these organizations have created a synergy that reaches far beyond medical treatment. They have fostered a sense of belonging, love, and support, creating safe spaces where children and adolescents affected by HIV can find solace, guidance, and empowerment.

The global response to end AIDS in children continues to be inadequate. Every hour eleven children die of AIDS. 1.7 million children are living with HIV and while three quarters (76%) of adults living with HIV are on treatment, only half (52%) of children are. Children living with HIV are even more vulnerable than adults: while children constitute 4% of people living with HIV, they represent 15% of AIDS-related deaths. In their Foreword to the Compendium Winnie Byanyima, the Executive of UNAIDS and John Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy say: “It is a disgrace that the world is not on track to end AIDS in children” and they describe the inequality between adults and children as “heartbreaking.”

However, they also issue a rallying call: “We can end AIDS in children. We must end AIDS in children. Together, we will end AIDS in children. This informative, inspiring, Compendium will be used to save and change children’s lives.”

DAR ES SALAAM, 1 February 2023—Ministers and representatives from twelve African countries have committed themselves, and laid out their plans, to end AIDS in children by 2030. International partners have set out how they would support countries in delivering on those plans, which were issued at the first ministerial meeting of the Global Alliance to end AIDS in children.

The meeting hosted by the United Republic of Tanzania, marks a step up in action to ensure that all children with HIV have access to life saving treatment and that mothers living with HIV have babies free from HIV. The Alliance will work to drive progress over the next seven years, to ensure that the 2030 target is met.

Currently, around the world, a child dies from AIDS related causes every five minutes.

Only half (52%) of children living with HIV are on life-saving treatment, far behind adults of whom three quarters (76%) are receiving antiretrovirals.

In 2021,160 000 children newly acquired HIV. Children accounted for 15% of all AIDS-related deaths, despite the fact that only 4% of the total number of people living with HIV are children.

In partnership with networks of people living with HIV and community leaders, ministers laid out their action plans to help find and provide testing to more pregnant women and link them to care. The plans also involve finding and caring for infants and children living with HIV.

The Dar-es-Salaam Declaration on ending AIDS in children was endorsed unanimously.

Vice-President of the United Republic of Tanzania, Philip Mpango said, “Tanzania has showed its political engagement, now we need to commit moving forward as a collective whole. All of us in our capacities must have a role to play to end AIDS in children. The Global Alliance is the right direction, and we must not remain complacent. 2030 is at our doorstep.”

The First Lady of Namibia Monica Geingos agreed. “This gathering of leaders is uniting in a solemn vow – and a clear plan of action – to end AIDS in children once and for all,” she said. “There is no higher priority than this.”

Twelve countries with high HIV burdens have joined the alliance in the first phase: Angola, Cameroon, Côte d'Ivoire, the Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, the United Republic of Tanzania, Uganda, Zambia, and Zimbabwe.

The work will centre on four pillars across:

1. Early testing and optimal treatment and care for infants, children, and adolescents;
2. Closing the treatment gap for pregnant and breastfeeding women living with HIV, to eliminate vertical transmission;
3. Preventing new HIV infections among pregnant and breastfeeding adolescent girls and women; and
4. Addressing rights, gender equality and the social and structural barriers that hinder access to services.

UNICEF welcomed the leaders’ commitments and pledged their support. "Every child has the right to a healthy and hopeful future, but for more than half of children living with HIV, that future is threatened," said UNICEF Associate Director Anurita Bains. "We cannot let children continue to be left behind in the global response to HIV and AIDS. Governments and partners can count on UNICEF to be there every step of the way. This includes work to integrate HIV services into primary health care and strengthen the capacity of local health systems."

“This meeting has given me hope,” said Winnie Byanyima, Executive Director of UNAIDS. “An inequality that breaks my heart is that against children living with HIV, and leaders today have set out their commitment to the determined action needed to put it right. As the leaders noted, with the science that we have today, no baby needs to be born with HIV or get infected during breastfeeding, and no child living with HIV needs to be without treatment. The leaders were clear: they will close the treatment gap for children to save children’s lives.”

WHO set out its commitment to health for all, leaving no children in need of HIV treatment behind. “More than 40 years since AIDS first emerged, we have come a long way in preventing infections among children and increasing access to treatment, but progress has stalled,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The Global Alliance to End AIDS in Children is a much-needed initiative to reinvigorate progress. WHO is committed to supporting countries with the technical leadership and policy implementation to realise our shared vision of ending AIDS in children by 2030.”

