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. 

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If we do not address HIV among populations affected by conflict, natural disasters and emergencies, we will not see the end of the HIV epidemic by 2030. This was the stark message from leaders at a major side event taking place on the margins of the United Nations General Assembly High-Level Meeting on Ending AIDS, being held in New York, United States of America, from 8 to 10 June.

Entitled “HIV and security: past, present and future,” the event was moderated by journalist Colette Braeckman, who was joined by a panel of eminent experts. The event was organized by UNAIDS and the United Nations Department of Peacekeeping Operations and was attended by the UNAIDS Executive Director, Michel Sidibé.

In setting the scene, Mr Sidibé noted that of the 314 million people affected by emergencies and conflicts in 2013, some 1.7 million were living with HIV. It was, he argued, vital not to leave behind in the response to HIV people living with HIV and people vulnerable to human rights violations and sexual exploitation.

The participants explored exactly how and why people may become more vulnerable to HIV in emergencies and conflict situations. Women and girls especially are at risk of assault and violence every day, even in the very camps and settlements where they seek refuge. Access to HIV prevention and treatment services can be disrupted, and traditional social networks and behaviours often break down during times of crisis, increasing the vulnerability of women and girls to sexual violence and HIV. Members of key populations and young people may also be exposed to HIV through higher-risk behaviours in emergency and conflict situations.

Panellists underscored the need for renewed urgent attention to HIV, security and sexual violence in conflict settings, recalling the adoption of UN Security Council Resolution 1983 five years ago. HIV and security is unfinished business, requiring the urgent attention of the Security Council. Panellists called for the urgent elimination of all forms of sexual abuse and exploitation in UN peacekeeping missions, increased accountability for abuses, and comprehensive support to victims. UN missions and troop-contributing countries have a duty of care to the communities they serve. Upholding this duty requires a culture shift in security and military institutions.

Looking to the future, national responses need to increase strategic information on the drivers of HIV risk and vulnerability in humanitarian crises to enable resources to be targeted effectively. It was argued that well-coordinated HIV programmes should be routinely incorporated into all emergency and post-conflict preparedness and humanitarian response programmes, with cross-border and regional collaboration a priority. In addition, people living with HIV and members of key populations must be included in the development of policies and plans related to the continuity of treatment and access to HIV services. It was emphasized that peacekeeping operations should also play a key role in the HIV response in such settings and help address HIV risk factors.

One of the fundamental recommendations highlighted was the need to have plans in place to deal with the possible impact of conflict and emergencies before such situations arise. Helping to build community resilience to potential traumas so that their effect can be mitigated is essential.

Most crucially, long-term, flexible and sufficient funding must be identified to address the sexual and reproductive health needs of adolescents and young women in humanitarian and fragile settings. Without intensified and fully-resourced humanitarian response, the world will not reach the growing numbers of people affected by displacement, conflict and violence and we will not be in a position to end AIDS by 2030.

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Olusegun Obasanjo, former President of Nigeria and Champion for an AIDS-Free Generation in Africa, chaired a discussion at a side event entitled “Financing vulnerabilities” held on the margins 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.

Joining Mr Obasanjo for the discussion were Helen Clark, the Administrator of the United Nations Development Programme, Patrick Guillaumont, the President of the Foundation for International Development Study and Research, Dorcas Makgato, Minister of Health of Botswana, Javier Bellocq, from the International HIV/AIDS Alliance, Antonio Patriota, Ambassador of Brazil to the United Nations, and Philippe Meunier, the French Global AIDS Ambassador.

This panel, moderated by Luiz Loures, UNAIDS Deputy Executive Director, focused on financing vulnerabilities and explored mechanisms to ensure that fragile communities are at the centre of the global public health agenda. Ensuring that the health of fragile communities is secured, at a time when new epidemics and health issues threaten to further increase the vulnerability of low- and middle-income countries, was also discussed, and the panel explored the social and economic risks of the most vulnerable people.

It was noted that a majority of the world’s poor live in middle-income countries and that equity is essential in the determination of funding allocations. A strong call was made for new commitment and innovations to meet the needs of key populations, including sex workers, men who have sex with men, injecting drug users, transgender people and prisoners, and people living with HIV.

Mr Obasanjo recalled the beginnings of the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as the establishment of the United States President’s Emergency Plan for AIDS Relief, at a time when very little funding was available. Today, Africa funds 55% of HIV treatment from domestic budgets. Mr Obasanjo emphasized the need for continued commitment to end the AIDS epidemic, both from domestic and international resources.

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On the eve of the United Nations General Assembly High-Level Meeting on Ending AIDS, mayors from global cities joined government representatives, the private sector and other stakeholders at the United Nations Headquarters in New York, United States of America, to discuss and showcase innovations in technology and financing for ending the AIDS epidemic by 2030. 

The participants explored key challenges in city responses and offered innovative examples in information technology, mobile and data applications, pharmaceuticals, diagnostics and other scientific advancements for reaching “hard-to-reach” people with HIV prevention and treatment services. More than 20 innovators in the public, private and non-profit sectors presented their innovations in a hands-on marketplace for mayors, ministers, policy-makers and implementers. Innovations that were showcased included new cervical cancer diagnostics, smartphone applications, web-based dashboards and commodity delivery systems by drone.  

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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.

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