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Global health and financing leaders and experts have come together at a high-level virtual event to tackle one of the most pressing issues facing the world today—health security. The event, “Investing in health is investing in economic recovery: Financing for HIV, stronger public health systems, and pandemic preparedness and response” was held ahead of the sixth Africa - European Union (EU) Summit which is taking place on 17 and 18 February.

While hosting 16% of the global population, and facing 26% of the global disease burden, Africa accounts for only 2% of global health spending. Despite the 2001 Abuja Commitment of governments to allocate 15% of their budget to health, the average is still only 7%.

Speakers discussed how Africa has been left behind in the COVID-19 response, with less than 12% of people in Africa fully vaccinated against COVID-19. Insufficient access to vaccines, medicines and technologies, and weak health systems have impeded the realization of the right to health of all Africans during the pandemic. In addition, fiscal constraints and unsustainable debt burdens, are hindering the path to recovery.

Cosponsored by the Government of France, the event was convened by UNAIDS, the African Union, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, the United Nations Development Programme, and the World Health Organization. Moderated by Dr. Donald Kaberuka, High Representative for Financing, African Union (AU), the session strived to find ways of broadening the revenue base available to African countries to increase health financing and to boost global solidarity.

Participants underlined the overarching need for investment in strengthened public health systems for universal healthcare, including community-led services, and avoiding overburdening the most vulnerable with out-of-pocket expenses to overcome the COVID-19 crisis. Further, tackling the current pandemics of HIV and COVID-19, and other infectious diseases such as malaria and TB, must happen simultaneously to prevent future pandemics and protect global health security.

Leaders stressed how essential HIV, health systems and pandemics preparedness investments are to save human lives and for economic recovery, and how there will be no steep recovery for Africa without health security for all.

Tackling existing pandemics, such as COVID and HIV, needs to happen at the same time as countries strengthen health systems and build up pandemic preparedness. 

Participants praised the increased African leadership and sovereignty and called for a renewed Africa-EU partnership that would support African institutions and rely on its leadership, in collaboration with multilateral institutions. Specifically, they called on the EU to further dedicate financing mechanisms for HIV, health and pandemic preparedness, including sustained and increased overseas development assistance (ODA).

The panel members also recognized the importance of domestic financing for long-term sustainability. However, the current financial constraints are overwhelming for many countries in the region. Decisive action to eradicate tax evasion and tax dodging will be critical: every year between 25 and 50 billion that could be used for the health and education of Africans are lost. Increasing domestic revenues requires brave international and national tax reforms. Possible ways forward discussed for broadening the revenue base included combating tax evasion, improving the conditions under which African countries obtain financing, debt relief and cancellation policies, and Special Drawing Rights reallocation.

Speakers highlighted that a growing share of revenue allocation, as well as better investment and the use of health and pandemics´ resources are urgently needed, leveraging the AIDS infrastructure and lessons learned from the rights-based AIDS response to prevent future pandemics.

The leaders called for robust international financing, through special drawing rights reallocation, debt relief, new concessional sources and additional ODA. They identified The Global Fund replenishment in 2022 as a key moment to ensure overarching support for the fight against AIDS, malaria and TB, to get back on track.  

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GENEVA, 17 December 2021–UNAIDS welcomes the announcement from the United Nations Secretary-General António Guterres of the appointment of Catherine Russell as the new Executive Director of UNICEF. Ms Russell will begin her new role in January 2022, taking over from Henrietta Fore who held the position since January 2018.

“We extend our heartfelt thanks to Henrietta Fore for her inspirational work on behalf of the world's children and warmly welcome Catherine Russell as UNICEF’s new Executive Director,” said Winnie Byanyima, Executive Director of UNAIDS. “We look forward to working closely with Ms Russell in our fight to end inequalities and end AIDS among children.”

Despite medicine being available to prevent HIV infection among children, in 2020, around 150 000 children became newly infected with the virus, bringing the total number of children living with HIV around the world to 1.7 million. In 2020, while 74% of adults aged 15 years and older living with HIV had access to treatment, just 54% of children aged 0–14 years had access to the life-saving medicine.

