Children

Yoo (Ban) Soon-taek, the wife of the Secretary-General of the United Nations, visited the clinic for children living with HIV at the Republican Clinical Infectious Diseases Hospital in Saint Petersburg, Russian Federation, on 16 June and met with women affected by HIV. During her visit, Ms Ban was familiarized with how the clinic helps children living with HIV with medical and psychological problems.

Ms Ban was deeply moved by the special care provided to the children at the HIV clinic. She learned that more than 300 abandoned children living with HIV had been adopted over the years. Yevgeny Voronin, the hospital’s chief physician, shared the story of a girl who was preparing to leave after 13 years.

The Director of the Women’s and Children’s Health Department at the Ministry of Health, Yelena Baibarina, stated during the meeting with Ms Ban that the Russian Federation had significantly reduced mother-to-child transmission of HIV. Ms Baibarina also stressed that it was important for the Ministry of Health to collaborate with nongovernmental organizations representing people affected by HIV.

Maria Godlevskaya and Irina Yevdokimova, of the non-profit-making partnership EVA, told Ms Ban about their social network of women affected by HIV and the challenges they faced. They stressed the need for closer interaction between public health and nongovernmental organizations working with women at higher risk of HIV for early diagnosis of HIV and to prevent mother-to-child transmission.

Yulia Godunova, Executive Director of EVA, told Ms Ban she was expecting her second child. She said that her wish was that neither she nor her children would ever face stigma and discrimination associated with HIV.

Ms Ban, a mother of three and grandmother of four, said that women should be leaders for change, “because it’s hard to find better motivation than children. I admire what you are doing for the sake of your children. You bring about change in society. Thank you.” 

Adolescent girls and young women are disproportionately affected by HIV. Of new infections among adolescents and young people aged 10–24 years, 65% are among adolescent girls and young women aged 10–24 globally. Much more needs to be done to promote prevention programmes based on gender equality, fulfilling sexual and reproductive rights and guaranteeing access to services for this key group, according to a panel meeting entitled “Children, adolescent girls and young women: preventing new HIV infections”.

There is little time to lose in addressing this situation. In 2015, nearly 390 000 [330 000–560 000] adolescent girls and young women aged 10–24 became newly infected with HIV globally, the vast majority of whom lived in southern Africa. In many countries in Africa, young women are more than twice as likely to acquire HIV as their male peers.

The panel, which met on 10 June at the United Nations General Assembly High-Level Meeting on Ending AIDS, taking place in New York, United States of America from 8 to 10 June, explored ways of empowering adolescent girls and young women to claim their rights, creating an environment where they can live free from discrimination and violence. This is seen as critical because the risk of acquiring HIV tends to be associated with gender inequalities and norms that reinforce these inequalities, such as gender-based violence, lack of secondary education, early or forced marriage and lack of choice about how and with whom to have sex.

Children were also the focus of the discussion given that despite a considerable drop in the number being infected with HIV, 150 000 [110 000–190 000] children acquired the virus in 2015. Only half of all children living with HIV had access to treatment in that year. The panel argued that more attention should be paid to tackling barriers to accessing services, greater uptake should be encouraged and the treatment gap should be closed. 

Young women should be meaningfully involved in developing policies and programmes and should have access to comprehensive sexuality education and high-quality sexual and reproductive health services, the panel noted. The structural causes of inequality need to be addressed and boys and men must also play a key role in promoting gender equality and preventing gender-based violence. In addition, more effective monitoring systems that can follow children and young people diagnosed with HIV and facilitate access to treatment and care were considered necessary.  

Such programmes would help place children and adolescent girls and young women where they belong—at the core of the AIDS response. 

Concerted global efforts have led to a 60% drop in new infections among children, which has averted 1.2 million new HIV infections among children in 21 priority countries since 2009

NEW YORK/GENEVA, 8 June 2016—UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced today that there has been a 60% decline in new HIV infections among children since 2009 in the 21 countries in sub-Saharan Africa that have been most affected by the epidemic.

