Children

Margaret Kenyatta, the First Lady of Kenya, reinforced her commitment to champion the elimination of mother-to-child transmission of HIV in a meeting with UNAIDS Deputy Executive Director Gunilla Carlsson in Nairobi, Kenya, on 29 May.

The First Lady and Ms Carlsson discussed the Beyond Zero platform, a groundbreaking initiative spearheaded by the First Lady. Through Beyond Zero, the First Lady has mobilized resources from the private sector to respond to the health and well-being of women and children, with a focus on HIV and sexual and reproductive health.

“There is so much momentum and support from Kenyans themselves for the Beyond Zero initiative. They feel that it is theirs and that they own it,” said Ms Kenyatta.

Beyond Zero has delivered 52 mobile clinics to every county in Kenya. The operationalization of the clinics has resulted in substantial community mobilization and demand creation for HIV services. Initiatives such as Beyond Zero have contributed to significant progress in the AIDS response in Kenya, with new HIV infections among children aged 0 to 14 years reducing from about 14 000 in 2013 to 6100 in 2016, while in the same period the percentage of mothers delivering without a skilled health provider decreased from 56% to 34%.

Building on those gains, the First Lady launched a new framework earlier this year to advance the Beyond Zero initiative. The framework adopts a life-cycle approach, addressing challenges, including HIV, at different stages of life. Ms Kenyatta’s championship for Kenya to reach validation by the World Health Organization for the pre-elimination of mother-to-child transmission of HIV is a core commitment of the framework.

“Beyond Zero is a powerful initiative. An advocacy platform that has fostered public–private partnership for the health agenda and the elimination of mother-to-child transmission of HIV in particular,” said Ms Carlsson.

In 2016, Member States agreed a set of targets at the United Nations High-Level Meeting on Ending AIDS to be met to put the world on course to end the AIDS epidemic by 2030. One of those targets was to strengthen national social and child protection systems to ensure that, by 2020, 75% of people living with, at risk of or affected by HIV benefit from HIV-sensitive social protection. The target is human rights-based. It feeds into and benefits from promoting, protecting and fulfilling all human rights and the dignity of all people living with, at risk of or affected by HIV.

Evidence of how social protection programmes meet the needs of people who are poor and excluded and benefit people living with, at risk of or affected by HIV is increasing. The question is not whether the AIDS response should increase attention to social protection, but how best to leverage resources and partnerships of movements working on ending poverty and inequality to work effectively towards ending AIDS.

Of 127 countries reporting in the UNAIDS National Composite Policy Index in 2017, 109 (86%) stated that they had an approved social protection strategy, policy or framework in 2016, and 99 of those countries (78%) were implementing those programmes. A total of 85 countries stated that their strategies were HIV-sensitive to at least some extent. More than half (47) of the 87 countries with a coordinating mechanism for their social protection strategy have included their national AIDS programme in that structure. However, only 12 countries reported that their social protection strategies were fully HIV-sensitive.

To step up efforts to get social protection on the Fast-Track, UNAIDS recently held a conference at which the participants heard about how to strengthen national social and child protection systems. The conference focused on three objectives: strengthening the links with social and other movements for ending poverty and inequality; intensifying action on social protection; and reinvigorating programming for HIV, food security and nutrition.

“Stronger linkages are required across health, education and community systems to reduce the vulnerability of people living with, at risk of and affected by HIV through social protection services,” said Tim Martineau, UNAIDS Deputy Executive Director, Programme, a.i.

The event also saw the launch of a new UNAIDS report, Social protection: a Fast-Track commitment to end AIDS. The report provides guidance on how to scale up what works in the context of different HIV epidemics and for different populations. It also provides guidance to governments, people living with or affected by HIV, policy-makers and other stakeholders on how to intensify the integration of HIV with social protection and other programmes for ending poverty and inequality towards ending AIDS.

“We must remember that without improving the material and emotional well-being of people, we cannot end the AIDS epidemic,” said Denys Dmytriiev, from the All Ukrainian Network of People Living with HIV.

The International Conference on Fast-Tracking Social Protection to End AIDS was held in Geneva, Switzerland, on 25 and 26 April.

Ending the AIDS epidemic among children, adolescents and young women requires ambitious targets and a Super-Fast-Track approach. Building on the successes of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partners* launched Start Free Stay Free AIDS Free in 2016 to provide a framework for the urgent work ahead.