UNICEF and UNAIDS work together to ensure all children are born free from HIV, and that all children and adolescents living with, and affected by HIV have access to the treatment, care and support they need to thrive.

With millions of lives on the line, UNAIDS and WHO World AIDS Day event saw global partners, including Prince Harry, the Duke of Sussex, urgently call for expanded access to health treatments and technologies and for human rights to be upheld

GENEVA, 1 December 2021—On the occasion of World AIDS Day 2021, UNAIDS, the World Health Organization (WHO) and partners came together at a special event in Geneva, Switzerland, to highlight the urgent need to end the economic, social, cultural and legal inequalities that drive the AIDS pandemic and other pandemics around the world.

“We are issuing an urgent warning. Only by moving fast to end the inequalities that drive the AIDS pandemic can we overcome it,” said Winnie Byanyima, Executive Director of UNAIDS. “World leaders must work together urgently to tackle the challenges head-on. I urge you: be courageous in matching words with deeds. It is outrageous that every minute that passes, we lose a precious life to AIDS. We don’t have time to waste.”

The world is off track from delivering on the shared commitment to end AIDS by 2030. In 2020 there were 37.7 million people living with HIV, 1.5 million new HIV infections and 680 000 AIDS-related deaths. Around 65% of HIV infections globally were among key populations, including sex workers and their clients, gay men and other men who have sex with men, people who inject drugs and transgender people, and their sexual partners.

“Even before the COVID-19 pandemic hit, many of the populations most at risk were not being reached with HIV testing, prevention and care services,” said Tedros Adhanom Ghebreyesus, WHO Director-General. “The pandemic has made things worse, with the disruption of essential health services, and the increased vulnerability of people with HIV to COVID-19. Like COVID-19, we have all the tools to end the AIDS epidemic, if we use them well. This World AIDS Day, we renew our call on all countries to use every tool in the toolbox to narrow inequalities, prevent HIV infections, save lives and end the AIDS epidemic.”

If the world does not tackle discrimination and inequalities, UNAIDS and WHO warn that the next decade could see 7.7 million AIDS-related deaths.

A powerful video narrated by Prince Harry, the Duke of Sussex, and Ms Byanyima was screened at the event demonstrating the disturbing parallels between access to HIV treatment and access to COVID-19 vaccines. Between 1997 and 2006, it is estimated that 12 million people died of AIDS-related illnesses in low- and middle-income countries as the price of medicines rendered them out of reach for many of the countries most affected by HIV. Today, 10 million people around the world still do not have access to the life-saving HIV medicines. The Duke of Sussex urged the world to learn from the history of AIDS and overcome the inequitable access to COVID-19 vaccines and to ensure that new HIV medicines and technologies are available to all.

A letter from the Duke of Sussex to WHO and UNAIDS was read out, in which he commemorated the 40 years of AIDS and expressed his gratitude for the work accomplished to date. In the letter he stressed the need for COVID-19 vaccine equity, drawing from the lessons learned from HIV.

Speakers highlighted the impact of HIV on young people. “Young people continue to be stigmatized, especially those in key populations, and inequalities continue to compromise the quality of our lives,” said Joyce Ouma, from the Global Network of Young People Living with HIV.

“Young people are the future of nations and the cornerstone of the global AIDS response,” said Anutin Charnvirakul, Deputy Prime Minister and Minister of Public Health, Thailand. “Eradicating all kinds of stigma must be our full global commitment with immediate action.”

During the event, the participants commemorated the lives of the 36 million people who have died from AIDS since the start of the pandemic and highlighted the urgent need to do more for the people most affected by HIV.

The Ambassador of Namibia, Julia Imene-Chanduru, representing the UNAIDS Programme Coordinating Board Chair, said, “AIDS remains an emergency that we must not forget in our response to COVID-19.”

Speakers urged all countries, partners and civil society to be bold in taking forward the commitment made in the Political Declaration on AIDS adopted at the 2021 United Nations High-Level Meeting on AIDS and in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS, both having ending inequalities at their core.

“We can see the importance of UNAIDS’ strategy, with an emphasis on ending inequalities,” said Stephanie Seydoux, French Ambassador for Global Health. “This is what allows us to make progress in the fight against this pandemic, and to ensure health for everyone.”

