- Of the 1.8 million children living with HIV globally, only 49% are receiving life-saving antiretroviral therapy (ART)
Globally, children under age 15 account for about 5 per cent of all people living with HIV, 7 per cent of new HIV infections and 10 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 ‘Unite for Children, Unite against AIDS’ goal of providing universal access to antiretroviral treatment to all children in need by 2015 was not achieved as coverage reached only 49%. Renewed focus has been called to strategically target more decentralized diagnostics and clinical management for children exposed and living with HIV, as well as smart integration with maternal, child and adolescent services at facility and within communities.
HIV BURDEN IN CHILDREN
- Of the estimated 1.8 million children under 15 years of age living with HIV, nearly 90% live in the sub-Saharan Africa.
- In 2015, less than half (47 per cent) of the estimated infants exposed to HIV received an early infant HIV testing by 2 months of age.
An estimated 1.8 million children under age 15 were living with HIV in 2015. In 2015, 150,000 children were newly infected with HIV, mainly through transmission of the virus from their mothers during pregnancy, delivery or while breastfeeding.
Because the virus progresses rapidly in infants, early treatment is vital to their survival. Without treatment, one third of children living with HIV are likely to 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 any child under the age 5 years. In reality, most children entering treatment programmes are older.
In 2015, an estimated 110,000 children died of AIDS-related causes globally. The vast majority of these deaths were preventable, either through antibiotic treatment of opportunistic infections or through antiretroviral treatment.
Coverage of antiretroviral treatment for HIV in children remains far too low
- 49% of children living with HIV received antiretroviral therapy versus 70% of pregnant women living with HIV and 46% of all adults living with HIV.
Source: UNAIDS 2016 estimates, July 2016
Note: CEE/CIS data are not available
There has been some progress in antiretroviral coverage for children living with HIV
- In 2015, about 870,000 children under age 15 were receiving antiretroviral therapy in all low- and middle-income countries, up from about 550,000 in 2011, 350,000 in 2009 and 190,000 in 2007.
- This means that less than half of children under the age of 15 living with HIV are receiving ART (49%).
In 2015, regional coverage of eligible children under age 15 receiving antiretroviral therapy varied widely, ranging from 20 per cent in West and Central Africa to 64 per cent in Latin America and the Caribbean. In sub-Saharan Africa, 49 per cent of children living with HIV received treatment, though wide disparities are found among sub regions: coverage was 63 per cent in Eastern and Southern Africa and only 20 per cent in West and Central Africa.
Early diagnosis and treatment is particularly critical in the case of infants. In fact, 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 worldwide remains low, at only 47 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 and 9 months of age using virological assay, and after breastfeeding is complete with a rapid antibody test Those found positive at any time point 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.
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.