Children

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.

MONTREAL, 30 July 2022—More than two decades ago at the 13^th International AIDS Conference (IAS) in Durban, Nkosi Johnson from South Africa stood up as the first child to speak publicly about HIV.

”Hello, my name is Nkosi Johnson, I am 11 years old and I have full-blown AIDS,” he said in front of a packed auditorium.

“I get very sad when I think of all the other children and babies that are sick with AIDS. ​I just wish that the government could start giving HIV treatment to pregnant HIV+ mothers to help stop the virus being passed on to their babies.”

Since Nkosi’s call for help in 2000, remarkable progress has been made. In a decade, coverage of HIV treatment to prevent vertical transmission for pregnant women living with HIV has increased to 85% from 45% and there has been a 53% reduction in new child HIV infections.

Last year, Botswana became the first high-burden country to be certified by the World Health Organization (WHO) for achieving an important milestone on the path to eliminating vertical transmission of HIV from mother to child.

But it’s still not enough.

Global targets towards reaching an AIDS-free generation have been missed year after year. In 2020, there were 1.7 million children living with HIV globally, almost half (46%) of whom were not receiving life-saving HIV treatment. In the same year there were 150 000 new HIV infections among children.

On the sidelines of this year’s IAS conference in Montreal, UNAIDS, networks of people living with HIV, UNICEF and WHO, together with technical partners, PEPFAR and The Global Fund are launching a new Global Alliance to End AIDS in children by 2030. The Alliance will be co-created with the broad participation of stakeholders, national governments, implementing agencies, regional and country-based organizations, faith-based and community partners including women, children and youth living with HIV. The aim is to measure and coordinate progress towards the bold targets of the Sustainable Development Goals (SDGs) and mobilize leadership, funding and action to end AIDS in children by 2030 by tracking work globally, regionally, nationally and at community levels.

“It is unacceptable that children are lagging far behind adults in accessing HIV treatment and that progress on eliminating vertical transmission has stalled in recent years,” said Winnie Byanyima, Executive Director of UNAIDS.

“The committee of co-sponsoring organizations of UNAIDS has approved the Global Alliance to End AIDS in children by 2030, co-led by UNAIDS, WHO and UNICEF as a Global Strategic Initiative. We are united in our commitment to reach this goal,” she added.

Most of these new infections could have been prevented if adolescent girls and women had universal access to HIV testing, prevention and treatment services and the support they need to stay in prevention care or on HIV treatment throughout pregnancy and breastfeeding. In addition, stigma, discrimination, punitive laws and policies, violence and entrenched societal and gender inequalities hinder access to care for women, adolescents and children.

Renewed political commitment and leadership is needed to eliminate vertical transmission and end AIDS in children once and for all. The launch of a new Global AIDS Strategy in 2021 and the Political Declaration on HIV and AIDS provide an opportunity to redirect global attention and redouble efforts to end AIDS in children

GENEVA, 30 March 2022—In the lead-up to the International Transgender Day of Visibility, on 31 March, UNAIDS has launched an initiative to raise awareness among parents, teachers and the wider community about gender identity during childhood.

The Unbox Me campaign advocates for the rights of transgender children. Most children love to have boxes or hidden places in which they can hide precious trinkets or prized possessions safely and securely. The hidden objects can reveal a lot about the child—who he or she is, what he or she likes and what his or her dreams are. For some transgender children, this act of hiding treasures in a box becomes a way of hiding their identity from disapproving eyes. Unbox Me is about giving transgender children visibility. It is a call for inclusion and acceptance.

In India, more than 90% of transgender people leave their homes or are thrown out by the age of 15 years. Inevitably, many live on the street with no money or education, often relying on sex work. Despite the campaign originating from India, its theme of acceptance and inclusion is universal.

Transgender people around the world are often marginalized and experience discrimination and violence. As a result, transgender people have a 34 times greater risk of acquiring HIV than other adults. Up to 24 countries in the world criminalize or prosecute transgender people. For example, early in the COVID-19 response, some governments instituted gender-specific mobility days during lockdowns, which resulted in arrests against transgender people out on the “wrong” day.