“We know how to beat AIDS and we know how to beat pandemics,” added Ms Byanyima. “The policies to address the inequalities standing in the way of progress can be implemented, but they require leaders to step up and be bold.”

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.

GENEVA, 24 November 2021—UNAIDS welcomes the first licensing agreement under the World Health Organization (WHO) COVID-19 Technology Access Pool (C-TAP) initiative, negotiated between Consejo Superior de Investigaciones Científicas (Spain’s High Council of Scientific Research) and the Medicines Patent Pool.

The C-TAP initiative builds on a successful model to increase access to HIV, tuberculosis and hepatitis C products in low- and middle-income countries and has proved to be effective in overcoming some barriers to access to health technologies for COVID-19. However, the initiative has so far been underutilized, and pharmaceutical companies and other holders of COVID-19 technologies have been reluctant to join C-TAP.

“I welcome this new agreement, but urge other pharmaceutical companies and COVID-19 technology-holders to share their know-how,” said Winnie Byanyima, Executive Director of UNAIDS. “Think of how many lives could be saved if COVID-19 vaccines, medicines and other technologies were available through this mechanism to everyone who needs them.”

The new licensing agreement shows that it is possible to share knowledge, technology and intellectual property rights in the fight against COVID-19.

The sharing of intellectual property rights, data and know-how should be a fundamental component of pandemic preparedness and response. UNAIDS encourages research institutes and holders of life-saving technologies, including vaccine manufacturers, to follow suit and join C-TAP and urges the governments of countries that host pharmaceutical companies to ensure that their technologies are offered to C-TAP as a matter of urgency.

The agreement contains key access provisions, such as the non-exclusive right to develop the licensed patents, know-how and material. There is no geographical limitation, so qualified companies worldwide will be able to develop the licences and commercialize the products derived from them. The terms of the agreement will be publicly available, ensuring transparency. The agreement includes a technology transfer package.

The agreement covers the licensing of a technology to detect antibodies to SARS-CoV-2, the virus that causes COVID-19, from either COVID-19 infection or a vaccine, and will allow the measurement of the effectiveness of vaccination programmes and help in the management of vaccination booster programmes. The tests derived from the technology are simple to use, which will allow their application in resource-limited settings, and companies based in low- and middle-income countries will not have to pay royalties for the technology’s use.

UNAIDS was a supporter of a call for action in May 2020, led by the Government of Costa Rica and WHO, which led to the setting up of C-TAP. UNAIDS is a member of the C-TAP Steering Committee.

UNAIDS thanks the Government of Spain for backing and facilitating the agreement and for its financial support of C-TAP.

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.

Brazzaville, Geneva, Nairobi, 2 December 2021 – Botswana has become the first high-burden country to be certified for achieving an important milestone on the path to eliminating mother-to-child transmission of HIV by the World Health Organization (WHO).

High-burden HIV countries are defined as those with more than 2% of pregnant women living with the virus. Botswana has achieved the “silver tier” status, which moves it closer to eliminating mother-to-child HIV transmission. WHO awards this certification to countries which have brought the mother-to-child HIV transmission rate to under 5 %; provided antenatal care and antiretroviral treatment to more than 90 % of pregnant women; and achieved an HIV case rate of fewer than 500 per 100,000 live births.

“This is a huge accomplishment for a country that has one of the most severe HIV epidemics in the world – Botswana demonstrates that an AIDS-free generation is possible,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “This groundbreaking milestone is a big step forward in ending AIDS on the continent and shows how visionary political leadership aligned with public health priorities can save lives. I look forward to other African countries also reaching this goal.”

Globally, 15 countries have been certified for eliminating mother-to-child HIV transmission. None of them had an epidemic as large as Botswana. The country’s feat to date on its journey to elimination is the result of a national response strategy spanning two decades. In 1999 and facing an HIV prevalence rate as high as 30%, Botswana initiated an aggressive programme to prevent mother-to-child transmission.

