The 2016 HLM on HIV’s Political Declaration: What we need to see on PMTCT, Paediatrics, Children & Adolescents
We, civil society organizations working on behalf of children & adolescents & their families, urge UN country delegations to ensure the following five points are covered in the 2016 High-Level Meeting’s Declaration of Commitment on HIV/AIDS and the Political Declarations on HIV and AIDS:
1) EMTCT: Commit to achieve and sustain by 2020 elimination of mother-to-child HIV transmission, with under 20,000 new HIV infections among children, and to take steps towards achieving WHO certification of elimination of mother-to-child HIV transmission. Commit to achieve a 75% reduction in HIV-related maternal mortality.
It is imperative to keep global attention specifically on eliminating mother to child HIV transmission (EMTCT) until we have achieved global elimination of mother-to-child transmission, which is essential to ending the AIDS epidemic. EMTCT cannot simply be rolled into a treatment for all approach, as it requires a variety of unique prevention, treatment, and care interventions. States must also create a sustainable infrastructure to maintain elimination, which should be tied into the WHO elimination certification process. We must also continue to focus on the health of HIV-positive pregnant and breastfeeding women, with HIV remaining the primary cause of death among women of childbearing age.
2) Paediatric Treatment: Commit to have, by 2020, at least 1.2 million children living with HIV on treatment and virally suppressed.
Given low early testing and treatment rates and high mortality among children, there is a clear need to address the specific barriers to progress among children rather than simply including paediatric treatment as a part of the larger body of 90-90-90 work. An explicit numeric treatment and viral load suppression target will give formal recognition to the understanding that 90-90-90 applies to children and will help galvanize the actions needed to meet that goal. Ensuring that at least 2 million children under 15 are virologically suppressed by 2020 will not only help us achieve the goal of an AIDS-free generation, but will also contribut to better health outcomes for them as they grow into adolescence and adulthood
3) HIV-sensitive Care, Support & Social Protection: Commit to ensuring 75% of children, adolescents and their parents living with and affected by HIV receive comprehensive care and support– including comprehensive social protection and child protection.
Comprehensive care & support—including comprehensive social protection & child protection—have been shown to both improve adherence and retention for children and parents and also enable HIV-affected children to achieve their developmental potential. New evidence also shows that comprehensive social protection (providing some form of cash transfer in addition to other social protection programs—sometimes known as ‘cash plus care’) improves adolescent adherence and reduces their risk behavior.
4) Supporting caregivers so children and adolescents can thrive: Commit to strengthening the capacity of families, the community-level child care workforce, and the social welfare workforce, so that together they can meet the developmental needs of children living with and affected by HIV, from pregnancy, to early childhood, and into adolescence.
We recognize the critical roles that families and other carers play in caring for HIV-affected children and adolescents – including fostering healthy growth and development. We must ensure programming helps family carers to deal with stresses & support children at each stage of development into adolescence. This requires scale-up of carer/parenting support programs.
5) Stigma elimination: Commit to a target that 90% of children living with and affected by HIV are free from stigma and discrimination due to their HIV status and/or that of their caregivers.
HIV-related stigma and discrimination cause severe psychological distress among children, and can prevent access to education, treatment, and care. Children orphaned by HIV and those living with HIV positive caregivers experience greater stigma and bullying than their peers. Other groups of children being discriminated against include children of parents of key populations, key populations adolescents and children & adolescents with disabilities.