Despite enormous progress, the AIDS epidemic remains one of the major critical issues of our time. The situation is dire for children - especially for adolescent girls. AIDS is a leading cause of death of adolescents globally - and in sub-Saharan Africa in particular. The UNICEF report titled 'For Every Child, End AIDS' indicates that over half of the world's new infections last year (i.e. 2015) were among women, children and adolescents. Every day, around 400 children become infected. Far too many children have dropped out of treatment, or never received it in the first place.
To end AIDS in children once and for all, the report argues that we need to focus on both treatment and prevention, with a deeper focus on the life-cycle of the child, beginning during pregnancy, in infancy and childhood, and through adolescence.
The publication contains four main chapters including Introduction. The introductory chapter draws our attention to addressing some newer challenges and their tackling which can provide the clearest path to success in ending AIDS. Children aged 0-4 years living with HIV face the most of risk of AIDS-related deaths compared with all other age-groups. Just half of the 1.8 million children (aged 0-14 years) living with HIV are on treatment, and treatment initiation in sub-Saharan Africa starts on average at nearly 4 years of age. Another challenge is that the number of adolescents living with HIV has increased by 28 per cent since 2005. With demographic trends indicating that the youth population is growing fast, the challenges posed by HIV will multiply if new infections among 15-19-year-olds are not halted. In a time of limited resources, working with other development sectors will be critical for both addressing the funding gaps and driving a more sustainable HIV response.
Chapter-1 focuses on 'Support over Lifetime'. People usually require support from systems that address their evolving needs: evidence-based public health policies; robust health systems that include supportive communities and compassionate health-care providers; educational systems that deliver quality learning; and equitable protection systems that safeguard the most vulnerable members of communities from violence, exploitation and abuse. Therefore, an integrated service is essential to meet the needs of all people including women and children. HIV-integrated services delivered by the health, education and protection sectors are necessary for the efficient and effective implementation of HIV interventions and also contribution to broader development outcomes. Protection and education responses are necessary to address the underlying social, economic and political barriers that impede HIV and broader development outcomes. Children are more than twice as likely as adults to live in extreme poverty, with nearly 385 million children living in extreme poverty today. Appropriate health insurance plans, thus, can provide financial protection and enhance utilisation among enrolled populations, including mothers and their infants.
Chapter-2 has focus on 'Mothers and Children'. In 2015, an estimated 1.4 million pregnant women were living with HIV, of which more than 1 million received the most effective regimens of antiretroviral medications (ARVs) for prevention of mother-to-child transmission (PMTCT), with an estimated 79 per cent coverage in sub-Saharan Africa. This occurred in part because countries have rapidly transitioned to the 'test and start' approach. Gains made in bridging the treatment gap among children are equally impressive. In 2009, approximately one in seven children living with HIV in the 21 Global Plan countries in Africa had access to antiretroviral therapy (ART).
In 2015, an estimated 150,000 children (aged 0-14 years) were newly infected with HIV globally, and nearly 85 per cent of them live in sub-Saharan Africa. The majority of these infections occurred during the breastfeeding period. The shift in the timing of HIV transmission from mother to child has created a new urgency for focusing on adherence to medicines and retaining mothers and infants in care to the end of the breastfeeding period. Stigma is another major obstacle, one that often seems to have a disproportionate impact on women, and must be addressed. Many women do not access PMTCT services due to fear of violence or abandonment by male partners, concerns about community-level ostracism or discrimination.
Chapter-3 focuses on 'Adolescents'. An estimated 1.8 million adolescents between the ages of 10 and 19 years were living with HIV in 2015, a total which is 28 per cent higher than the comparable estimate of 1.4 million in 2005.The global HIV epidemic among adolescents has not received adequate focus where it matters most - in the lives of adolescents themselves. However, new global public health commitments provide hope. With a focus on prevention of new HIV infections, testing and treatment, no adolescent should die an AIDS-related death, and those who are free of HIV should remain that way. This chapter suggests strategies to accelerate progress for adolescents: i) Strengthen data collection and analysis to drive decision-making; ii) Invest in a combination of high-impact interventions to reach adolescents most at risk of HIV infection, illness and death; iii) Prioritise efforts to address forced sex, sexual exploitation among adolescent girls; iv) Analyse and respond to the needs of adolescent key populations; v) Educate adolescents about HIV; vi) Support children transitioning to adolescent/ adult care; and vii) Learn by doing: Apply implementation science to investigate effective operational approaches to bring innovations.
The current situation of the AIDS in children response calls for innovation in implementation, dissemination and optimisation, using what is known as a foundation to help focus new action.
Mankind should stand together in an exciting and challenging new landscape that demands creative ways to address both age-old barriers like stigma and lack of knowledge, and the emerging issues such as prevention of new infections in the booming adolescent population. Ending AIDS in children will also require the present world to address the social and economic factors that continue to fuel the AIDS epidemic.
The writer is an independent researcher.
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