We cannot end AIDS 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. Yet, none of the recent global HIV targets for children and adolescents were met. Indeed, progress has slowed, halted and, in some cases, reversed. HIV continues to affect millions of children and adolescents worldwide, and its impact is growing. 2.8 million children and adolescents are living with the disease, and every day around 850 become newly infected. A further 15 million children face challenges due to perinatal exposure to HIV. And many more millions of children and adolescents – both HIV positive and negative – are grappling with the impacts of the disease. These include, poverty, orphanhood, sexual exploitation and abuse, early childhood development delays, poor mental health, violence, stigma and of missing out on education. Children and adolescents experiencing poverty and exclusion are being left behind by the response. This includes, adolescent girls, adolescent parents affected by HIV and their children, the children of key populations, and other groups affected by poverty and discrimination. COVID-19 has exacerbated the inequalities children and adolescents face. And made it harder to address them. And the setbacks in HIV service delivery caused by COVID-19 will take additional time and resources to restore.
SUPPORTING CHILDREN & ADOLESCENTS AFFECTED BY HIV TO SURVIVE AND THRIVE – WHAT WILL IT TAKE?
More investment is urgently needed from all types of international and domestic donors to fill the critical funding gap for children and adolescents. Without additional funds, we will not meet global HIV targets. Progress will continue to stagnate and even get worse. Investment decisions must follow the science to ensure that no-one is left behind and that resources are used efficiently. This includes efforts to ensure that resources prioritise frontline service delivery, and that they are benefitting those communities with the greatest need.
Set strong national targets for children and adolescents with a resourcing plan that donors can engage with. Governments must prioritise them in national action plans and budgets, and ensure that programmes for children and adolescents are resourced effectively. Donors must promote action on children and adolescents in their guidance and policy, and ring-fence funds for them. And governments and civil society must prioritise children and adolescents in their funding requests. All stakeholders must work together to track what level of financial resources are targeting children and adolescents and measure impact on their outcomes; and strengthen the voices of children and adolescents in decision-making across these processes.
Put first those children and adolescents ordinarily left behind. This includes, adolescent parents affected by HIV and their children, the children of key populations, and other children and adolescents experiencing poverty and exclusion. Building an AIDS-free generation means equipping them, their caregivers, and their service providers with the skills, resources, and opportunities to prevent and respond to the disease. It means creating an enabling environment in which laws, policies and social norms prioritise and support those left behind. And where they take leadership roles in the design and delivery of services, and in challenging stigma and discrimination against them.
Track what is happening to children and adolescents and act upon it. They must be incorporated into data collection and decision-making processes. This includes, the Population-based HIV Impact Assessments that guide much of the global HIV response. And, national Community Led Monitoring on the quality of service delivery.
Scale up proven technologies for identifying, testing and treating HIV in children and adolescents. This includes, optimal treatment regimens that can deliver viral load suppression such as dispersible dolutegravir, which is now available for younger children; long-acting PrEP, early infant diagnosis, point of care testing, and family-based index testing are all proven innovations that need to be scaled up. Administering PrEP amongst pregnant HIV negative women is another important innovation since 30-40% of all vertical transmission is driven by incident HIV during pregnancy. This requires greater investment in these technologies, as well as in building the knowledge and capacity of frontline health workers to use them effectively.
Combine biomedical HIV services with broader health, social and economic support tailored to the evolving needs of each child and adolescent. These include, nurturing care, nutrition, poverty reduction, mental health, sexual and reproductive health and rights services, education, ending violence, building gender equality and other health challenges such as paediatric tuberculosis. This holistic approach is proven to increase the resilience of excluded children and adolescents and improve multiple outcomes simultaneously, including HIV.
Support communities to lead. Communities have long been designing and delivering integrated programs that address the complex needs of those ‘hardest to reach’ and are often their only life-line. And while strong national policies and laws are important, they are only enacted when complemented by supportive and resourced communities and families, including religious and cultural leaders. We must build the overall capacity of small community-based organisations, including those led by children, adolescents and youth; invest in more trained, well-paid frontline community health workers who can deliver comprehensive care and support with and for children and adolescents; make funding more accessible to community organisations; and strengthen their voice in decision-making.
- Donor Policy Report: How much funding is going to children and adolescents, where, on what and what are the gaps?
- Policy Recommendations: Realising the rights of children and adolescents at the 2021 High Level Meeting on HIV
- Advocacy Messages: At the heart of important discussions that use scientific evidence to re-energize commitments and actions needed to achieve the Global targets to end AIDS by 2030. These are available in French, Portuguese and Swahili.
- COVID-19 Policy Briefing: Prioritising Children, Adolescents and Caregivers Affected by HIV in the COVID-19 response
- Our open letter to governments and donors on inclusion and Universal Health Coverage
- Frequently Asked Questions about the Coalition and its mission