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Current Status + Progress
Only one third of children in need of life-saving antiretroviral drugs are receiving them

Globally, children under age 15 account for about 9 per cent of all people living with HIV, 11 per cent of new HIV infections and 13 per cent of all HIV-related deaths. Children under 1 year of age are among those most vulnerable to HIV and among the least served by treatment and care services. Evidence shows that early initiation of antiretroviral drugs in infants with HIV can save lives. Yet coverage among children remains too low – 34 per cent in 2012. Antiretroviral treatment services will have to expand rapidly if the ‘Unite for Children, Unite against AIDS’ goal of providing universal access to antiretroviral treatment to all children in need by 2015 is to be achieved. 

HIV PREVALENCE IN CHILDREN

An estimated 3.3 million children under age 15 were living with HIV in 2012. Of these, 260,000 were newly infected, mainly through transmission of the virus through their mothers during pregnancy, delivery or while breastfeeding. Approximately 90 per cent of children living with HIV are in sub-Saharan Africa.

Because the virus progresses rapidly in infants, early treatment is vital to their survival. Without treatment, one third of children living with HIV will die in their first year of life, rising to almost half by age 2. International guidelines advise that immediate antiretroviral therapy is crucial if HIV infection is detected in infancy. In reality, most children entering treatment programmes are older.

In 2012, an estimated 210,000 children died of AIDS-related causes. The vast majority of these deaths were preventable, either through antibiotic treatment of opportunistic infections or through antiretroviral treatment. That said, coverage of antiretroviral therapy in children under age 15 is only half that of adults.

Coverage of antiretroviral treatment for HIV in children is about half that of adults
Percentage of eligible adults (aged 15 or older) and children (aged 0─14) living with HIV who are receiving antiretroviral therapy in low- and middle-income countries, 2012

Source: UNAIDS, Global Report: UNAIDS report on the global AIDS epidemic 2013, UNAIDS, Geneva, 2013, pp. A87, A94.

PROGRESS

In 2012, about 650,000 children under age 15 were receiving antiretroviral therapy in low- and middle-income countries, up from about 350,000 in 2009 and 75,000 in 2005. This means that only about a third of children under age 15 in need of treatment are receiving it.

Even in countries deemed priorities for intensified support, coverage of antiretroviral treatment in children lags far behind that of adults
Percentage of eligible adults (aged 15 or older) and children (aged 0─14) receiving antiretroviral therapy in the 22 Global Plan priority countries, 2012

Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting.

In 2012, regional coverage of eligible children under age 15 receiving antiretroviral therapy varied widely, ranging from 7 per cent in the Middle East and North Africa to 85 per cent in Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS). In sub-Saharan Africa, a third of children in need received treatment, though wide disparities are found among subregions: Coverage was 40 per cent in Eastern and Southern Africa and only 15 per cent in West and Central Africa.

Early diagnosis and treatment is particularly critical in the case of newborns. In fact, the ‘Children with HIV Early Antiretroviral Therapy’ study from South Africa shows a 76 per cent reduction in mortality when treatment is initiated in the first 12 weeks of life among infants who test positive for HIV.

Countries have made good progress in expanding access to HIV-testing services at the point of care. However, the uptake of HIV testing among children worldwide remains low, at only 39 per cent. The revised treatment guidelines of the World Health Organization (WHO) recommend that infants, if HIV-exposed, should be tested by 4 to 6 weeks of age using virological assays. Those found positive should be started on antiretroviral therapy immediately upon diagnosis. Low treatment coverage is also reported among HIV-exposed infants in low- and middle-income countries who are started on cotrimoxazole prophylaxis (41 per cent) and among those receiving antiretroviral prophylaxis to prevent mother-to-child transmission (52 per cent).

For more data and analysis on HIV and AIDS in children, see UNICEF’s Children and AIDS: Sixth stocktaking report by clicking here.

REFERENCES

UNAIDS, Report on the Global AIDS Epidemic, UNAIDS, Geneva, 2013.

UNAIDS, Global AIDS Response Progress Reporting 2014. Guidelines: Construction of core indicators for monitoring the 2011 Political Declaration on HIV/AIDS, UNAIDS, Geneva, 2014.

UNICEF, Children and AIDS: Sixth stocktaking report, UNICEF, New York, 2013.

UNICEF, Progress for Children: A report card on adolescents, No. 10, UNICEF New York, 2012.

UNICEF, Progress for Children: Achieving the MDGs with equity, No. 9, UNICEF New York, 2010.

UNICEF, The State of the World’s Children 2014 in Numbers: Every child counts – Revealing disparities, advancing children’s rights, UNICEF, New York, 2014.

UNICEF, The State of the World’s Children 2013: Children with disabilities, UNICEF, New York, 2013.

UNICEF, UNAIDS, UNESCO, UNFPA, ILO, WHO and The World Bank, Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood, UNICEF, New York, 2011.

WHO, Global Update on HIV Treatment 2013: Results, impact and opportunities, WHO, Geneva, 2013.

WHO, UNAIDS and UNICEF, Global HIV/AIDS Response: Epidemic update and health sector progress towards universal access – Progress report 2011, UNAIDS, Geneva, 2011. 

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Towards an AIDS-free generation - Children and AIDS Stocktaking Report, 2013

An AIDS-free generation means a generation in which all children are born free of HIV and remain so for the first two decades of life, from birth through adolescence. 

 

Notes on the Data

GLOBAL AIDS RESPONSE PROGRESS REPORTING/UNIVERSAL ACCESS

In an effort to harmonize data collection and minimize the reporting burden on countries, UNAIDS, WHO and UNICEF have developed a joint reporting tool. The tool, which has been translated into several UN languages, combines the Global AIDS Response Progress Reporting and Universal Access reporting on the health sector response to HIV/AIDS. Countries that have not yet begun using the tool are advised to download the latest version. Accompanying guidelines support countries in using the tool and provide detailed descriptions of the indicators used.

  • For more information, click here.
  • For Global AIDS Response Progress Reporting/Universal Access reporting guidelines, click here.
  • To view the latest version of the reporting tool, click here.
  • To view a list of indicators, click here.

SPECTRUM/EPP ESTIMATE MODELLING

UNAIDS, WHO and UNICEF are using Futures Institute's modelling software, Spectrum/EPP, to generate estimates, which support policy decisions concerning public health. Spectrum includes modules for HIV estimates and projectors.

  • For more information, click here.
  • For estimates methodology, click here.

NATIONALLY REPRESENTATIVE SURVEYS

Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), AIDS Indicator Surveys (AIS), reproductive health surveys, sexual behaviour surveys and other nationally representative surveys are currently used to collect data on HIV and AIDS.