Children

Treatment coverage among children living with HIV lags behind adult treatment coverage in most of the sub-Saharan African countries with large HIV epidemics. Across all countries, treatment coverage among children living with HIV in 2019 was just 53% [36–64%], representing a global failure to provide life-sustaining care to 840 000 of the 1.8 million [1.3 million–2.2 million] children living with HIV.

As vertical infections decline, the proportion of children aged 5–14 years who are living with HIV has increased. Of the estimated 840 000 children living with HIV not on treatment in 2019, 560 000 of them were between the ages of 5 and 14 years. Efforts to find and treat these undiagnosed children living with HIV must be accelerated. One strategy is to ensure that children who have lost one or both parents to AIDS-related illnesses have been reached by integrating HIV testing services into programmes supporting orphans and other vulnerable children.

In addition, studies indicate that large proportions of people enrolled on HIV treatment have family members, including children, whose HIV status is unknown. Testing those family members through index testing that is rights-based and gender-sensitive can be an effective strategy for identifying older children living with HIV. Index family testing also improves timely linkages to care, with initiation rates of 42–96% reported in various studies. Such family-based approaches also enable parents and their children to access care jointly, which can improve retention.

Faith-based organizations play a key role in all areas of the HIV response and provide a significant part of HIV-related health care through their networks of hospitals, clinics and community systems, particularly in high-burden countries. For this reason, UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) launched a joint initiative to capitalize on the global and national leadership of faith-based organizations and to harness the power that a network of faith-based organizations could offer in some countries, including Côte d’Ivoire.

The UNAIDS–PEPFAR faith-based initiative was launched in Côte d’Ivoire on 14 October 2020 under the leadership of the Ministry of Health and Public Hygiene through the national AIDS control programme.

Following the national launch, several activities were initiated in the country as part of the initiative. These include the ongoing development of the Faith-Based Action Plan, under the leadership of the national AIDS control programme, which aims to ensure effective coordination and close monitoring of programmes, as well as synergy and complementarity in their implementation.

Caritas Côte d’Ivoire, which is a member of Caritas Internationalis, the organization in charge of implementing the social doctrine of the Catholic Church at the global and country levels, launched the GRAIL (Galvanizing Religious Actors for Better Identification and Linkage to Paediatric HIV) project on 9 February. This project will strengthen the involvement of faith-based organizations in accelerating the early diagnosis and treatment of children living with HIV in Côte d’Ivoire.

During the launch of the GRAIL project, a representative of the Ministry of Health and Public Hygiene welcomed the commitment of the Catholic Church in the national response to HIV and recalled the place of paediatric AIDS in national priorities.

“The COVID-19 pandemic that we are facing is a very worrying health and social emergency that requires a strong response. Many of the people affected are children living with HIV,” said Bruno Yedoh Essoh, the President of Caritas Côte d’Ivoire.

“Gaps in the diagnosis and care of children living with HIV are notable and an effective national partnership with faith-based organizations in Côte d’Ivoire can help fill these gaps,” said Jean-François Somé, a UNAIDS PEPFAR/Global Fund to Fight AIDS, Tuberculosis and Malaria Implementation Adviser who represented UNAIDS at the launch.

The GRAIL project will focus on training religious leaders and faith-based health service providers on paediatric HIV and on actions to reduce stigma and discrimination against people living with HIV, including children. The first session of a training workshop for religious leaders and faith-based health service providers on paediatric AIDS started immediately after the launch of the GRAIL project. Other training sessions are planned around the country.

Global partners that are committed to ending paediatric AIDS have come together to call on countries to rapidly scale up access to optimal, child-friendly HIV treatment for infants and children. The partners include the United Nations Children’s Fund, the World Health Organization (WHO), UNAIDS, the United States President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, the Elizabeth Glaser Pediatric AIDS Foundation, and the Clinton Health Access Initiative (CHAI).

Children living with HIV continue to be left behind by the global AIDS response. In 2019, only 53% (950 000) of the 1.8 million children living with HIV (aged 0–14 years) globally were diagnosed and on treatment, compared to 68% of adults. [1] The remaining 850 000 children living with HIV have not been diagnosed and are not receiving life-saving HIV treatment. Two thirds of the missing children are aged 5–14 years and do not routinely attend traditional health facilities. Engaging communities and the families of people living with HIV, tuberculosis and other related diseases and offering family services are needed in order to find and start on treatment those missing children.