“Botswana’s pathfinding accomplishment demonstrates the remarkable progress that can be achieved when the needs of mothers living with HIV and their children are prioritized,” said Winnie Byanyima, UNAIDS Executive Director. “Children are among the groups left furthest behind in the HIV response. Addressing this inequality and preventing new HIV infections in children is critical if we are to end AIDS. Political commitment, strong leadership and the hard work of dedicated health care workers and communities in Botswana have delivered impressive results.”

Women living with HIV who do not receive antiretroviral (ARV) medicine have a 15–45% chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. That risk drops to less than 5% if treatment is given to both mothers and children throughout the stages when transmission can occur. Botswana quickly achieved national ARV coverage before going on to implement increasingly effective regimens, following WHO guidance.

In 2013, Botswana became one of the first countries in the world to implement the so-called ‘Option B+’, a plan for treating all pregnant and breastfeeding women living with HIV with a highly effective lifelong triple antiretroviral treatment regimen at the time of diagnosis.

Mohamed Fall, UNICEF Regional Director for Eastern and Southern Africa, asserted that the country’s progress could serve as an example for others.

“We applaud Botswana for this remarkable achievement, which serves as inspiration to other countries in Eastern and Southern Africa,” said Mr Fall. “The progress on prevention of mother to child transmission of HIV in this region is truly a public health success, with more than 1.7 million new infections in children averted since 2010. We look forward to congratulating other countries very soon and continuing the journey to full and sustained elimination over time.”

The global validation criteria and processes date to 2015, when UNAIDS, UNICEF, WHO and other partners created the Global Validation Advisory Committee to standardize the measurement of achievements for eliminating mother-to-child transmission of HIV and syphilis. In 2017 and in recognition of the achievements made by countries with a high burden of HIV that were demonstrating significant and sustained reductions in the mother-to-child transmission rate, new Path to Elimination criteria were introduced. The elimination agenda has broadened to a “triple elimination” of mother-to-child transmission of HIV, syphilis and hepatitis B.

Botswana is now updating its guidance regarding syphilis and will expand its elimination objectives moving forward.

Please click the link below for audio-visual material: https://drive.google.com/drive/folders/1s9cONZBU2rkZtRZrpRGRXED2AJj5_3Yc?usp=sharing

UNICEF

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

WHO

The World Health Organization contributes to a better future for people everywhere. Good health lays the foundation for vibrant and productive communities, stronger economies, safer nations and a better world. As the lead health authority within the United Nations system, our work touches people’s lives around the world every day. In Africa, WHO serves 47 Member States and works with development partners to improve the health and well-being of all people living here. The WHO Regional Office for Africa is located in Brazzaville, Congo. Learn more at www.afro.who.int and follow us on Twitter, Facebook and YouTube.

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.

Launched by the UNAIDS Executive Director, Winnie Byanyima, in mid-September, the Respect campaign is raising awareness among UNAIDS staff of the UNAIDS/World Health Organization Policy on Preventing and Addressing Abusive Conduct, updated in early 2021.

“It is our right to work in a respectful environment, a right that each and every one of us is entitled to, as well as obligated to uphold. Together, we will make our workplace equal, safe and empowering,” wrote Ms Byanyima in a message to all staff.

The policy expanded the scope of protection to include interns and consultants and now describes, with examples, types of abusive conduct. The new policy also removed the requirement for complaints to be made within a specific time limit.

“A few colleagues came up to me to share their own stories and situations when they didn’t feel valued. They were appreciative that we are naming these issues. This is a way to show our support and explain avenues to address these situations to those who had to endure them. It also increases the stakes for those who act in this way because they know that all of us know this is not acceptable,” said Mumtaz Mia, who leads the culture transformation process at UNAIDS.

The campaign aims at improving knowledge and understanding of what is considered abusive conduct by using everyday examples and is based on six different experiences representative of abusive conduct, from discrimination, to abuse of authority, to sexual harassment and homophobia.

“Every staff member and consultant at UNAIDS is entitled to and has the right to expect a safe and respectful workplace. This is an obligation that each one of us, from the Executive Director to our ancillary staff, has to our workmates. Our staff surveys have told us that hasn’t always been the experience for everyone working in the organization and so the Respect campaign is a much-needed and positive development which the Staff Association hopes will contribute to building a better and healthier UNAIDS workplace for each and every one of us,” said Stuart Watson, Chair of the UNAIDS Secretariat Staff Association.