New HIV infections among children in the 21 countries dropped from 270 000 [230 000–330 000] in 2009 to 110 000 [78 000–150 000] in 2015. Equally impressive are gains made in bridging the treatment gap among children. In 2005, fewer than one in 10 children had access to antiretroviral treatment—this gap has now been reduced to one in two. In the past five years alone, treatment scale-up for children grew twofold. The impact is that AIDS-related deaths among children were reduced by 44%.

“These astounding results show that the world is on the Fast-Track to eliminating new HIV infections among children and ensuring that their mothers are alive and healthy,” said UNAIDS Executive Director Michel Sidibé. “It’s beautiful to know that we could soon have a new generation free from HIV.”

The results were published in a new report, On the Fast-Track to an AIDS-free generation, which was launched at an event hosted by UNAIDS and PEPFAR on the opening day of the United Nations General Assembly High-Level Meeting on Ending AIDS, taking place in New York, United States of America, from 8 to 10 June.

“This shows what is possible through the combined power of science, communities and focused action,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “PEPFAR is building on this success, driving harder and smarter to prevent HIV infections and end AIDS among children, adolescents and young women through our DREAMS Partnership, Accelerating Children’s HIV/AIDS Treatment initiative and other efforts.”

During the event, UNAIDS also released global data for children that showed that new HIV infections among children have declined globally by 50% since 2010—down from 290 000 in 2010 to 150 000 in 2015. It also showed that 49% of children living with HIV around the world now have access to life-saving treatment. On the eve of the event, UNAIDS and partners announced that Armenia, Belarus and Thailand have joined Cuba in receiving official certificates of validation from the World Health Organization for eliminating new HIV infections among children. Thailand is the first country with a major HIV epidemic (450 000 people living with HIV in 2014) to receive such a validation.

It was during the High-Level Meeting on HIV and AIDS in 2011 that UNAIDS and PEPFAR joined with partners to launch the Global Plan towards the elimination new HIV infections among children by 2015 and keeping their mothers alive (Global Plan). The focus of the Global Plan was to increase efforts to prevent new HIV infections in all countries, but particularly in the 22 countries that, in 2009, accounted for 90% of pregnant women living with HIV.

The new report released today shows the progress made since the Global Plan was launched. It outlines that seven countries have reduced new HIV infections among children by more than 70% since 2009 (the baseline for the Global Plan), including: Uganda, by 86%; South Africa and Burundi, by 84%; Swaziland, by 80%; Namibia, by 79%; Mozambique, by 75%; and Malawi, by 71%. In Nigeria, however, the decline was much smaller, at just 21%. In India, the only Global Plan country outside of sub-Saharan Africa, new HIV infections in children dropped by 44% and coverage of services to pregnant women increased from less than 4% in 2010 to 31% in 2015. 

The new report demonstrates that treatment or prophylaxis (excluding the less-effective single-dose nevirapine) coverage for pregnant women living with HIV in the countries most affected by the epidemic increased dramatically from 2009. By 2015, more than 80% of pregnant women living with HIV in the 21 countries in sub-Saharan Africa had access to medicines to prevent transmission of the virus to their child—up from just 36% (excluding the less-effective single-dose nevirapine) in 2009.

The World Health Organization recommends that all pregnant women living with HIV should be offered lifelong HIV treatment, extending beyond Option B+ to include all women diagnosed with HIV regardless of pregnancy. By 2015, all of the Global Plan countries, with the exception of Nigeria, were routinely offering lifelong HIV treatment to all pregnant women living with HIV. The massive scale-up of treatment has helped to reduce AIDS-related deaths among women of reproductive age, which declined by 43% between 2009 and 2015.  

Incredible journey

Six countries—Botswana, Mozambique, Namibia, South Africa, Swaziland and Uganda—met the Global Plan goal of ensuring that 90% or more of pregnant women living with HIV had access to life-saving antiretroviral medicines. Six additional countries provided antiretroviral medicines to more than 80% of pregnant women living with HIV—Burundi, Cameroon, Malawi, the United Republic of Tanzania, Zambia and Zimbabwe.

