By Florence Anam, Love Alliance Programme Manager
19 November 2021
It’s World Children’s Day! Should we be celebrating?
World Children’s Day is celebrated annually on 20 November to commemorate the Declaration of the Rights of the Child by the UN General Assembly on that date in 1959. The theme this year is ‘Investing in our future means investing in our children’.
But when it comes to HIV, children worldwide have little to celebrate. Despite all the progress made in both prevention and treatment, children continue to be affected disproportionately by HIV. In 2020 alone, 350,000 children acquired HIV and 210,000 died of AIDS-related illnesses.
Significant gaps persist globally in the testing of infants and children exposed to HIV. In 2020, approximately 800,000 children aged 0-14 years living with HIV were not on antiretroviral treatment – a significant drop from 2019. Only 40% of children living with HIV and on treatment had suppressed viral loads, compared to 67% of adults.
Investing in our future means that children exposed to and living with HIV must have access to timely diagnosis and effective, child-friendly, and age-appropriate treatment and care in order to improve their health and save lives. It means that mothers and caregivers have the information, tools and support they need to protect their children. It means there are adequate human resources for health to ensure that service delivery addresses the needs of the communities, with access to treatment, prevention and testing tools for all who may need them. It also means that the rights of children and their caregivers are respected in an environment with progressive laws that reduce inequalities, address stigma, discrimination, criminalization, and violence.
Living up to global commitments
In the last two years, huge scientific and policy progress has been realized at the global level thanks to intensified advocacy and collaborative action from global health actors, communities, and civil society organizations.
The Global AIDS Strategy and the UN Political Declaration both adopted by member states commit to eliminating vertical transmission of HIV and ending paediatric AIDS by 2025, as well as to the 95-95-95 targets for testing: 95% of people living with HIV know their HIV status; 95% of people who know their status are on treatment; and 95% of people on treatment have a suppressed viral load.
These political advances coincide with big steps forward in pediatric HIV treatment. New World Health Organization (WHO) treatment guidelines recommend Dolutegravir (DTG)-based HIV treatment for all children, with dosing recommendations for infants and children over four weeks of age and more than 3 kg. The guidelines also make progressive recommendations for Point of Care testing for early infant diagnosis and viral load monitoring. Pediatric DTG (pDTG) does not require special storage, is taken once a day, dissolves in liquid and tastes like strawberries. Not only is this treatment great for the babies, but also much easier for parents and caregivers to administer.
However, experience has shown that we must go beyond biomedical interventions in order to end inequalities and make accessible these cutting-edge prevention and treatment options for children most affected by HIV.
Our call to action
- Invest in treatment literacy: Many parents and caregivers still do not have access to clear, accurate information about HIV testing and treatment options for infants and children. Effective adherence depends on good understanding of treatment benefits and side effects, and the chance to ask questions about any concerns. It is vital to support parents and caregivers with the information and tools they need to be able to meet their children’s HIV prevention and treatment needs.
- Invest in protecting the rights of families affected by HIV: A hostile legal or social environment presents many barriers to accessing services, drives inequalities and promotes exclusion. Addressing stigma, discrimination and unfavorable laws requires resources, concerted action, and effective enforcement.
- Invest in community-led services and support structures: Communities know best what they need, and are best placed to create safe and trusted spaces for service provision and follow-up.
Investing in communities is the best way to ensure that children living with HIV not only survive but thrive – and that is something worth celebrating!