As part of the campaign, conversations on abusive conduct are taking place within UNAIDS teams, with staff invited to learn more about abusive conduct. Looking to the future, the campaign will continue, building on the current campaign and reflecting the lived experiences of staff across the organization.

The recent UNAIDS Global Staff Survey revealed that 55% of respondents feel that UNAIDS takes allegations of discrimination, abuse of authority, ill treatment and sexual harassment seriously. Half of the respondents also said that they feel comfortable to speak up and address colleagues about incivility or exclusionary behaviour they experience or observe. While these are above benchmark figures, UNAIDS’ management will keep monitoring the situation. The aim is to narrow the gap between experienced abusive conduct and reporting and action against the conduct, as well as the overall reduction of abusive conduct for a safe, equal and empowered UNAIDS for everyone.

Data from South Africa highlight the challenge faced by many treatment programmes when it comes to successfully retaining people in HIV care.

The HIV treatment programme in South Africa reaches more people living with HIV than any other in the world, with more than 5 million adults (aged 15 years and older) receiving antiretroviral therapy in 2020. Among the 2.5 million adults living with HIV in South Africa who are not on treatment, a steadily increasing percentage are people who had started treatment but are no longer receiving it.

Efforts to support people on treatment to maintain treatment and achieve durable viral suppression are critical to improving health outcomes, maximizing the preventive benefits of treatment and preventing the emergence of drug-resistant strains of HIV. The World Health Organization recently updated its HIV treatment guidelines with a new recommendation to trace people who have disengaged from care and provide support for re-engagement.

COVID-19 has underscored the crucial need for pandemic responses to include social protection measures that reach and benefit marginalized populations.

As the pandemic swept across western and central Africa in early 2020, the region was already grappling with socioeconomic distress and humanitarian crises. Social restrictions imposed to contain the pandemic exacerbated those challenges. Impoverished and vulnerable populations, including people living with HIV and key populations, were hit hard.  

Surveys conducted between June and August 2020 in 17 countries in the region on the situation and needs of people living with HIV—with support from UNAIDS, in partnership with the Network of African People Living with HIV West Africa—revealed that up to 80% of people living with HIV were experiencing livelihood losses, and more than 50% of them needed financial and/or food assistance.  

These findings convinced UNAIDS and the World Food Programme (WFP) to launch a pilot project on unrestricted cash transfers in July 2020 to help people living with HIV and key populations cope with the socioeconomic impact of HIV and COVID-19 in four priority countries: Burkina Faso, Cameroon, Côte d’Ivoire and Niger. The initiative was designed to capitalize on WFP’s existing arrangements with service providers and on UNAIDS’ community engagement and relationships with civil society networks in the four priority countries.

Cash transfers are increasingly recognized as an effective form of social protection, with positive social and economic effects. They provide income support and help households avoid selling off assets or removing children from school, and they have multiplier effects on local economies. They constituted approximately 40% of global social safety net expenditures in 2018, but less than 20% in western and central Africa.

As the pandemic spread across western and central Africa, only a few countries (Côte d’Ivoire and Senegal among them) allocated additional support for vulnerable households in the form of cash transfers or social grants.

The immediate objective of the pilot was to reach about 5000 households with one-off, unconditional cash transfers, which ranged from US$ 88 per beneficiary (in Côte d’Ivoire) to US$ 136 (in Cameroon).

“I am so grateful for this support. I used it to pay the fees for my sewing course and to buy a sewing machine to start my own business. I also helped my mother who lost her job due to the pandemic,” said a young woman living with HIV in Cameroon.

Civil society organizations and financial service providers were engaged during the planning of the pilot. Eligibility for the transfers was decided based on a variety of vulnerability criteria, and beneficiaries were identified with the support of community-led organizations. Additional steps involved sensitizing beneficiaries, distributing the cash transfers, troubleshooting and monitoring the process. Specific attention was made to ensure confidentiality and to mitigate any potential stigma for beneficiaries.

Across the four countries, almost 4000 beneficiaries were reached, and it is estimated that a further 19 000 household members also benefited from the cash transfers, most of which went towards food, health care, education and housing expenses, or for income-generating activities. Country experiences varied in terms of the depth of their collaboration with community partners and the extent to which government actors were involved.  