Major successes have also been seen in increasing access to treatment for children living with HIV in the 21 countries: access has increased more than threefold since 2009—from 15% in 2009 to 51% in 2015. However, this is still only half of all children in need of treatment. Major efforts are required to ensure that all children born to HIV-positive mothers are tested for HIV within the first two months of life. Without immediate access to treatment, around 30% of children living with HIV will die within the first year of life and more than 50% will die before they reach their fifth birthday.

The Global Plan also aspired to reduce new HIV infections among women of reproductive age by 50%. The actual decline was just 5%—well below the target. This suggests that women, including young women, continue to be left behind and are not being reached with HIV prevention services. Between 2009 and 2015, around 4.5 million [3.8 million–5.4 million] women became newly infected with HIV in the 21 priority countries in sub-Saharan Africa, and AIDS-related illnesses remain the leading cause of death among adolescents on the continent.

At the launch of the report, UNAIDS, PEPFAR and partners also launched a Super Fast-Track framework for ending AIDS among children, adolescents and young women—Start Free, Stay Free, AIDS-Free. The initiative will build on the progress already made to Fast-Track action to end the AIDS epidemic and sets ambitious targets to eliminate new infections among children, find and ensure access to treatment for all children living with HIV and prevent new HIV infections among adolescents and young women. Together, these steps will put the world on a path to ending AIDS among children.

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.

PEPFAR

The United States President’s Emergency Plan for AIDS Relief (PEPFAR) is the United States Government initiative to save the lives of those affected by HIV/AIDS around the world. This historic commitment is the largest by any nation to combat a single disease internationally, and PEPFAR investments also help alleviate suffering from other diseases across the global health spectrum. PEPFAR is driven by a shared responsibility among donor and partner nations and others to make smart investments to save lives. Learn more at pepfar.gov and connect with us on Facebook and Twitter.

African health ministers, leaders of paediatric HIV treatment programme implementers, philanthropic foundations, civil society and private sector partners convened in New York, United States of America, on 6 June to celebrate successes in closing HIV treatment gaps for children and to call for an expanded global partnership to build on this momentum to end paediatric AIDS.

Many countries have made important strides towards ending paediatric AIDS, but major challenges persist. Even as the number of children newly infected with HIV continues to decline, only about half of HIV-exposed children are tested for HIV within the first two months of life and only 30% of children living with HIV are linked to HIV treatment in a timely manner. Because far too many children living with HIV begin treatment too late, children are far more likely than adults living with HIV to die of AIDS-related illnesses.

At a major global ministerial meeting in Abidjan, Côte d’Ivoire, in May, health ministers from Africa endorsed a Fast-Track approach for children. This approach calls for reaching a 95% coverage of antiretroviral therapy for both pregnant women and children living with HIV by 2018. By reaching this target, the world could effectively end paediatric AIDS by 2020—one decade earlier than the elimination goal for the epidemic as a whole.

To reach these ambitious targets, attendees at this week’s meeting in New York emphasized the importance of a renewed, expanded, inclusive global partnership to close the paediatric HIV treatment gap. During an interactive conversation among the meeting participants, speakers emphasized the importance of involving families, communities and civil society organizations. There was also agreement regarding the need to engage the private sector in efforts to develop new paediatric treatment tools and fund programmes to close gaps across the continuum of care for children. The Medicines Patent Pool, which has prioritized paediatric HIV treatment in its negotiations of licences for the generic manufacture of priority antiretroviral medicines, is an example of how innovative approaches to private sector involvement can contribute to improved access to essential treatments.

Meeting attendees stressed the need for improved coordination of the many efforts being undertaken to address various aspects of paediatric HIV treatment. At the Abidjan meeting, health ministers endorsed efforts to maximize coordination in the paediatric AIDS arena.

To achieve the Fast-Track Targets for children—and to sustain these gains over time—new resources will be needed. Several countries are taking steps to increase domestic allocations for paediatric HIV treatment. Namibia, for example, covers 60% of its national AIDS response with domestic resources, and Felix Kabange Numbi, Minister of Public Health for the Democratic Republic of the Congo, reported that his country is pledging to increase domestic resources for AIDS.