Peter Sands, Executive Director of The Global Fund, said, “In 2023, no child should be born with HIV, and no child should die from an AIDS-related illness. Let’s seize this opportunity to work in partnership to make sure the action plans endorsed today are translated into concrete steps and implemented at scale. Together, led by communities most affected by HIV, we know we can achieve remarkable results.”

PEPFAR's John Nkengasong, U.S. Global AIDS Coordinator, said he remains confident. "Closing the gap for children will require laser focus and a steadfast commitment to hold ourselves, governments, and all partners accountable for results. In partnership with the Global Alliance, PEPFAR commits to elevate the HIV/AIDS children's agenda to the highest political level within and across countries to mobilize the necessary support needed to address rights, gender equality and the social and structural barriers that hinder access to prevention and treatment services for children and their families."

EGPAF President and CEO, Chip Lyons, said that the plans shared, if implemented, would mean children were no longer left behind. “Often, services for children are set aside when budgets are tight or other challenges stand in the way. Today, African leaders endorsed detailed plans to end AIDS in children – now is the time for us all to commit to speaking up for children so that they are both prioritized and included in the HIV response.”

Delegates emphasized the importance of a grounds-up approach with local, national and regional stakeholders taking ownership of the initiative, and engagement of a broad set of partners. The alliance has engaged support from Africa REACH and other diverse partners and welcomes all countries to join.

“We have helped shape the Global Alliance and have ensured that human rights, community engagement and gender equality are pillars of the Alliance,” said Lilian Mworeko, Executive Director of the International Community of Women living with HIV in Eastern Africa on behalf of ICW, Y+ Global and GNP+. “We believe a women-led response is key to ending AIDS in children.”

Progress is possible. Sixteen countries and territories have already been certified for validation of eliminating vertical transmission of HIV and/or syphilis; while HIV and other infections can pass from a mother to child during pregnancy or while breastfeeding, such transmission can be interrupted with prompt HIV treatment for pregnant women living with HIV or pre-exposure prophylaxis (PrEP) for mothers at risk of HIV infection.

Last year Botswana was the first African country with high HIV prevalence to be validated as being on the path to eliminating vertical transmission of HIV, which means the country had fewer than 500 new HIV infections among babies per 100 000 births. The vertical transmission rate in the country was 2% versus 10% a decade ago.

UNAIDS, networks of people living with HIV, UNICEF and WHO together with technical partners, PEPFAR and The Global Fund unveiled the Global Alliance to end AIDS in children in July 2022 at the AIDS conference in Montreal, Canada. Now, at its first ministerial meeting, African leaders have set out how the Alliance will deliver on the promise to end AIDS in children by 2030.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Estimates indicate that in Indonesia in 2021, only 25% of the 19,000 children living with HIV received life-saving antiretroviral therapy and 2,400 children died from AIDS-related causes.

Despite global scientific breakthroughs providing more effective treatment for adults and children, for many children living with HIV in Indonesia access to antiretroviral therapy remains elusive.  Exacerbating the situation is the entrenched societal and gender inequalities that present barriers to women, adolescents and children to access quality prevention and care services.  

With many competing priorities, national and local commitment of resources to scale-up efforts to eliminate vertical transmission of HIV and increase ARV coverage among children living with HIV remain limited. This has resulted in insufficient investment in community-based services for women, adolescents and children living with HIV.

To reduce AIDS-related deaths among children, and ensure children and adolescents living with HIV have access to high quality comprehensive care and support, Indonesia must expand community-based services and community-led programmes tailored to the needs of these very vulnerable yet often left-out groups.

Lentara Anak Pelangi (LAP), an organization that provides HIV services, including psychosocial support, for children and adolescents living with HIV in Jakarta has seen some successes through their One Child One Life program.

“We want these adolescents to be the next generation of positive leaders and influencers who inspire other teens living with HIV” said Prof. Irwanto, founder of Lentera Anak Pelangi.

The One Child One Life program provides disclosure and post-disclosure support, mental health assessment and care as well as education.

“Lentera Anak Pelangi has supported my daughter since she was very young. LAP’s in-person and online activities have been very helpful for her. Through Sekolah LAP, my daughter has started to learn how to build her self-confidence and open her mind to learn more things. I also learned the meaning of this illness and find friends facing the same struggle and fight to continue to be healthy,” Explained the mother of one LAP beneficiary.

“My son and I have been greatly helped by LAP’s education support. During the pandemic, we often received sembako (staple foods). My son loves to be part of LAP because he gets to meets other teens who share similar circumstances. We also receive information on how to provide care for our family,” another mother said.