Stigma, discrimination and criminalization tend to make transgender and gender-diverse people invisible, with extreme forms of discrimination leading to even the denial of the existence of gender-diverse people.

This campaign is part of an ongoing UNAIDS collaboration with advertising agency FCB India. Last year, UNAIDS partnered with FCB and released a successful short film, The Mirror, as part of the #SeeMeAsIAm campaign about a young boy looking in the mirror and dressing up as a woman. The film served to raise awareness among parents, teachers and the wider community about gender identity during childhood. Building on the film, Unbox Me seeks to bring home the reality of the many transgender children who are denied their true identity. 

Swati Bhattacharya, FCB India’s Creative Chairperson, who conceptualized this campaign, said, “In India, children usually have a box which they use to store their most precious possessions, but in the case of transgender children they need to hide their box of treasures, since some of their most precious possessions don’t fit the gender norm that society expects them to conform to.”

UNAIDS works closely with the transgender community, civil society organizations and governments all around the world to decriminalize transgender people, secure their rights and ensure that they have access to health, education and social protection and that they are protected from abuse and exploitation.

“Many of us take our gender identity for granted, but for many children it is not so easy. It’s a matter of daily survival, a daily struggle,” said Mahesh Mahalingam, the UNAIDS Director of Communications and Global Advocacy. “Children all around the world must be supported in expressing their identity freely.”

In India, the Unbox Me campaign has garnered support among the education community. Teachers in many schools across India are using the boxes featured in the campaign as a conversation starter to raise awareness about gender identity.

Many prominent personalities and community leaders have also participated in the Unbox Me campaign, notably Indian film director Zoya Akhtar and television anchor Barkha Dutt.

UNAIDS is now extending the campaign to the global level.

If you would like to participate in the campaign or share your thoughts, contact UNAIDS at Communications@unaids.org.

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.

Experiences of violence too often occur early in life. Violence in childhood has been linked to increased risks of: HIV and other sexually transmitted infections; mental health problems; delayed cognitive development; poor school performance and dropout; early pregnancy; reproductive health problems; communicable and noncommunicable diseases; and injury.

Among the 11 countries with available data between 2016 and 2020, violence (physical, sexual and/or emotional) experienced within the past 12 months by children (aged 13 to 17 years) ranged from 19.2% in the Republic of Moldova and Zimbabwe to 65.4% in Uganda among males, and from 17.7% in the Republic of Moldova to 57.5% in Uganda among females.

The percentage of young people (aged 18 to 24 years) who experienced one or more types of violence during childhood (before the age of 18) is high across all 11 countries with available data between 2016 and 2020, ranging from 26.3% in Zimbabwe to 75.6% in Uganda among males, and from 26.5% in Zimbabwe to 75.3% in Uganda among females.

Most of the 150 000 new HIV infections among children in 2020 could have been prevented. A strong start would be to better engage women and girls at significant risk of acquiring HIV infection in integrated antenatal care and HIV services, including HIV prevention and testing, delivered at the local level, and to ensure that those who are HIV-positive receive treatment before pregnancy. Nearly 65 000 child infections occurred in 2020 because women already living with HIV were not diagnosed during pregnancy and did not start treatment.

More than 35 000 additional child infections occurred because women acquired HIV during pregnancy or breastfeeding, which led to a spike in their viral load and a high risk of vertical transmission. Women at substantial risk of HIV infection require tailored combination HIV prevention, including pre-exposure prophylaxis, more comprehensive counselling, repeat HIV testing and the provision of self-testing kits for partners.

More than 38 000 additional child infections occurred when mothers who started antiretroviral therapy did not continue treatment during pregnancy and breastfeeding, and nearly 14 000 occurred among women who were on treatment but not virally suppressed. Improving the quality of treatment and care—including the use of optimized treatment regimens and peer-assisted retention efforts (such as mentor mothers)—can help close these gaps.