It was agreed that philanthropy offers a potentially important avenue to generate new resources for paediatric HIV treatment. ELMA Philanthropies, for example, is allocating US$ 12.5–15 million per year for at least the next three years to support HIV treatment programmes for children, with a comparable amount to be invested in supportive programmes for childhood development.

Caritas Internationalis recently brought together global partners in two events to discuss the role of faith-based organizations and the private sector in closing the global HIV testing and treatment gap for children living with HIV. The meetings, held in the Vatican City from 11 to 15 April, were co-organized with UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Vatican’s Bambino Gesù paediatric hospital.

Cardinal Peter Turkson, President of the Pontifical Council for Justice and Peace, hosted and opened a high-level meeting with representatives of the private sector, including pharmaceutical and diagnostics companies, faith-based organizations responding to HIV, people living with HIV, national governments, the United Nations and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In his opening remarks to the meeting, the Cardinal drew from Pope Francis’ pastoral letter to the world (the encyclical Laudato si’). In the letter, the Pope challenges the world to take renewed and coordinated action against factors that result in the deterioration of the natural and social environment, such as climate change, pandemics, poverty, conflict and violence.

In a separate statement, Pope Francis specifically called on the meeting participants to find “new possibilities of providing greater access to life-saving diagnosis and treatment” for children. At the end of the meeting, the participants committed themselves to find collective solutions, such as multipartner agreements to encourage more research on HIV treatment for children, to accelerate the process of testing, approving and registering new HIV medicines for children, to find innovative solutions to prevent medicine and supply stock-outs and to strengthen health system. The participants agreed to reconvene in order to finalize a road map to improve access to HIV treatment for all.

In a separate three-day consultation on paediatric HIV, the participants debated and agreed upon the most urgent actions needed to strengthen equitable access to testing and treatment for children living with HIV. That event was attended by more than 80 participants, mainly from sub-Saharan Africa, but also from countries as far afield as Armenia, Colombia, India and Viet Nam, as well as representatives of national and multilateral agencies.

Deborah Birx, PEPFAR Global AIDS Coordinator, and Luiz Loures, Deputy Executive Director of UNAIDS, presented to the consultation an overview of the state of the HIV epidemic among children and the global response to date. Discussions focused on the current challenges in reaching children with HIV testing and treatment.

In order to end the AIDS epidemic by 2030, it was agreed that there is an urgent need to Fast-Track access to HIV testing, prevention and care services and treatment for all. Attention was given to the central role played by faith-based organizations in the delivery of community-based HIV and other health services to children and their extended families. Such organizations can often reach the populations that are in greatest need but that have the poorest access to HIV services.

Caritas Internationalis will present the recommendations of the three-day consultation to the United Nations General Assembly High-Level Meeting on Ending AIDS, to be held in New York, United States of America, from 8 to 10 June.

A strong, efficient and supported workforce in health-care facilities is essential for providing effective HIV services to people living with HIV. However, the needs of family carers, home-based carers and community carers are often overlooked. UNAIDS recently co-hosted a meeting with the Coalition for Children Affected by AIDS in collaboration with the United Nations Children's Fund to explore how to address the specialized needs of home carers caring for children affected by HIV.

Countries have made rapid progress in reducing mother-to-child transmission of HIV—new HIV infections among children globally declined by 58% between 2000 and 2014. However, globally only 32% of children living with HIV have access to antiretroviral therapy and without a strong family and support system children will be left behind.

The meeting aimed to address the important issues facing families and communities caring for children within a home setting and was driven by concern about the lack of age-appropriate, evidence-informed HIV policy, programming and implementation. It recognized the urgent need to empower parental figures and caregivers. The participants discussed their experiences and best practices to be shared with donors, implementers and activists in order to better support home caregivers.

The consultation was hosted in collaboration with the Partnership for Maternal and Child Health, and the Regional Inter-Agency Task Team on Children in Eastern and Southern Africa. It brought together nearly 60 experts in child health and development, including representatives of civil society, implementers, scientists, funders and activists.  

Deputy Executive Director of UNAIDS Luiz Loures encouraged the participants to proactively engage in the United Nations General Assembly High-Level Meeting on Ending AIDS, which is to be held in New York, United States of America, from 8 to 10 June 2016. 

