Pediatric HIV

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.

Despite the great progress made since the early days of the HIV epidemic, the HIV response for children is still lagging behind the response for adults.

Children living with HIV are particularly susceptible to tuberculosis (TB), one of the leading causes of AIDS-related deaths. In 2020, according to government statistics, 9400 people died of AIDS-related illnesses in Côte d’Ivoire, including 800 children under the age of 14 years. There were 21 000 people under the age of 15 years living with HIV in the country—only 49% had access to antiretroviral therapy. How to correct such an inequality was the question at the heart of a national consultation on paediatric HIV and TB that was held from 8 to 10 June in Abidjan, Côte d'Ivoire.

The consultation, Acting Together for a Generation without AIDS and Tuberculosis, was aimed at improving the prevention and management of HIV and TB among children and adolescents in Côte d’Ivoire.

In her opening speech, Dominique Ouattara, the First Lady of Côte d’Ivoire, called for “The development of an ambitious road map that will enable Côte d'Ivoire to achieve its commitments.” She invited all the participants to engage in a dialogue on the challenges and priority actions needed, and to discuss the roles, responsibilities and contributions of each partner.

The consultation is part of the Confessional Initiative, a UNAIDS and United States President’s Emergency Plan for AIDS Relief initiative that is organizing national consultations and training in Cameroon, Côte d’Ivoire, Kenya, Nigeria and the United Republic of Tanzania.

“The consultation presented the national situation regarding diagnosis, treatment and prevention of HIV and tuberculosis among children, identified the key challenges, outlined the solutions, priority actions and resources needed to improve the national roll-out of optimal paediatric HIV and tuberculosis treatment and diagnosis and identified good practices for replication through civil society and faith-based organizations,” said Patrick Brenny, the Director for the UNAIDS Regional Support Team for Western and Central Africa.

The targets in the 2016 United Nations Political Declaration on Ending AIDS and in Start Free, Stay Free, AIDS Free for paediatric AIDS have not been met. Globally, during 2020 an estimated 160 000 children acquired HIV, far from the global 2020 target of 20 000. Modelling has also shown that the COVID-19 pandemic could have a major impact on new HIV infections among children in sub-Saharan Africa.

Ms Ouattara appealed to the 350 participants to work towards reducing inequalities and asked all stakeholders to join forces to achieve certification of the elimination of mother-to-child transmission of HIV. “Today, in 2021, no child should die of AIDS or tuberculosis in our country," she added.

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.

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.

At a ceremony in Abidjan, UNAIDS Executive Director, Michel Sidibé has honoured the First Lady of Côte d’Ivoire, Dominique Ouattara, for her humanitarian work and her commitment to improving access to paediatric treatment for children living with HIV. 

“Ms. Ouattara’s personal involvement is the clearest sign of her commitment to the most disadvantaged and of her interest in the health of mothers and their children, not only in Côte d’Ivoire but in the whole of Africa,” said Mr Sidibé.

Ms Ouattara is to become a Special Advocate for UNAIDS, helping to raise awareness for programmes aimed at preventing new HIV infections among children and advocating for women and children living with HIV to access antiretroviral therapy.

“This distinction will be a catalyst for my commitment to the elimination of AIDS. From now on, every action to prevent mother-to-child transmission of HIV in Côte d’Ivoire, in Africa and in the world will find a favourable echo in me. I am fully engaged in this fight and I will remain committed until we reach an AIDS-free generation,” said Ms Ouattara.

Ms Ouattara has been involved in humanitarian issues for many years. In 1998, she created the Children of Africa Foundation, which has supported several projects in Côte d’Ivoire, including the construction of a school and a centre for unaccompanied children as well as the promotion of child immunization campaigns.