An estimated 95 000 children died of AIDS-related illnesses in 2019, in part due to lack of early diagnosis of HIV among infants and children and immediate linkage to optimal HIV treatment regimens. Untreated, 50% of infants infected with HIV during or around the time of birth will die before the age of two years. [1]

The United States Food and Drug Administration recently gave tentative approval for the first generic formulation of dolutegravir (DTG) 10 mg dispersible tablets. [2] This approval was the result of an innovative partnership between Unitaid, CHAI and ViiV Healthcare, together with generic suppliers, which accelerated the timeline of development by several years. The approval was quickly followed by the announcement on World AIDS Day of a groundbreaking agreement negotiated by Unitaid and CHAI that reduces the cost of HIV treatment by 75% for children in low- and middle-income countries, where the DTG 10 mg dispersible tablets will be available at a cost of US$ 4.50 for a 90-count bottle. [3] 

This now means that WHO-recommended, preferred first-line DTG-based antiretroviral treatment is now available in more affordable and child-friendly generic formulations for young children and infants as young as four weeks of age and weighing more than 3 kg. [4]  Rapid transition to this treatment, in combination with improved HIV diagnosis for children and other supportive measures, will help to urgently reduce the 95 000 preventable AIDS-related deaths in children.

DTG-based HIV treatment leads to better outcomes for children. DTG is less likely to be affected by drug resistance and achieves viral load suppression sooner; child-friendly dispersible tablets improve adherence due to a lower pill burden and being easier to administer. These factors help children achieve and maintain viral load suppression, the gold standard for measuring the effectiveness of HIV treatment. DTG-based treatment is the standard of care for adults. Starting on this regimen from infancy reduces the need for changes in treatment as they mature through childhood, adolescence and adulthood. Fewer regimens and regimen changes simplifies management of health care, improves stock management and reduces wastage. 

WHO has recommended DTG-based HIV treatment for all infants and children since 2018 [4] and provided dosing recommendations for infants and children over four weeks of age and more than 3 kg in July 2020. [5]

Suppliers have indicated their ability to meet global scale-up ambitions. Accurate forecasts of demand are critical to inform production planning and delivery timelines. It is therefore critical that national programmes start including DTG 10 mg dispersible tablets in their new procurement plans, review stocks and orders for existing non-DTG treatment for children, share forecasts with HIV treatment procurement partners and suppliers and place orders as early as possible.

The partners are committed to support national governments as they develop rapid transition plans from existing suboptimal HIV treatment to DTG-based treatment for infants and children, including advocacy for political commitment, mobilizing international and domestic resources, new policies and guidelines, managing medicine supply, distribution and stock, training health-care workers and sensitizing and engaging affected communities to ensure demand and treatment literacy for children living with HIV and their caregivers in order to ensure rapid uptake of these new formulations.

Further guidance for national programmes and partners is available from WHO. [5] The CHAI HIV New Product Introduction Toolkit has dedicated resources to help countries transition to paediatric DTG. [6]

Quotes from partners

“National governments, partners on the ground and affected communities need to work together to find and treat the children and infants whose lives can be saved by these new medicines,” said Shannon Hader, UNAIDS Deputy Executive Director for Programme. “The new medicines are cheaper, more effective and more child-friendly than current treatments for infants and young children. We need to get them into clinics to save lives now.”

“The United States President’s Emergency Plan for AIDS Relief works tirelessly to ensure clients can access the best available HIV treatment, including advanced, paediatric regimens for children living with HIV,” said Deborah L. Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy. “The accelerated introduction and expansion of paediatric DTG has the potential to save and improve the lives of thousands of children around the world. The United States President’s Emergency Plan for AIDS Relief will continue to collaborate with global and local partners to ensure the young children we serve can promptly access paediatric DTG.”

“Providing antiretroviral drugs to people living with HIV is at the core of our support to national HIV programmes,” said Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “This new and affordable child-friendly HIV treatment is a tremendous step forward that will improve and save the lives of some of the most vulnerable in society—young children infected with HIV. We are committed to support countries to make a fast transition to these new drugs.”

