The latest report on the progress towards the ‘Start Free, Stay Free, AIDS Free’ targets shows that despite the efforts and progress made, HIV response for children has fallen behind, as we are subpar in meeting the target for eliminating new HIV infections among children. The July 2020 report from UNAIDS in Geneva also states that because of new infections, children die needlessly from other related illnesses that could be prevented with simple and cheap treatments, if the children were diagnosed and treated on time.
The ‘Start Free, Stay Free, AIDS Free’ framework has three simple concepts for reducing new infections. First, babies have a right to enter the world free from HIV. Second, through HIV prevention, children, adolescents and young women have a right to stay free from contracting the virus. Third, children and adolescents who acquire HIV have the right to be diagnosed, treated and cared for so that they can remain AIDS free.
“For too long, the response to HIV has overlooked children, adolescent girls and young women,” said Henrietta Fore, the Executive Director of the United Nations Children’s Fund (UNICEF). She noted there is hope from the recent momentum in reducing new infections among adolescent girls and young women. “We must not let COVID-19 and its economic headwinds slow the process, and to achieve that we must remain bold and ambitious in our joint efforts to ensure that the next generation of children remain free of HIV/AIDS, so that 1.4 million children with HIV will have access to treatment therapy by 2020.”
Countries around the globe have agreed to a range of prevention and treatment targets on HIV so babies and children can start their lives HIV free. One of the targets is to reduce new born infection rate (0-14 years) or HIV infections to less than 40,000 by 2018 and 20,000 by 2020. However, newly published estimates show that 150,000 children were newly infected in 2019; a 52% reduction since 2010, but still four times the 2018 target.
“The lack of optimal HIV medicines with suitable pediatric formulations has been a longstanding barrier to improving health outcomes for children living with HIV, contributing towards low treatment coverage,” said Tedros Adanom Ghebreyesus, the Director-General of the World Health Organisation. To meet world health standards, pregnant women in Sierra Leone living with HIV are diagnosed, started and retained on antiretroviral medicines during pregnancy, delivery and breastfeeding so the chance that they will pass on the virus is less than 1%.
Globally, 85% of pregnant women living with HIV received those medicines in 2019, but despite the high coverage, children are still becoming infected due to unequal access to treatment services in Western and Central Africa. For this reason, the Directorate of Sexual Reproductive Health together with the National School of Midwifery is encouraging more women to make use of the nearest health facility during pregnancy, and discouraging them, especially those in rural communities, from seeking the services of traditional birth attendants, who are not well equipped to provide the much required services.
Despite the failures, the positive news is that there is possibility that the world could meet the ‘Start Free, Stay Free, AIDS Free’ targets. With heightened commitment, the main obstacles to the targets would be overcome together and reverse the failures.
By Ade Campbell