The experience of the pilot demonstrated that delivering rapid cash transfers to marginalized people living with HIV and key populations in very difficult circumstances is possible, and that it provides valuable emergency support.   

Critical lessons learned include the need for inclusive and flexible approaches, working in ways that are clear and transparent to community partners and systematically involving community partners throughout the process. Defining clear and unbiased eligibility criteria, applying them consistently and sensitizing beneficiaries and communities are also vital.

Capacity-building and other support (including funding) for community partners is another critical element. Community-level organizations, trusted counsellors and peer educators were essential for establishing trust, identifying and reaching the intended beneficiaries, minimizing stigma and assessing the impact of the cash transfers. Engaging with government structures from the beginning helps to create the potential for long-lasting improvements.  

One-off cash transfers of this kind can help households withstand short-term shocks, but they do not do away with the need to fully integrate vulnerable and marginalized populations into crisis responses and comprehensive social protection systems. It is imperative that countries across Africa expand inclusive, multipurpose social protection that is accessible and sustainable. Enhancing the people-centredness of cash transfers and slotting them in with other forms of social provisioning and support that are not necessarily cash-based—such as free or subsidized primary health care, education, water and energy—is part of this process.

Following this pilot experience on the use of cash transfers to support the most vulnerable people living with HIV and key populations, UNAIDS and the Civil Society Institute for Health have further strengthened their collaboration on advancing HIV-sensitive and inclusive social protection in western and central Africa. Recently they organized, with the support of LUXDEV funding and in collaboration with several UNAIDS Cosponsors, a capacity-building workshop to mobilize and build the capacity of civil society and communities and to promote dialogue and collaboration among civil society organizations, partners and governments to advance inclusive, HIV-sensitive social protection in the region.

Building on the recommendations of the workshop, a number of follow-up activities were agreed to enhance the role and positioning of communities in advancing HIV-sensitive social protection within their countries and the region. 

“The cash transfer initiative in Niger came at the right time. The cash transfers were used by the beneficiaries to stockpile food and pay rent, but most importantly to allow the children to continue their schooling. This initiative demonstrated the value and importance of working together with the communities and our Cosponsors to achieve a common goal,” said El Hadj Fah, the UNAIDS Country Director for Niger.

Almost half (46%) of the world’s 1.7 million children living with HIV were not on treatment in 2020 and 150 000 children were newly infected with HIV, four times more than the 2020 target of 40 000

GENEVA, 21 July 2021—In the final report from the Start Free, Stay Free, AIDS Free initiative, UNAIDS and partners* warn that progress towards ending AIDS among children, adolescents and young women has stalled and none of the targets for 2020 were met.

The report shows that the total number of children on treatment declined for the first time, despite the fact that nearly 800 000 children living with HIV are not currently on treatment. It also shows that opportunities to identify infants and young children living with HIV early are being missed—more than one third of children born to mothers living with HIV were not tested. If untreated, around 50% of children living with HIV die before they reach their second birthday. 

“Over 20 years ago, initiatives for families and children to prevent vertical transmission and to eliminate children dying of AIDS truly kick-started what has now become our global AIDS response. This stemmed from an unprecedented activation of all partners, yet, despite early and dramatic progress, despite more tools and knowledge than ever before, children are falling way behind adults and way behind our goals,” said Shannon Hader, UNAIDS Deputy Executive Director, Programme. “The inequalities are striking—children are nearly 40% less likely than adults to be on life-saving treatment (54% of children versus 74% of adults), and account for a disproportionate number of deaths (just 5% of all people living with HIV are children, but children account for 15% of all AIDS-related deaths). This is about children’s right to health and healthy lives, their value in our societies.  It’s time to reactivate on all fronts—we need the leadership, activism, and investments to do what’s right for kids.”

Start Free, Stay Free, AIDS Free is a five-year framework that began in 2015, following on from the hugely successful Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. It called for a super Fast-Track approach to ensure that every child has an HIV-free beginning, that they stay HIV-free through adolescence and that every child and adolescent living with HIV has access to antiretroviral therapy. The approach intensified focus on 23 countries, 21 of which were in Africa, that accounted for 83% of the global number of pregnant women living with HIV, 80% of children living with HIV and 78% of young women aged 15–24 years newly infected with HIV.