“Children in low- and middle-income countries often wait years to access the same medications as adults, hindering their quality of life, or even resulting in preventable deaths. We are proud to have worked with partners on this groundbreaking agreement that will bring quality assured dispersible DTG to children at a record pace,” said Philippe Duneton, Unitaid Executive Director. “Ensuring access to this treatment will transform the lives of children living with HIV, helping them to remain on treatment and saving thousands of lives.”

“For the first time, children living with HIV in low- and middle-income countries will have access to the same first-line antiretroviral medication at the same time as those in high-income countries,” said Iain Barton, Chief Executive Officer of the Clinton Health Access Initiative. “The partnership should serve as a model to remove barriers that hinder development of paediatric formulations to deliver top-line medications quickly and affordably.”

“The persistent treatment gap between adults and children prevents us from achieving an AIDS-free generation,” said Chip Lyons, President and Chief Executive Officer of the Elizabeth Glaser Pediatric AIDS Foundation. “Children living with HIV around the world urgently require age-appropriate, effective and accessible formulations. Approval of dispersible DTG is a momentous step forward, but meaningless if this new formulation doesn’t quickly reach the babies and small children who desperately need it most. The Elizabeth Glaser Pediatric AIDS Foundation is committed to supporting accelerated roll-out, uptake and delivery of new, optimal paediatric antiretroviral medicines in partnership with global, regional and local leaders.”

“The persisting treatment gap between mothers and children is unacceptable with the new scientific breakthroughs that are within our reach to change the trajectory”, said Chewe Luo, Associate Director and Chief of HIV, United Nations Children’s Fund. “The United Nations Children’s Fund welcomes global commitments and progress made in developing better diagnostic approaches and optimal regimens for children to improve their outcomes.”

“This has the potential to be a true game-changer for children with HIV", said Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes at WHO. “We must do all in our power to help countries get this new paediatric DTG 10 mg to all the children who need it."

[1] UNAIDS. Start Free Stay Free AIDS Free - 2020 report. 07 July 2020. https://www.unaids.org/en/resources/documents/2020/start-free-stay-free-aids-free-2020-progress-report

[2] https://www.accessdata.fda.gov/drugsatfda_docs/pepfar/214521PI.pdf

[3] UNITAID press release. Groundbreaking Agreement Reduces by 75% the Cost of HIV Treatment for Children in Low-and Middle-Income Countries. https://unitaid.org/news-blog/groundbreaking-agreement-reduces-by-75-the-cost-of-hiv-treatment-for-children-in-low-and-middle-income-countries/#en 

[4] World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. Interim guidance. 1 December 2018, https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51.

[5] World Health Organization. Considerations for introducing new antiretroviral drug formulations for children. Policy brief. 1 July 2020, https://www.who.int/publications/i/item/9789240007888.

[6] Clinton Health Access Initiative. HIV new product introduction toolkit. Pediatric 10 mg dispersible, scored resources, https://www.newhivdrugs.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.

On World AIDS Day, the UNAIDS Executive Director visited an HIV community village and a children’s hospital

Kinshasa, 2 December 2020—UNAIDS Executive Director Winnie Byanyima visited an HIV community village in Kinshasa as part of the World AIDS Day ceremonies in the capital of the Democratic Republic of the Congo. She commended the country on its vast experience in responding to pandemics such as Ebola after the country announced the end of the latest Ebola outbreak on 18 November.

“I thank the Congolese government, our friends from civil society and partners who together have enabled the country to respond to its many challenges, particularly HIV, Ebola and now COVID-19,” said Ms Byanyima.

Ms Byanyima stressed that more people in the country need life-saving HIV treatment and that more needs to be done to support women in particular. “Despite considerable progress, only 57% of people living with HIV are on antiretroviral therapy,” Ms Byanyima said. “Coverage of antiretroviral therapy is higher among men (72%) than among women (51%), a real sign of gender inequality.” She added that if women do not feel safe to disclose their HIV status or feel that they will be supported or accepted if they are living with HIV, they will not enrol onto HIV treatment.

Out of the 520 000 people living with HIV in the Democratic Republic of the Congo, more than 64% are women. There are 68 000 children under the age of 14 years who are living with HIV in the country, of whom only 25% are on treatment, which is why Ms Byanyima called on the country to accelerate paediatric care, including HIV services.

At the Kalembelembe Children’s Hospital she spoke to staff and adolescents who have grown up accessing care and support at its paediatric centre. The adolescents asked the Executive Director to continue to advocate for funding to maintain peer support groups for adolescents living with HIV, the elimination of user fees, the inclusion of all adolescents living with HIV in education and the elimination of legal barriers requiring parental consent for HIV testing for adolescents.

