Dr Stuart Kean
Advocates require resilience and this has been a prerequisite for those advocating over many years to ensure that children living with HIV have had their needs recognised and rights addressed to access testing, treatment and care. The voices of children, especially those under 14, are rarely heard. Indeed, they’re too young to attend meetings to negotiate with policy makers that targets include them; or to demand that governments allocate resources for them to be tested speedily and to access medications that are effective, palatable and affordable.
Over the past 20 years, following significant advocacy efforts including by the faith community, successive HIV High Level Meetings attended by all governments in New York in 2001, 2006, 2011 and 2016, have made increasingly ambitious commitments, promising that children would be able to access testing and treatment. In 2016 these efforts resulted in the Political Declaration on Ending AIDS, that agreed a very ambitious target to get 1.6 million children living with HIV tested and on treatment by 2018. This target represented a doubling from the 800,000 children on treatment in 2015. These advocacy efforts also resulted in the creation in 2016 of the Start Free, Stay Free, AIDS Free – Super-Fast Track initiative for children living with HIV, charged with implementing the ambitious targets.
So, after all these efforts, it was shocking and frustrating to recently read UNAIDS say that: “in spite of great progress made since the early days of the epidemic the HIV response for children has fallen behind. Year after year, the bold target of eliminating new HIV infections among children is being missed and children are dying needlessly from AIDS-related illnesses—deaths that could be prevented with simple and cheap treatments if the children were diagnosed and treated in time.”[i] The latest statistics for 2019 showed that globally, only 950 000 children (aged 0-14 years), that is 53% requiring antiretroviral therapy, were receiving it, up from just over 860 000 in 2015, but the target was 1.4 million by 2020 and this compares poorly with adult treatment coverage of 68%. Globally, in 2019. only 60% of HIV-exposed infants received a diagnostic test within the first 2 months of birth as recommended. UNAIDS acknowledges this represents: “nothing less than a global failure to provide life-sustaining care to the most vulnerable within our communities”[ii].
To make matters worse COVID-19 threatens to disrupt health services and reverse gains made in preventing mother-to-child transmission of HIV. Since 2010, new HIV infections among children in sub-Saharan Africa have declined by 43%, from 250 000 in 2010 to 140 000 in 2018, but the curtailment of these services by COVID-19 for six months could see new child HIV infections rise drastically, by as much as 37% in Mozambique, 78% in Malawi, 78% in Zimbabwe and 104% in Uganda.[iii]
In spite of the disappointment of promises not being met, this is a time for resilience and renewed advocacy for children living with HIV, especially for religious leaders and faith communities to stand up and speak out on the failure of previous advocacy and programme actions.
The faith community has played a critical role supporting children and adolescents using four distinctive assets:
service delivery through faith-inspired health providers e.g. introducing point-of-care diagnostics and transitioning to providing the latest regimens e.g. dispersible dolutegravir;
community outreach through faith community groups e.g. strengthening family-based index testing;
using places of worship to create demand for HIV services e.g. for HIV testing and treatment adherence; and
advocacy by religious leaders and FBOs demanding policy change and holding government accountable for their commitments.
At this challenging time in the HIV response, and 10 years since religious leaders signed a pledge to commit themselves to strengthened efforts to respond to HIV, we, people of faith, must stand up and Take Action for Children living with HIV to access testing and treatment.
Religious leaders and the members of the faith community should call for the following action:
UNAIDS’ new strategy and the 2022 High Level Meeting must commit to setting new targets that will ensure that all children exposed to HIV are tested and those living with HIV are initiated on HIV treatment within 6 weeks of birth, since peak mortality occurs at 6-8 weeks.
Donors, FBOs and faith groups must commit to contribute providing the resources required to complete the commitments made in:
the Start Free, Stay Free, AIDS Free super fast-track framework for ending AIDS in children, adolescents, and young women,
the Rome Action Plan (https://www.paediatrichivactionplan.org) and
the Paediatric HIV Service Delivery Framework (http://www.childrenandaids.org/sites/default/files/2019-07/UNICEF-paediatric-service-delivery_Advocacy-Brief.pdf )
Religious leaders and FBOs must fulfil the commitments they agreed in the Rome Action Plan (https://www.paediatrichivactionplan.org/fbos)
At country level, religious leaders and faith communities must advocate for governments to meet their targets for children and adolescents living with HIV, particularly asking that the latest antiretroviral treatment regimens are available and local stockouts are monitored. In addition, religious leaders must raise awareness on the value of testing and treatment for babies and children. They must build strong relationships with families and partners and impact their communities with stories of hope: timely testing and optimal paediatric ARVs formulation offer children the opportunity to develop and grow healthy, and to live long and productive lives (https://www.faithandcommunityinitiative.org).
Dr. Stuart Kean is an independent consultant who has worked for the last 20 years on policy and advocacy related to children affected by HIV. Stuart co-chairs the Advocacy Working Group of the Regional Inter Agency Task Team on Children and AIDS in Eastern and Southern Africa, and he’s a member of several networks including: the HIV Strategy Group of the World Council of Churches Ecumenical Advocacy Alliance, the Coalition for Children Affected by AIDS and the Child Survival Working Group. Stuart’s work has included: policy analysis on HIV policies, research related to children and HIV, and strengthening local advocacy capacity.
[i]UNAIDS Press release 7 July: https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/july/20200707_start-free-stay-free-aids-free
[ii] UNAIDS, 2020 Global AIDS Update — Seizing the moment P77: https://www.unaids.org/en/resources/documents/2020/global-aids-report
[iii] WHO & UNAIDS, May 2020: The cost of inaction: COVID-19-related service disruptions. https://www.who.int/news-room/detail/11-05-2020-the-cost-of-inaction-covid-19-related-service-disruptions-could-cause-hundreds-of-thousands-of-extra-deaths-from-hiv