Children Affected by HIV ‘Left Furthest Behind’ As Pioneering Global Research Reveals $1 Billion Funding Gap


Critical new data brings world closer to ending AIDS in children and meeting SDGs

Children and adolescents in some of the world’s poorest communities are ‘left furthest behind’ in the global battle to end AIDS and meet UN Sustainable Development Goals (SDGs), with a $1 billion hole in funding needed to realise the key targets, a landmark new report reveals.

The pioneering research, Donor Commitments to Children and Adolescents Affected by HIV and AIDS maps, for the first time ever, where, and what, money is spent on support for children and young people impacted by HIV, and identifies funding gaps for achieving HIV targets and SDGs.

The report, by the international Coalition for Children Affected by AIDS, in partnership with Avenir Health, the World Health Organization, UNICEF and UNAIDS, spotlights an estimated $1 billion shortfall between the $2.8 billion ($US) that UNAIDS says is needed annually in low- and middle-income countries for services for children aged 0–17 and current spending of just $1.8 billion.

It says plugging the $1 billion gap would make global targets for children and adolescents affected by HIV achievable and end AIDS by 2030 and goes further to highlight eight key steps to address the gaps in support.

Coalition manager Corinna Csaky said: “We cannot control the AIDS epidemic without addressing the needs of children and adolescents. Their ability to start free and stay free of HIV is the cornerstone of ending AIDS by 2030.

“Children and adolescents affected by HIV are also amongst those furthest behind in the attainment of the Sustainable Development Goals. This report takes us one step closer to realising these global commitments. For the first time, we know where the funding gaps are and what it will take to address them.”

Funding gaps highlighted include an additional $160 million needed for biomedical support, such as HIV testing and treatment.  A further $840 million are required for building strong health systems and tackling wider social and economic barriers experienced by children and adolescents affected by HIV.

The report also reveals how the lack of investment particularly impacts on populations often marginalised by society including adolescent girls and young women, orphans and vulnerable children, and children and adolescents from ‘Key Populations’ that are at increased risk of HIV infection – for example, those associated with sex work.

The Coalition’s eight-point action plan calls for:

  • Greater political leadership, with governments and donors prioritising children and adolescents affected by HIV, with particular focus on those left furthest behind: adolescent parents affected by HIV and their children; the children of key populations; and those affected by poverty and broader social and structural exclusion;
  • Increased investments in children and adolescents affected by HIV – with ring-fenced funds;
  • Prioritization of investments in cost-effective solutions that target populations left behind. Among such solutions we highlight community driven interventions delivered by frontline health workers, communities, and peers; integrated interventions that combine biomedical support with, for example, mental health, social protection, and early childhood development interventions;
  • Funding to plug the financial gaps in the HIV programming portfolio. Early infant diagnosis, self testing, and family-based testing to find the many children living with HIV who go undiagnosed, antiretroviral therapy for older children, and prevention for adolescent girls and boys all stand out in the report as underfunded areas;
  • New partnerships to share costs with those seeking health system strengthening, pandemic preparedness, universal health coverage, education, economic growth, and other Sustainable Development Goals that directly affect children and adolescents affected by HIV;
  • Increased visibility of funding for children and adolescents affected by HIV and the impact it is having;
  • Efforts to strengthen the voices of children, adolescents, caregivers, and those who work alongside them in monitoring and decision-making around funds;
  • Research into HIV trends in children and adolescents and that the findings be used to guide efforts to tackle HIV and achieve SDGs.

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Note to editors 

  1. Financial analysis in Donor Commitments to Children and Adolescents Affected by HIV and AIDS is based largely on publicly available data accessed via the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Panorama Spotlight dashboard, the Global Fund Data Explorer, and the UNAIDS HIV Financial Dashboard. The PEPFAR online database allows examination of spending by a number of predetermined categories, some of which are specific to children and others of which include both children and adults. To identify total funding for children, PEPFAR conducted a special analysis to allocate shared categories by age group. That analysis is based on budgets rather than expenditures.
  2. The Coalition says Donor Commitments to Children and Adolescents Affected by HIV and AIDS is part of a ‘longer conversation’ and plans to build a fuller picture of funding for children and adolescents by researching support from private trusts and foundations and taking in depth studies of particular countries.
  3. The Coalition for Children Affected by AIDS ( is a unique group of global donors, United Nations agencies, non-governmental agencies, and independent experts. We work together to enable all children affected by HIV and AIDS to survive and thrive. This includes children and adolescents infected with HIV and AIDS, those at risk of infection, and children affected by the social and economic impacts of others close to them having the disease. The Coalition aims to make the HIV sector more effective for children and to mobilize broader international development sectors to ensure that they better serve children affected by HIV and AIDS. Coalition members are esteemed leaders in a wide range of fields who have dedicated their careers to understanding and improving the lives of children affected by HIV in every region of the world. Each has extensive technical knowledge, is influential at the global level, and is deeply committed. They have all joined the Coalition to strengthen our collective voice in calling for more to be done to enable children affected to realize

Quotes from Coalition members: 

The valuable data contained in this report proves the need for financial investment and political engagement on behalf of children globally. Now action must be taken by the global health community to use this new resource to inform where and how funding is allocated to address the inequities facing children and realize the promise of an AIDS-free generation. The global AIDS response must prioritize children, and this is a significant contribution to that end.” Chip Lyons, President & CEO of the Elizabeth Glaser Pediatric AIDS Foundation, a Member of the Coalition for Children Affected by AIDS  

“I urge other advocates to use this report to champion change for children and adolescents everywhere. Many children and adolescents, including young mothers like me, urgently need greater investment – from all sources – to ensure that we survive and thrive.  And we must be supported to play our part in deciding where and how resources are spent; monitoring whether they are reaching those children and adolescents ordinarily left behind; and evaluating whether they are having an impact.”  Miriam Hasasha, Young Mother Ambassador for the Coalition for Children Affected by AIDS and peer educator with Teens Uganda and UNYPA 

This report confirms what those of us working on the front-line have known for a long time – that that there is a major gap between our targets for children and adolescents and our investment in them. The precise size of that gap is less important than the fact that we are far off the level of financial support required.  This report is an opportunity to put things right.”  Luann Hatane, Executive Director of Paediatric-Adolescent Treatment Africa and Co-Chair of the Coalition for Children Affected by AIDS 

In an era when resources are constrained and needs exacerbated by COVID-19,economic crises, and conflict, it is more important than ever to identify where money is being spent, on what, and to what effect. This report reminds us that we all have a responsibility to use resources efficiently and smartly—to get it right and do more of what works. And it reminds us that many of the costs of delivering support to children and adolescents affected by HIV are associated with building strong health systems and human capital—costs that could, and should, be shared with other sectors, not just HIV.” Florence Anam, Programme Manager at the Global Network of People Living with HIV and Member of the Coalition for Children Affected by AIDS