HIV in the Democratic Republic of the Congo, like in the rest of sub-Saharan Africa, particularly affects young women. Ms Byanyima reiterated that to end AIDS, the focus must be put on women and girls. “Every week, 4500 young women in sub-Saharan Africa are infected with HIV,” she said. “This is unacceptable, we need to make a radical difference in the response to HIV.”

Upon her arrival in Kinshasa, Ms Byanyima met with the Minister of Health, Eteni Longondo. She congratulated him on his leadership in responding to COVID-19 and shared her concerns about keeping HIV at the top of the agenda, despite the multitude of pressures of the three colliding pandemics of Ebola, HIV and COVID-19. 

AIDS-related deaths in the Democratic Republic of the Congo have dropped by 61% in the past 10 years, from 37 000 in 2010 to 15 000 in 2019.  HIV prevalence hovers around 1% among adults, but 23 000 people became newly infected with HIV last year. 

Bold ambitious targets

UNAIDS’ new report, Prevailing against pandemics by putting people at the centre, calls on countries to make far greater investments in global pandemic responses and to adopt a new set of bold, ambitious but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.

The global AIDS response was off track before the COVID-19 pandemic hit, but the rapid spread of the coronavirus has created additional setbacks. Modelling of the pandemic’s long-term impact on the HIV response shows that there could be an estimated 123 000 to 293 000 additional new HIV infections and 69 000 to 148 000 additional AIDS-related deaths between 2020 and 2022.

“The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” said Winnie Byanyima, Executive Director of UNAIDS. “Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”

Getting back on track

Although some countries in sub-Saharan Africa, such as Botswana and Eswatini, have done remarkably well and have achieved or even exceeded the HIV targets set for 2020, many more countries are falling way behind. The high-performing countries have created a path for others to follow. UNAIDS has worked with its partners to distil those lessons into a set of proposed targets for 2025 that take a people-centred approach.

The targets focus on a high coverage of HIV and reproductive and sexual health services together with the removal of punitive laws and policies and on reducing stigma and discrimination. They put people at the centre, especially the people most at risk and the marginalized—young women and girls, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men.

New HIV service delivery targets aim at achieving a 95% coverage for each sub-population of people living with and at increased risk of HIV. By taking a person-centred approach and focusing on the hotspots, countries will be better placed to control their epidemics.

The 2025 targets also require ensuring a conducive environment for an effective HIV response and include ambitious antidiscrimination targets so that less than 10% of countries have punitive laws and policies, less than 10% of people living with and affected by HIV experience stigma and discrimination and less than 10% experience gender inequality and violence.

On World Children’s Day, UNAIDS is joining with partners to call for accelerated access to better tools to prevent, diagnose and treat HIV in children and tuberculosis (TB) in children living with HIV with a joint statement announcing the launch of the Rome Action Plan 2020.

Children living with HIV are disproportionately being left behind by the HIV response. Treatment coverage among children globally is extremely low. In 2019, only 53% of the estimated 1.8 million children living with HIV were found and on treatment. That means that 850 000 children living with HIV are not on life-saving HIV treatment. More than half of those missing children are in just five countries—the Democratic Republic of the Congo, Kenya, Mozambique, Nigeria and South Africa—and two thirds of those children are aged 5–14 years. Furthermore, we are not doing enough to prevent new infections, with 150 000 new HIV infections among children aged under 15 years in 2019. Therefore, specific programmes and activities must be rapidly deployed to reach those children and allow them to benefit from the extraordinary expansion of paediatric innovations.

The reasons for this are manyfold. Mothers are not tested for HIV during pregnancy and breastfeeding and therefore cannot receive HIV treatment that will keep them healthy and prevent their child becoming HIV infected. Children are not tested for HIV at or shortly after birth so cannot benefit from early HIV treatment with better outcomes. The most commonly available HIV treatments for HIV are not child-friendly, often tasting bitter and cannot be dissolved or sprinkled on food for infants and young children who cannot swallow tablets.

Children and especially children living with HIV are particularly vulnerable to TB, which is the commonest cause of death among people living with HIV. TB among children living with HIV is difficult to diagnose and the treatment is complicated and unpleasant to take, especially in combination with HIV treatment.