Through the One Child One Life program, children living with HIV have been supported to suppress their HIV viral load, return to school and participate in youth support groups.  LAP also supports children with special needs and supplemental nutritional support when required. However, their coverage remains small due to funding and human resource constraints.

“Science has made it possible to diagnose and treat HIV. We have come a really long way in 40 years. In Indonesia, we must eliminate vertical transmission of HIV and ensure that all children living with HIV access life-saving antiretroviral therapy and quality care including psychosocial support when needed.” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.”

UNAIDS Indonesia together with Lentera Anak Pelangi and other implementing partners continue to call for optimized investments in community-based services and community-led programmes for women, adolescents and children living with HIV. 

In December 2021, Botswana became the first high HIV burden country to be certified by the WHO Global Validation Advisory Committee (GVAC) as having achieved a critical milestone along the path to eliminating vertical HIV transmission. As striking as what Botswana has achieved, however, is how it went about documenting this achievement—using the certification process as an avenue to empower women living with HIV and reinforce their fundamental rights.¹

Botswana is the first high HIV burden country to be certified for achieving the required indicators for the Silver Tier on the “Path to Elimination of HIV” criteria that were introduced in 2017. The Silver Tier requires an HIV case rate of fewer than 500 per 100 000 live births, a vertical HIV transmission rate of under 5% and the provision of antenatal care and antiretroviral treatment to more than 90% of pregnant women.

UNAIDS data show that over 95% of pregnant women in Botswana were receiving antiretroviral therapy in 2021, up from 77% in 2010. Vertical transmission rates were only 2.2%, down from 9.0% a decade earlier. According to a woman living with HIV in Kgalagadi South, “I have three children...I breastfed all three, and all of them were given medication for prevention of HIV.”

Botswana placed women living with HIV at the centre of the process of documenting the country’s prevention success. With the support of UNAIDS, the International Community of Women living with HIV oriented networks of women living with HIV to administer the human rights assessment tool to their networks in 10 of Botswana’s districts.² These networks led the process, and the Government of Botswana provided logistical support to ensure the engagement of women living with HIV within a safe space. Women living with HIV, who are represented on the National Validation Committee, also reviewed a draft of the national validation report.

GVAC validated that Botswana’s programmes and services to eliminate vertical HIV transmission are consistent with international, regional and national standards on human rights, gender equality and community engagement. As one woman living with HIV in Kweneng West remarked, “the nurses and health-care officers give the option for all to test-and-treat. It is always a clear choice, and not a forced one.”

95% OF PREGNANT WOMEN IN BOTSWANA WERE RECEIVING ANTIRETROVIRAL THERAPY IN 2021

The Botswana Ministry of Health, with the engagement of women living with HIV and the support of the Joint Programme, convened a workshop in May 2022 to foster partner and stakeholder involvement for ensuring that rights-based approaches are used to maintain the country’s Silver Tier certification—and its possible progression to the Gold Tier.

¹ As of December 2021, 15 countries and territories—Anguilla, Antigua and Barbuda, Armenia (HIV only), Belarus, Ber- muda, Cayman Islands, Cuba, Dominica, Malaysia, the Maldives, the Republic of Moldova (syphilis only), Montserrat, Sri Lanka, St Kitts and Nevis and Thailand—have been certified for eliminating vertical HIV and syphilis transmission. Countries apply using standardized criteria for the assessment of programme performance, data and laboratory sys- tems, and they ensure the integration of human rights, gender equality and community engagement under a process overseen by the United Nations Children’s Fund (UNICEF), UNFPA, WHO and UNAIDS.

² These included the Botswana Network of People Living with HIV (BONEPWA+), Bomme Isago (a local partner of the International Community of Women living with HIV) and the Botswana Network on Ethics, Law and HIV/AIDS (BONELA).

The path to elimination of vertical transmission of HIV

• PATH TO ELIMINATION VALIDATION
  • BRONZE: 90% antenatal care coverage (at least one visit), 90% HIV testing coverage among pregnant women, 90% antiretroviral treatment coverage among pregnant women living with HIV Case rate of new paediatric HIV infections due to MTCT^a of ≤750 cases per 100 000 live births MTCT rate <5%
  • SILVER: 90% antenatal care coverage (at least one visit), 90% HIV testing coverage among pregnant women, 90% antiretroviral treatment coverage among pregnant women living with HIV Case rate of new paediatric HIV infections due to MTCT of ≤500 cases per 100 000 live births MTCT rate <5%
  • GOLD: 95% antenatal care coverage (at least one visit), 95% HIV testing coverage among pregnant women, 95% antiretroviral treatment coverage among pregnant women living with HIV Case rate of new paediatric HIV infections due to MTCT of ≤250 cases per 100 000 live births MTCT rate <5%
• FULL VALIDATION: 95% antenatal care coverage (at least one visit), 95% HIV testing coverage among pregnant women, 95% antiretroviral treatment coverage among pregnant women living with HIV Case rate of new paediatric HIV infections due to MTCT of ≤50/100 000 cases per 100 000 live births MTCT rate <5%

Source: Adapted from: Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus. Geneva: WHO; 2021 (https://www.who.int/publications/i/item/9789240039360).

