- Of the 2.1 million children living with HIV globally, only 43% are receiving life-saving antiretroviral therapy (ART)
Globally, children under age 15 account for about 6 per cent of all people living with HIV, 9 per cent of new HIV infections and 11 per cent of all AIDS-related deaths. Children under 1 year of age are among those most vulnerable to HIV. Evidence shows that early initiation of antiretroviral drugs in infants with HIV can save lives; yet, coverage of critical intervention among children remains too low. While there has been slow progress reported in scaling up access to treatment for children living with HIV, the 90-90-90 treatment targets call for 90% of those living with HIV to know their status, 90% of those who know their status to be on treatment, and 90% of those on treatment to be virally suppressed. Renewed focus has been called to strategically target more decentralized diagnostics and clinical management for children exposed and living with HIV, as well as integration with maternal, child and adolescent services at facilities and within communities.
HIV BURDEN IN CHILDREN
- Of the estimated 2.1 million children under 15 years of age living with HIV, nearly 90% live in sub-Saharan Africa.
- In 2016, less than half (43 per cent) of the estimated infants exposed to HIV were tested for HIV by 2 months of age.
- International guidelines advise that immediate antiretroviral therapy is crucial if HIV infection is detected in any child under the age 5 years. In reality, most children entering treatment programmes are older.
An estimated 2.1 million children under age 15 were living with HIV in 2016. In 2016, 160,000 children were newly infected with HIV, mainly through transmission of the virus from their mothers during pregnancy, delivery or while breastfeeding.
In 2016 an estimated 120,000 children died of AIDS-related causes globally. The vast majority of these deaths were preventable, either through antibiotic treatment of opportunistic infections and/or through antiretroviral treatment.
THERE HAS BEEN SOME PROGRESS IN ANTIRETROVIRAL COVERAGE FOR CHILDREN LIVING WITH HIV
- In 2016 about 920,000 children under age 15 were receiving antiretroviral therapy (ART) globally, up from about 640,000 in 2012, 350,000 in 2009 and 85,000 in 2005.
- This means that less than half of children under the age of 15 living with HIV are receiving ART (43%).
In 2016 coverage of eligible children under age 15 receiving ART varied widely, ranging from 2 per cent in some countries to over 95 per cent in others. Regionally, coverage of ART for children ranged from 21 per cent in West and Central Africa to 62 per cent in East Asia and the Pacific. Coverage data for Eastern Europe and Central Asia, North America and Western Europe are not available, although levels are believed to be high.
Early diagnosis and treatment are particularly critical in the case of infants. The ‘Children with HIV Early Antiretroviral Therapy’ study from South Africa demonstrated 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 some progress in expanding access to early infant HIV-testing services. However, the uptake of HIV testing among children aged 0-14 worldwide remains low, at only 43 per cent. WHO’s revised treatment guidelines recommend that infants, if HIV-exposed, should be tested by 4 to 6 weeks and 9 months of age using virological assay, and when the child stops breastfeeding with a rapid antibody test. Those found positive should be started on antiretroviral therapy immediately upon diagnosis.
For more information on UNICEF’s programme and policy work on HIV and AIDS in children, click here.
Though progress has been made in preventing HIV infection in children, a UNICEF analysis of UNAIDS data suggests that without accelerated action, the 2020 super-fast-track targets for eliminating HIV transmission in children, reducing new infections in adolescent girls and young women, and for increasing HIV treatment in children and adolescents living with HIV will not be met.
Children are still dying of AIDS-related causes. Children living with HIV (aged 0–4) face the highest risk of AIDS-related death compared to all other age groups. The AIDS-response must focus on solutions for this extremely vulnerable population. Preventing new infections, but also testing and starting treatment early are the best ways to end AIDS among the youngest children. In an age when the tools and knowledge are at hand to prevent and treat HIV in children, new infections and deaths among this age group reflect a collective failure to prioritise children.
At the turn of the century, and the beginning of the Millennium Development Goals, an HIV diagnosis was equivalent to a death sentence for most children and their families in low-income countries. But now, an early diagnosis paired with treatment and care can ensure long healthy lives, regardless of location, and can help prevent transmission of HIV to others. Since 2000, 30 million new infections were prevented, nearly 8 million deaths averted, and 15 million people living with HIV are now receiving treatment.
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.
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.
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.