“The Rome Action Plan has driven new diagnostics and more effective, affordable and palatable treatments for children living with HIV. We have a moral obligation to now ensure those tools actually reach the children who need them most,” said Shannon Hader, UNAIDS Deputy Executive Director, Programme. “We need action—to reach those children countries need to focus in on their data, understand where and how the children who are missed are likely to be reached and eliminate any artificial barriers—from policy to implementation—that get in the way. And as for innovation—better diagnostics and treatments for both HIV and TB among children—we’re not done yet. We will continue to advocate and partner for more and better.”

Since 2016, as part of the UNAIDS and United States President’s Emergency Plan For AIDS Relief faith initiative, the Vatican has been bringing together key partners in a series of high-level dialogues to find better ways to prevent, diagnose and treat HIV in children, and this year included a focus on TB among children living with HIV for the first time. On 5 and 6 November, the Vatican’s Cardinal Turkson convened the virtual Rome Five meeting. This innovative dialogue brought together leaders from the private and public sectors, governments, regulatory authorities, faith-based and community-based organizations and other implementing partners to find solutions to reduce the burden of HIV and TB among children.

The meeting resulted in a new Rome Action Plan 2020, a series of ambitious commitments made by participating organizations aimed at overcoming the bottlenecks to HIV and TB services for children. Among the many commitments made by the partner organizations, UNAIDS has committed to supporting governments to collect and report on the burden of HIV and TB among children so that national responses can be targeted to where they are most needed. UNAIDS will set and report on ambitious age-specific global targets for the prevention, testing and successful treatment of HIV in children and TB in children living with HIV. UNAIDS will continue to advocate at the highest political level for increased investment and committed actions at the country level so that the world can get on track to ending AIDS and TB among children living with HIV.

GENEVA, 7 July 2020—The latest report on the progress towards the Start Free, Stay Free, AIDS Free targets shows that despite great progress made since the early days of the epidemic, the HIV response for children has fallen behind. Year after year, the bold target of eliminating new HIV infections among children is being missed and children are dying needlessly from AIDS-related illnesses—deaths that could be prevented with simple and cheap treatments if the children were diagnosed and treated in time.

“To see so many tools available, so many new HIV infections among children that have been prevented, so many children living with HIV doing well, but to see others missed and still left behind is a tragedy,” said Winnie Byanyima, Executive Director of UNAIDS. “We cannot accept that tens of thousands of children still become infected with HIV and die from AIDS-related illnesses every year.”

The Start Free, Stay Free, AIDS Free framework has three simple concepts. First, babies have a right to enter the world free from HIV. Second, through HIV prevention, children, adolescents and young women have a right to stay free from the virus. Third, children and adolescents who do acquire HIV have the right to be diagnosed, treated and cared for, so that they can remain AIDS-free.

The world’s countries have agreed to a range of HIV prevention and treatment targets. So that children start out their lives HIV-free, one of those targets was to reduce new child (aged 0–14 years) HIV infections to less than 40 000 by 2018 and 20 000 by 2020. However, newly published estimates show that 150 000 children were newly infected with HIV in 2019—a 52% reduction since 2010, but still four times the 2018 target.

By ensuring that pregnant women living with HIV are diagnosed, started on and retained on antiretroviral medicines during pregnancy, delivery and breastfeeding, the chance that they will pass on the virus is less than 1%. Globally, 85% of pregnant women living with HIV received those medicines in 2019. But despite this high coverage, children are still becoming infected due to unequal access to treatment services (primarily in western and central Africa), women falling out of care and pregnant and breastfeeding women becoming newly infected with HIV.

“As a global community, we have made remarkable progress toward controlling the HIV pandemic, yet we are still missing far too many children, adolescents and young women,” said Angeli Achrekar, Principal Deputy United States Global AIDS Coordinator, United States President’s Emergency Plan for AIDS Relief. “We must all redouble our efforts to urgently reach these critical populations—and PEPFAR remains deeply committed to doing its part.”

The stay-free component set a target of reducing new HIV infections among adolescent girls and young women to less than 100 000 by 2020. Adolescent girls and young women have long been disproportionately affected by HIV—among the Start Free, Stay Free, AIDS Free focus countries, adolescent girls and young women make up 10% of the total population but represent 25% of new HIV infections and are at an almost twofold higher risk of HIV infection compared with their male peers. However, new HIV infections among young women have been falling. In South Africa, where combination prevention programmes for adolescent girls and young women are in place, new HIV infections among this age group have dropped by 35%. And in Eswatini, new HIV infections among young women aged 15–24 years have dropped by 54%.

