The latest Global AIDS Strategy 2021-2026 focuses on ending the inequalities that prevent progress toward ending AIDS. The sad reality is that there are huge discrepancies in the services provided for children living with HIV (aged 0-14 years) compared with those for adults living with the disease. The extent of these discrepancies became even more apparent in the recently released In Danger, Global AIDS Update for 2022. It highlights gaps in three key areas: first, only 59% of children (aged 0-14) living with HIV know their status compared with 86% of adults; second, only 52% of children living with HIV are on treatment compared with 76% of adults; and third, only 41% of children living with HIV are virally suppressed compared with 70% of adults. What makes
these statistics even more worrying is that the gap between children and adults is increasing rather than narrowing.
In 2021 an estimated 800 000 children living with HIV were still not receiving HIV treatment, and whilst children comprised 4% of people living with HIV in 2021, they comprised 15% of AIDS-related deaths. Progress in preventing vertical transmission has slowed with only a 22% decline of new infections in children from 2016 to 2021 and 160,000 newly infected with HIV. This is almost 440 new HIV infections in children every day. These data lead UNAIDS in their latest report to say: “ . . . despite years of high-level pledges of urgent action to eliminate vertical transmission of HIV and close children’s HIV testing and treatment gaps, and children continue to experience some of the most serious HIV-related inequalities”.
The greatest paediatric treatment challenge is rapidly finding children living with HIV who were missed at birth and during breastfeeding and linking them to treatment. For
younger children, too, it is still concerning that only 63% of HIV-exposed infants in 2021 were tested by two months of age. Yet without treatment, 50% of infants with HIV will die by two years of age. It is also shocking that stigma continues to hinder the successful implementation of paediatric testing, treatment, and adherence.
Yet, there is good news, as new ambitious targets have been set for 2023 and 2025, and a new Global Alliance has just been launched, which aims to end AIDS in children by 2030. We also know what needs to be done, and faith communities have a significant role in helping government and other service providers to achieve the new targets.
A compendium of promising practices of African faith community interventions will be published shortly. It highlights that faith communities could help to identify missing children and reduce loss-to-follow-up, especially related to finding and testing missing children and family members. They can also support adherence and retention, and faith leaders as paediatric champions can undertake advocacy to tackle stigma and speak out to ensure targets are achieved. There are three specific areas of activity faith communities could contribute to:
Implement innovative tools to find and diagnose all children living with HIV, including testing machines in local clinics and facilities, and testing family and household members of everyone who test positive in a way that upholds and protects their rights.
Support the rapid introduction and scale-up of access to the latest WHO-recommended, optimized, child-friendly HIV treatment and achieve sustained viral load suppression.
Confront stigma, discrimination and unequal gender norms that prevent pregnant and breastfeeding women - especially adolescent girls, young women and key populations - from accessing HIV testing, prevention, and treatment services for themselves and their children.
This is a time when religious leaders and faith communities must speak out and advocate for governments to review their targets and provide sufficient funding to ensure that the inequalities faced by children and adolescents
living with HIV are ended as a matter of urgency.
Dr Stuart Kean,
Interfaith Health Platform