“The HIV community has a long history of tackling unprecedented challenges, today we need that same energy and perseverance to address the needs of the most vulnerable—our children. African leaders have the power to help us change the pace of care and should act and lead until no child living with HIV is left behind,” said Ren Minghui, Assistant Director-General of the Universal Health Coverage/Communicable and Noncommunicable Diseases Division of the World Health Organization.

Although the 2020 targets were missed, the 21 focus countries in Africa made better progress than the non-focus countries. However, there were major disparities between countries, and these countries still bear the highest burden of disease: 11 countries account for nearly 70% of the “missing children”—those living with HIV but not on treatment. There was a 24% decline in new HIV infections among children from 2015 to 2020 in focus countries versus a 20% decline globally. Focus countries also achieved 89% treatment coverage for pregnant women living with HIV, compared to 85% globally, but still short of the target of 95%, and there were huge differences between countries. For example, Botswana achieved 100% treatment coverage, yet the Democratic Republic of the Congo only reached 39%.

“While we are deeply distressed by the global paediatric HIV shortfalls, we are also encouraged by the fact that we largely have the tools we need to change this,” said Angeli Achrekar, Acting United States Global AIDS Coordinator. “So, let this report be a call to action to challenge complacency and to work tirelessly to close the gap.”

The report outlines three actions necessary to end new HIV infections among children in the focus countries. First, reach pregnant women with testing and treatment as early as possible—66 000 new HIV infections occurred among children because their mothers did not receive treatment at all during pregnancy or breastfeeding. Second, ensure the continuity of treatment and viral suppression during pregnancy, breastfeeding and for life—38 000 children became newly infected with HIV because their mothers were not continued in care during pregnancy and breastfeeding. Third, prevent new HIV infections among women who are pregnant and breastfeeding—35 000 new infections among children occurred because a woman became newly infected with HIV during pregnancy or breastfeeding.

There has been some progress in preventing adolescent girls and young women from acquiring HIV. In the focus countries, the number of adolescent girls and young women acquiring HIV declined by 27% from 2015 to 2020. However, the number of adolescent girls and young women acquiring HIV in the 21 focus countries was 200 000, twice the global target for 2020 (100 000). In addition, COVID-19 and school closures are now disrupting many educational and sexual and reproductive health services for adolescent girls and young women, highlighting the urgent need to redouble HIV prevention efforts to reach young women and adolescent girls.

“The lives of the most vulnerable girls and young women hang in the balance, locked into deeply entrenched cycles of vulnerability and neglect that must urgently be interrupted. With the endorsement of United Nations Member States, the new global AIDS strategy recommits us all to address these intersecting vulnerabilities to halt and reverse the effects of HIV by 2030. We know that rapid gains can be achieved for girls and young women; what is needed is the courage to apply the solutions, and the discipline to implement these with rigor and scale,” said Chewe Luo, United Nations Children’s Fund Chief of HIV and Associate Director of Health Programmes.

UNAIDS and partners will continue to work together to develop new frameworks to address the unfinished agenda. New targets for 2025 were officially adopted by United Nations Member States in the 2021 Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030 in June this year, providing a road map for the next five years.

“It is clear that ending mother-to-child transmission requires innovative approaches that support the whole woman throughout the life course, including intensified primary prevention efforts, such as pre-exposure prophylaxis (PrEP), access to comprehensive reproductive care, and focused attention on adolescent girls and young women. The Start Free, Stay Free, AIDS Free report includes new the new targets for 2025 that, if met, will propel a new era of HIV prevention and treatment for women, children and families. This is not the time for complacency, but rather an opportunity to redouble investments to reduce and eliminate mother-to-child transmission,” said Chip Lyons, President and Chief Executive Officer of the Elizabeth Glaser Pediatric AIDS Foundation.

*The United States President’s Emergency Plan for AIDS Relief, UNAIDS, the United Nations Children’s Fund and the World Health Organization, with support from the Elizabeth Glaser Pediatric AIDS Foundation. 

