Changing the trajectory of the pediatric HIV response

The end of 2025 marks a turning point in the pediatric HIV response. With the funding cuts that began at the start of the year, HIV treatment and prevention for children and adolescents has been severely impacted and continues to be threatened. 

A new report, produced by UNAIDS, UNICEF and Avenir Health shows how gains made in this area in the last 20 years are at great risk: if we continue on the current trajectory, the report warns we could see 3 million children newly infected with HIV by 2040 and 1.8 million children lost to AIDS-related causes. 

In comparison, the November 2025 Lancet HIV special issue on pediatric HIV laid out a number of promising innovations that could change the trajectory of the pediatric HIV response. With new forms of ART administration for neonates and infants expected, intensified interest in ART-free remission possibilities for perinatally infected children, renewed prioritization around primary prevention options during pregnancy, and much-needed study of HIV exposed by uninfected children, the issue previews many different avenues for transformational change.

For those of us, including the Coalition for Children Affected by AIDS (CCABA) who have spent decades building evidence and advocating for quality HIV treatment and prevention services for children and young people, the Lancet issue is an important reminder to us and others that there is unique scientific momentum worth watching in the maternal and pediatric HIV space. But the UNICEF report also reminds us that clinical advancement is only one piece of the puzzle and, if history repeats itself, will have limited impact without the political leadership, collaboration structures and financial commitment required for action.

Evidence indicates that the world is not even fully implementing the tools it already possesses. Progress on preventing mother-to-child transmission has stalled for years. . Point-of-care early infant HIV diagnosis, despite being found to be cost-effective, has never been brought to scale. Meanwhile, the exciting promise of twice-yearly lenacapavir as an potentially transformational HIV prevention option for pregnant and breastfeeding women must be tempered by the fact that generics will not be available until 2027. And frankly no single product, no matter how innovative, can carry an entire global response.

This gap between innovation and implementation is where children have so often been left behind. Innovations stall when there is not equal excitement about the investments and implementation strategies needed to bring those innovations to the patient populations they are designed to help.

So what next? At the most recent ICASA, CCABA convened to reflect on this moment with a renewed sense of purpose. Members expressed concern that despite the promise outlined in the November issue, children will once again be left behind as agendas shift, domestic health priorities collide, and funding dwindles. Collaboration platforms that have been integral to keeping pediatric HIV in important political and clinical discussions – such as the Global Alliance, the High-Level Rome Dialogues on Pediatric HIV and TB, and even CCABA – are at risk of being sidelined or ceasing to exist.

Across our discussions, CCABA Members reaffirmed that those of us who work in this field must collaborate more deliberately while streamlining and strengthening partnership structures. Doing so will allow us to speak more confidently and cohesively to ensure that the needs of children stay central as the global HIV response evolves.

CCABA Members coalesced around the need to better understand how the global call for more integrated services will help – but also potentially hinder – access to maternal and pediatric services and innovations, those that exist now and those in the future. Members are confident that national governments can lead and own successful pediatric HIV responses, but only if they work with communities and partners to go beyond the clinical when defining what quality of care means for women, children and families and how such care will be delivered.

Data from the July 2025 UNICEF HIV/AIDS regional estimates for children, adolescents and pregnant women in Eastern and Southern Africa, shows that of all new HIV infections, 11% of these were in children aged 0-14 and 13% of all AIDS-related deaths are among the same age group. It is clear that new clinical tools that improve HIV prevention, treatment, care and support for children are needed. But it is political support for all to fully funded, high-quality clinical, caregiver and community support services that determines whether a mother or child remains HIV-free or, if living with HIV, gets diagnosed early, starts treatment, remains in care, and ultimately survives. 

As a Coalition, we are hopeful and determined to continue to advocate for and with children and adolescents affected by HIV and remain fervent supporters of our collective work to achieve the goal of ending AIDS by 2030.