Ahead of the United Nations High-Level Meeting on AIDS, which will take place in New York in June, the Organisation of African First Ladies against HIV/AIDS (OAFLA) has called for the response against the epidemic to be stepped up.   

Meeting in Addis Ababa, Ethiopia, OAFLA First Ladies recognized the huge progress already made in reducing the impact of HIV, but warned against complacency, calling on stakeholders to increase investment in the response. The First Ladies said more resources were required to prevent new HIV infections among children and keep their mothers healthy and alive and to broaden access to testing services. They also said that increased resources were necessary in order to ensure that people access treatment immediately if need be, to allow young people, particularly young women and girls, to access combination prevention services, and to end gender-based violence, which increases the risk of HIV exposure.

Addressing the OAFLA General Assembly, UNAIDS Executive Director Michel Sidibé congratulated the First Ladies for playing a transformative role by championing social justice and keeping the issue of HIV high on the political agenda. He added that achieving zero mother-to-child transmission of the virus, reaching universal health access for children and ending the AIDS epidemic by 2030 were possible if the right decisions were made now.

PRETORIA/GENEVA, 2 December 2015—The Executive Director of UNAIDS, Michel Sidibé, has appointed South African First Lady Tobeka Madiba Zuma as UNAIDS Special Advocate for the Health of Women, Youth and Children. During a ceremony in Pretoria, South Africa, Mr Sidibé and Madam Zuma also signed a memorandum of understanding between UNAIDS and the Tobeka Madiba Zuma (TMZ) Foundation to strengthen collaboration between UNAIDS and the TMZ Foundation.

Madam Zuma will use her position as a UNAIDS Special Advocate to speak out on issues related to women’s sexual and reproductive health, especially on HIV prevention among adolescent girls and young women.

“I am delighted to be here with the First Lady of South Africa, Madam Zuma, to recognize her work to improve the lives of women and girls in South Africa, and to appoint her as UNAIDS Special Advocate for the Health of Women, Youth and Children,” said Mr Sidibé. “UNAIDS will continue to support her in her good work.”

Madam Zuma, as patron and founder of the TMZ Foundation, conducts extensive advocacy work on women’s health, with a focus on HIV, tuberculosis and breast and cervical cancer.

“I would like to thank UNAIDS for having worked with myself and the TMZ Foundation in recent years. I would also like to thank my husband, President Jacob Zuma, for taking bold steps to take us from denial to taking responsibility for the HIV epidemic,” said Madam Zuma. “I am happy and honoured, and pledge to use my position as First Lady of South Africa to raise awareness of these issues.”

Adolescent girls and young women in South Africa between the ages of 15 and 24 are at a much higher risk of HIV. It is estimated that new HIV infections among adolescent girls and young women in this age group account for a quarter of all new HIV infections in South Africa.

There are a range of biological and sociological factors that place young women and girls at higher risk of HIV infection, including early sexual debut, relationships with men much older than themselves, who may already be HIV-positive, and gender-based violence.
“Girls should have books, not babies,” remarked Madam Zuma, reflecting on the high prevalence of teenage pregnancy in the country.

The memorandum of understanding between UNAIDS and the TMZ Foundation will help to advance efforts in South Africa to improve the health of women, children and young people as part of the Sustainable Development Goals.

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.

Representatives of ministries of health, national AIDS committees and civil society organizations from 19 countries in western and central Africa gathered in Dakar, Senegal, from 16 to 18 November to take stock of progress, challenges and opportunities for the prevention of mother-to-child transmission and paediatric care of HIV.

Together with experts from international organizations, they called for action to Fast-Track the AIDS response and achieve the 90–90–90 treatment target by 2020. To reach the target in the context of mother-to-child transmission of HIV and paediatric care of HIV, it is critical to scale up HIV testing and antiretroviral therapy for pregnant women and children living with HIV.

The participants agreed on key elements of a regional strategy to accelerate the identification and effective management of pregnant women and children living with HIV. They also called on national and international actors to mobilize and cooperate so that children are no longer born with HIV or die of AIDS-related causes in western and central Africa.