^a MTCT = mother-to-child transmission of HIV.

Globally, only half (52%) of children living with HIV are on life-saving treatment. UNAIDS, UNICEF, and WHO have brought together a new alliance to fix one of the most glaring disparities in the AIDS response.

MONTREAL/GENEVA/NEW YORK, 1 August 2022 – Globally, only half (52%) of children living with HIV are on life-saving treatment, far behind adults where three quarters (76%) are receiving antiretrovirals, according to the data that has just been released in the UNAIDS Global AIDS Update 2022. Concerned by the stalling of progress for children, and the widening gap between children and adults, UNAIDS, UNICEF, WHO and partners have brought together a global alliance to ensure that no child living with HIV is denied treatment by the end of the decade and to prevent new infant HIV infections.

The new Global Alliance for Ending AIDS in Children by 2030 was announced by leading figures at the International AIDS Conference taking place in Montreal, Canada.

In addition to the United Nations agencies, the alliance includes civil society movements, including the Global Network of People living with HIV, national governments in the most affected countries, and international partners, including PEPFAR and the Global Fund. Twelve countries have joined the alliance in the first phase: Angola, Cameroon, Côte d'Ivoire, The Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

Consultations by the alliance have identified four pillars for collective action:

1. Closing the treatment gap for pregnant and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment;
2. Preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women;
3. Accessible testing, optimized treatment, and comprehensive care for infants, children, and adolescents exposed to and living with HIV;
4. Addressing rights, gender equality, and the social and structural barriers that hinder access to services. 

Addressing the International AIDS Conference, Limpho Nteko from Lesotho shared how she had discovered she was HIV positive at age 21 while pregnant with her first child. This led her on a journey where she now works for the pioneering women-led mothers2mothers programme. Enabling community leadership, she highlighted, is key to an effective response.

“We must all sprint together to end AIDS in children by 2030,” said Ms. Nteko. “To succeed, we need a healthy, informed generation of young people who feel free to talk about HIV, and to get the services and support they need to protect themselves and their children from HIV. mothers2mothers has achieved virtual elimination of mother-to-child transmission of HIV for our enrolled clients for eight consecutive years—showing what is possible when we let women and communities create solutions tailored to their realities.” 

The alliance will run for the next eight years until 2030, aiming to fix one of the most glaring disparities in the AIDS response. Alliance members are united in the assessment that the challenge is surmountable through partnership.

“The wide gap in treatment coverage between children and adults is an outrage,” said UNAIDS Executive Director Winnie Byanyima. “Through this alliance, we will channel that outrage into action. By bringing together new improved medicines, new political commitment, and the determined activism of communities, we can be the generation who end AIDS in children. We can win this – but we can only win together.”

"Despite progress to reduce vertical transmission, increase testing and treatment, and expand access to information, children around the world are still far less likely than adults to have access to HIV prevention, care, and treatment services," said UNICEF Executive Director Catherine Russell. "The launch of the Global Alliance to End AIDS in Children is an important step forward – and UNICEF is committed to working alongside all of our partners to achieve an AIDS-free future."

“No child should be born with or grow up with HIV, and no child with HIV should go without treatment,” said Dr Tedros Adhanom Gheberyesus, WHO Director-General. “The fact that only half of children with HIV receive antiretrovirals is a scandal, and a stain on our collective conscience. The Global Alliance to End AIDS in Children is an opportunity to renew our commitment to children and their families to unite, to speak and to act with purpose and in solidarity with all mothers, children and adolescents.”

Dr. Osagie Ehanire, Minister of Health of Nigeria, pledged to “change the lives of children left behind” by putting in place the systems needed to ensure that health services meet the needs of children living with HIV.

Nigeria, Dr Ehanire announced, will host the alliance’s political launch in Africa at a Ministerial meeting in October 2022.

About UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. Follow UNICEF on Twitter and Facebook.

About WHO

Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues, and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable. Learn more at www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube, and Twitch.