Networks of people living with HIV welcome the recent Dar-es-Salaam Declaration on ending AIDS in children, which includes bold new commitments — including ring-fenced funding to diagnose and treat pediatric HIV. Still, without more meaningful representation of children, women living with HIV and, particularly new mothers within the response, the global community risks squandering its chance to turn the tide against a neglected epidemic.
Today, only about half of children living with HIV are on life-saving treatment, according to UNAIDS’ latest global AIDS update. As a result, nearly one in five people who die of AIDS-related illness are children, according to 2021 figures.
The heads of state and health ministers of 12 African countries recently adopted the Dar-es-Salaam Declaration on ending AIDS in children. The document was the product of the first meeting of the Global Alliance to End AIDS in Children, which includes countries, donors and global networks of people living with HIV; namely the International Community of Women Living with HIV (ICW), Global Network of Young People Living with HIV (Y+ Global), and the Global Network of People Living with HIV (GNP+).
ICW, Y+ Global and GNP+ (the global networks), applaud the declaration and the ambitious targets included in the country plans that accompany it. The global networks now call upon donors and domestic governments to fund these goals.
“Historically, programmes to safeguard children living with or affected by HIV have been made in rooms without donors and because of this, many plans have gone unfunded,” explained GNP+’s Florence Riako Anam. “With Global Fund and PEPFAR as Global Alliance partners, I believe that plans to support and care for women and children stand a better shot than ever of being backed up by sound country plans.”
“The alliance and the declaration harness a unique opportunity,” she said. “Now is the time to invest in seizing this moment.”
Still, the global networks warn that the alliance’s true impact will depend on its ability to meaningfully incorporate children and women living with HIV, particularly new mothers.
“The Global Alliance to End AIDS in Children has made admirable efforts to representatives of people living with HIV with the help of international networks,” said Y+ Global’s Maximina Jokonya. Jokonya coordinates the HER Voice Fund to increase the engagement of adolescent and young women in Global Fund processes. “However, the voices of new mothers still remain under-represented in global discussions.”
Following this, the global networks now call on partners to ensure women living with HIV who have recently become mothers and are accessing services are included in decision-making platforms. For example, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has this year included community representation slots for breastfeeding mothers as part of planning meetings to produce the 2023/24 Country Operation Plans (COPs). These plans outline how U.S. donor funding will be spent, including priorities and targets.
The global networks call on other donors, including the Global Fund, to guarantee the same level of engagement in their national application processes to ensure that the lived experiences of women living with HIV, particularly new mothers, are reflected in planning.
“Research shows that a woman’s risk of HIV infection is four times higher than that of her peers in the six months after she delivers,” Jokonya explained. “At the same time, women and families are negotiating new realities around breastfeeding, caregiving, family planning and relationships after birth that can all have a bearing on a woman’s HIV risk and that of her child in the first two years.”
She concluded: “If we don’t understand this lived reality, we can’t effectively diagnose, treat or care for children affected by HIV or their mothers.”
The global networks continue to play a crucial role in the alliance, partnering with others to provide community input into consultations and the ultimate declaration. This follows successful advocacy by networks earlier last year that led to the creation of a Community Oversight Taskforce within the global alliance to ensure community-led monitoring of its work. Additionally, people living with HIV pushed for the addition of a fourth pillar of work for the alliance to address social and structural barriers to diagnoses and treatment — including gender inequality.
More recently, the trio developed a community monitoring checklist to guide alliance countries in creating effective, efficient, and responsive programming. This includes real representation of women and other key populations within national platforms and dedicated funding to develop new leaders within these communities.
Networks of people living with HIV call on governments and donors to mainstream the checklist into both PEPFAR COPs and the Global Fund’s latest funding cycle.
“We have helped shape the Global Alliance and have ensured that human rights, community engagement and gender equality are pillars of the Alliance,” said Lillian Mworeko of the International Community of Women living with HIV in Eastern Africa. “We believe that women- and key population-led responses are key to ending AIDS in children.”
The Global Alliance to End AIDS in Children aims to prevent new HIV pediatric infections and ensure that by 2030 all HIV-positive children can access lifesaving treatment. As part of this work, the alliance also aims to avert new HIV infections among breastfeeding and pregnant women or — for those already infected — ensure access to treatment. Currently, the alliance comprises 12 countries: Angola, Cameroon, Côte d’Ivoire, Democratic Republic of Congo, Kenya, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. The alliance also includes UNAIDS, the World Health Organization, UNICEF, Global Fund, PEPFAR, Pediatric-Adolescent Treatment Africa (PATA) and the Elizabeth Glaser Pediatric AIDS Foundation