Start Free Stay Free AIDS Free prioritizes action in 23 countries** that account for 87% of new HIV infections among children aged 0–14 years and approximately 87% of all children and adolescents living with HIV globally. In 2016, 2.1 million children were estimated to be living with HIV.

In its first progress report, Start Free Stay Free AIDS Free reflects on the achievements made during the first year of implementation and highlights areas where urgent action is needed.

“The world is on the Fast-Track to eliminating new HIV infections among children and ensuring that their mothers are alive and healthy, but we need to do more to ensure that all children living with HIV have access to treatment immediately,” said Michel Sidibé, Executive Director of UNAIDS.

The report shows that globally in 2016, there were 160 000 new HIV infections among children and that 140 000 occurred in the 23 priority countries. Although there was an overall decline in new HIV infections, the decline was at a much slower rate than in previous years.

The report highlights concerns around new HIV infections among young women and girls. In 2016, around 200 000 adolescents between the ages of 15 and 19 years were newly infected with HIV in the 23 priority countries, 72% of whom were young women.

Most—more than 70%—of all new HIV infections among young people are in sub-Saharan Africa, which also has the fastest growing youth population in the world.

“A high number of new HIV infections among adolescents and a fast-growing population could make for an HIV explosion among young women in Africa,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “The United States Presidents Emergency Plan for AIDS Relief is driving harder and smarter to prevent HIV infections and ultimately help end AIDS among children, adolescents and young women. Every person deserves the chance to survive, thrive and pursue their dreams.”

Gains seen in access to treatment

The report shows that while important gains have been made in access to antiretroviral therapy for pregnant women living with HIV, much more needs to be done to reach children.

In 2016, around 78% of pregnant women living with HIV had access to antiretroviral therapy in the 23 priority countries.

Start Free targets

Reduce new HIV infections among children to 40 000 by 2018.

Reach and sustain 95% of pregnant women living with HIV with lifelong HIV treatment by 2018.

Stay Free targets

Reduce the number of new HIV infections among adolescents and young women to less than 100 000 by 2020.

Provide voluntary medical male circumcision for HIV prevention to 25 million additional men by 2020 globally, with a focus on young men aged 10–29 years.

AIDS Free targets

Ensure that 1.6 million children (0–14 years) and 1.2 million adolescents (15–19 years) living with HIV have access to antiretroviral therapy by 2018.

The increase in the roll-out and uptake of antiretroviral therapy during pregnancy and throughout breastfeeding is estimated to have averted around 270 000 new HIV infections among children in 2016 alone.

The numbers of children on treatment has also increased, but not on a big enough scale. In 2010, only 17% of children aged 0–14 years had access to treatment. By 2016, that had risen to around 43%, with around 920 000 children accessing antiretroviral therapy. Although this is a marked improvement, access to treatment for children still falls far behind access for adults. In 2016, around 54% of adults living with HIV had access to treatment.

The report cites multiple reasons for the slow growth of access to treatment for children, including poor testing rates. Only nine of the 23 priority countries managed to test and diagnose 50% or more of children who were exposed to HIV in 2016. There are particularly low rates of early infant diagnosis in the first two months of life, when it is most important to test, as HIV-related mortality is at its highest. Without access to testing and treatment, half of all children living with HIV will die before their second birthday.

Ways forward

The report offers a set of important actions countries can take to eliminate new HIV infections among children, to test and diagnose children and young people who may have been exposed to HIV and to ensure that children and young people access HIV prevention, quality medicines and age-appropriate sexual and reproductive education and care and support throughout their lives, free from stigma and discrimination.

Other important actions include accelerating new medicines and diagnostics, promoting community engagement and services, voluntary medical male circumcision, access to information on sexual and reproductive health and access to pre-exposure prophylaxis for young people at a higher risk of HIV.

“The future for children and adolescents depends on actions we take collectively today,” said Mr Sidibé.

The latest estimates, for the end of 2017, will be released in July 2018 and will provide further insight into the progress of Start Free Stay Free AIDS Free.

* United Nations Children’s Fund, World Health Organization and the Elizabeth Glaser Pediatric AIDS Foundation.

**Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Uganda, United Republic of Tanzania, Swaziland, Zambia and Zimbabwe.