“For too long, the response to HIV has overlooked children, adolescent girls and young women,” said Henrietta Fore, the Executive Director of the United Nations Children’s Fund. “But there is hope. The recent momentum in reducing new infections among adolescent girls and young women in countries like Eswatini and South Africa show us what is possible when governments and communities, led by girls themselves, join forces. We must not let COVID-19 and its economic headwinds slow us down. We must remain bold and ambitious in our joint efforts to ensure that the next generation of children remain free of HIV and AIDS.”

So that children and adolescents stay AIDS-free, countries called for ambitious but achievable targets for HIV treatment for children—to provide 1.4 million children living with HIV with antiretroviral therapy by 2020. In 2019, however, only 950 000 (53%) of the 1.8 million children living with HIV were receiving HIV treatment—much lower than the 67% of adults on treatment.  It is clear that to save lives, the missing 840 000 children not on treatment —an estimated two thirds of whom are estimated to be between 5 and 14 years—must be diagnosed and treated as a matter of urgency.

“The lack of optimal HIV medicines with suitable paediatric formulations has been a longstanding barrier to improving health outcomes for children living with HIV, contributing towards low treatment coverage,” said Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization. “Access to services for vulnerable groups must be expanded through stronger community engagement, improved service delivery and tackling stigma and discrimination.”

Despite the failures, the positive news is that we do know how the world could have met the Start Free, Stay Free, AIDS Free targets. And with enough commitment, we can still overcome the main obstacles to the targets and reverse the failures.

“The past decade has been marked by innovation and progress in the field of paediatric HIV, but the dramatic miss on targets for children in this latest report is simply unacceptable. We must urgently renew our commitment to fighting for an AIDS-free generation, but today, as a global community, we are failing the most vulnerable among us: children and youth,” said Chip Lyons, President and Chief Executive Officer, Elizabeth Glaser Pediatric AIDS Foundation.

“We can do better. We must do better,” added Ms Byanyima. “We know how to save lives and stop new HIV infections among children. I demand that we spare no effort. Anything less is shameful.” 

UNAIDS and the United States President’s Emergency Plan for AIDS Relief launched the Start Free, Stay Free, AIDS Free framework in 2016 to build on the achievements of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, which ended in 2015.

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.

New modelling has shown that the COVID-19 pandemic could have a major impact on new HIV infections among children in sub-Saharan Africa.

Since 2010, new HIV infections among children in sub-Saharan Africa have declined by 43%, from 250 000 in 2010 to 140 000 in 2018, owing to the high coverage of HIV services for mothers and their children in the region. However, if those services were disrupted because of the COVID-19 response, those gains would be reversed, with a six-month curtailment seeing new child HIV infections rising drastically, by as much as 83% in Mozambique, 106% in Zimbabwe, 139% in Uganda and 162% in Malawi.

There were approximately 30 000 new HIV infections among children (aged 0–14 years) per year in Uganda in the 1990s and early 2000s. The provision of antiretroviral medicines to prevent mother-to-child transmission scaled up from just 9% of expectant mothers living with HIV in 2004 to more than 95% by 2014, and that high coverage has been maintained since. New HIV infections among children (aged 0–14 years) plummeted to an estimated 11 000 in 2014; they further declined to 7500 in 2018. But the impact caused by COVID-19 could be high.

In Africa, where a pregnant woman living with HIV lives has a big influence on whether her baby will be born HIV-free, and, if not, how her infant will acquire HIV.

There are a many reasons for vertical (mother-to-child) transmission of HIV, including: women not receiving antenatal and prevention of vertical HIV transmission services during pregnancy or breastfeeding; women starting antiretroviral therapy but falling out of care during pregnancy or breastfeeding; and women becoming infected with HIV during breastfeeding or pregnancy. However, not all countries face the same challenges, and to make rapid progress in eliminating vertical transmission it is crucial to know which means of transmission is contributing to the most new HIV infections among children in a country or region.

While the causes of vertical transmission of HIV in different regions vary, one thing is sure: far too many babies are still becoming infected with HIV.