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
PEPFAR is the largest commitment by any nation to address a single disease in history. Managed and overseen by the U.S. Department of State, and supported through the compassion and generosity of the American people, PEPFAR has saved 20 million lives, prevented millions of infections, and helped transform the global AIDS response.

UNICEF
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Elizabeth Glaser Pediatric AIDS Foundation
EGPAF is a proven leader in the fight for an AIDS-free generation and has reached over 31 million pregnant women with services to prevent transmission of HIV to their babies. Founded in 1988, EGPAF has supported over 15,000 sites and currently works in 17 countries to offer HIV counseling, prevention, diagnosis, and treatment services alongside high-quality family health care. Each stage of life—from infancy to adulthood—brings new and different challenges, and EGPAF is driven to see a world where no other mother, child, or family is devastated by this disease. For more information, visit www.pedaids.org.

Like the rest of the world, COVID-19 has hit Côte d’Ivoire hard. As soon as the first cases of COVID-19 were confirmed in March 2020, a national response plan was developed by the government. Unfortunately, the restrictive measures to protect the population had an impact on the use of health services, including those related to HIV, threatening the fragile retention in care of people living with HIV. Pregnant and lactating women living with HIV and their children, one of the most vulnerable groups, have been particularly affected, and maintaining their access to services and care was essential to avoid undoing years of effort.

The United Nations Development Programme (UNDP) and UNAIDS joined forces to help retain 333 pregnant and lactating women living with HIV in antenatal, maternity and paediatric services in Abidjan. The project will provide, over nine months, 1000 food kits and 1000 hygiene kits to help beneficiaries with food assistance and help them protect themselves against COVID-19.  A food kit contains 20 kg of rice, six litres of oil, 10 pieces of soap and four boxes of children’s flour, and a hygiene kit contains two bottles of hydroalcoholic gel, two bottles of liquid soap and 50 surgical masks. The project also aimed to ensure that the women have access to the comprehensive package of services developed under Côte d’Ivoire’s prevention of mother-to-child transmission of HIV (vertical transmission) programme, to ensure that all exposed children of the project’s beneficiaries are screened early and have access to appropriate care and to document and share good practices.

One of the beneficiaries, Ouattara Maimouna, who has been living with HIV for five years and is a breastfeeding mother of three children, said, “Doctor, this gift was incredibly important to us. It has helped us a lot! This stock of food helps me feed my family. I cannot thank you enough, because I ran out of ways to sustain the small business that used to support my family.”

“About 700 hygiene kits and 700 food kits have been distributed since the project started in December 2020. The United States President’s Emergency Plan for AIDS Relief’s (PEPFAR) implementing partners unanimously indicate that the kits have contributed to the loyalty of pregnant and breastfeeding women to prevention of vertical transmission of HIV and paediatric care services, as well as to self-support groups,” said Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire.

At this stage of implementation, some lessons learned are already emerging. The project has been very well received by the beneficiaries because of their vulnerability, which has been aggravated by the COVID-19 crisis. The support has helped to increase their compliance with appointments at the various prenatal consultations, to improve the continuity of treatment and viral load testing for pregnant and breastfeeding women and to strengthen the link between women living with HIV and the staff providing both clinical and community care. The project also emphasizes the importance of taking into account the social component in the care of women in prevention of vertical transmission of HIV services.

The distribution of food and hygiene kits will continue until the end of 2021. Pregnant and breastfeeding women living with HIV have become more vulnerable in the midst of the response to COVID-19 and assistance strategies that respond to their specific sensitivities must be designed. “The mobilization of UNDP, UNAIDS, PEPFAR implementing partners and their nongovernmental organization partners has ensured a coalition of support for advocacy and the scaling up of outreach efforts to vulnerable populations,” added Ms Quenum. “While this one-time initiative is useful, efforts should be made to integrate other activities, such as nutrition promotion and the integration of a social component in the care of women living with HIV in vertical transmission services and other care sites.”

An HIV-sensitive and inclusive social protection assessment will start in the coming months in collaboration with the key ministries involved. Mobilization of funds for social aspects related to women living with HIV and advocacy for sustainable support measures will be required.