In commemoration of Zero Discrimination Day, the UNAIDS China Country Office has launched an audio adaptation of the award-winning children’s book The bravest boy I know.

The book tells the story of the heart-warming friendship between Xiao Ming, an eight-year-old living with HIV, and his best friend Xiao Li, sending the critical message that with treatment and support from families, friends and schools, children living with HIV can have a normal and happy childhood, and that children living with HIV have the right to a life free from discrimination, as other children do.

The audiobook was launched on 6 March in Beijing, China, by Huang Xiaoming, the renowned actor and UNAIDS Goodwill Ambassador for China. The aim of the new audiobook is to disseminate the message of zero discrimination among a younger audience. A short video also catering to the needs of children comes with the audiobook, both of which are available to download for free.

Close to 10 years after its first edition, a fully updated International Technical Guidance on Sexuality Education published today by UNESCO advocates quality comprehensive sexuality education to promote health and well-being, respect for human rights and gender equality, and empowers children and young people to lead healthy, safe and productive lives.

“Based on the latest scientific evidence, the International Technical Guidance on Sexuality Education reaffirms the position of sexuality education within a framework of human rights and gender equality,” says UNESCO Director-General Audrey Azoulay. “It promotes structured learning about sexuality and relationships in a manner that is positive and centred on the best interest of the young person. By outlining the essential components of effective sexuality education programmes, the Guidance enables national authorities to design comprehensive curricula that will have a positive impact on young people’s health and well-being.”

The Technical Guidance is designed to assist education policy makers in all countries design accurate and age-appropriate curricula for children and young people aged 5 – 18+.

Based on a review of the current status of sexuality education around the world and drawing on best practices in the various regions, the Guidance notably demonstrates that sexuality education:

•  helps young people become more responsible in their attitude and behaviour regarding sexual and reproductive health
• is essential to combat the school dropout of girls due to early or forced marriage, teenage pregnancy and sexual and reproductive health issues
• is necessary because in some parts of the world, two out of three girls reported having no idea of what was happening to them when they began menstruating and pregnancy and childbirth complications are the second cause of death among 15 to 19-year olds
• does not increase sexual activity, sexual risk-taking behaviour, or STI/HIV infection rates. It also presents evidence showing that abstinence-only programmes fail to prevent early sexual initiation, or reduce the frequency of sex and number of partners among the young.

 The publication identifies an urgent need for quality comprehensive sexuality education to:

• provide information and guidance to young people about the transition from childhood to adulthood and the physical, social and emotional challenges they face.
• tackle the challenges posed by sexual and reproductive health issues, which are particularly difficult during puberty, including access to contraception, early pregnancy, gender-based violence, sexually transmitted infections (STIs) and HIV and AIDS
• raise awareness of HIV prevention and transmission, of which only 34 per cent of young people around the world can demonstrate accurate knowledge
• complement or counter the large body of material of variable quality that young people find on the internet, and help them face increasingly common instances of cyberbullying.

The Guidance was produced in collaboration with UNAIDS, United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), UN Women, and the World Health Organization (WHO).

GENEVA, 23 December 2017—UNAIDS warmly welcomes the announcement by the United Nations Secretary-General that Henrietta Holsman Fore has been appointed as the new Executive Director of the United Nations Children’s Fund (UNICEF). Ms Fore is a champion of economic development, education, health and humanitarian assistance and was the first woman to serve as the Administrator of the United States Agency for International Development and as the Director of United States Foreign Assistance.

“We look forward to working closely with Henrietta Holsman Fore and continuing to collaborate with UNICEF on our common goals—stopping new HIV infections among children, ensuring access to HIV treatment and making sure that children living with and affected by HIV get the care and support they need,” said Michel Sidibé, Executive Director of UNAIDS.

UNICEF is a founding Cosponsor of UNAIDS and in 2011 joined UNAIDS, the United States President’s Emergency Plan for AIDS Relief and other partners to develop the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. The plan helped to significantly reduce new HIV infections among children in the countries most affected by HIV.

From 2010 to 2016 there was a 56% decline in new HIV infections among children in eastern and southern Africa. However, access to treatment for children continues to lag behind. Globally, just 43% of children living with HIV had access to life-saving antiretroviral therapy in 2016, compared to 54% of adults. 

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.