After missing the global HIV/Aids targets, new benchmarks that put people at the centre, especially those most at risk, need to be set
November 27 2015 saw UNICEF (the United Nations Children’s Fund) release their annual Statistical Update on HIV among Children and Adolescents at a Critical Thinking Forum in Johannesburg. In collaboration with UNAIDS (the Joint United Nations Programme on HIV and Aids) and hosted by the Mail & Guardian, the event offered insight and analysis into the foundation for UNICEF’s advocacy around children and adolescents living with, or at risk of HIV along with the most recent data for low and middle-income countries. The results are not good for the age group 10-19 and much has to be done to address this continuing threat to the next generation.
“HIV remains the number one cause of death among adolescents in Africa, and yet adolescents have been left behind in the response,” says UNICEF’s regional director in Eastern and Southern Africa, Leila Gharagozloo-Pakkala. “Young people living with HIV must have access to treatment, care and support, while those who are HIV-negative must be given the knowledge and means to stay HIV-free.”
At the turn of the century and the start of the Millennium Development Goals (MDG), an HIV diagnosis was the equivalent of a death sentence for most children and their families in low-income countries. Today, that has changed. Now an early diagnosis, along with the right treatment and care, means that people can live long and healthy lives, regardless of where they live, and treatment can help reduce the risk of transmission to others. Since 2000, 30 million new infections were prevented and nearly eight million deaths averted. On top of that, 15 million people who are living with HIV are receiving the proper treatment, so they can live productive lives.
These figures are the result of an impressive legacy. A legacy of hard work, determination and commitment that saw organisations such as UNICEF and UNAIDS work tirelessly to bring medical care and community support to the people who needed it most. For many of the pregnant women living with HIV in low- and middle-income countries today, there is treatment that is allowing them to remain healthy and prevent the transmission of the HI virus to their children. This has averted around 1.3 million new infections in children since 2000. Still, statistics have found that every hour 26 children aged 0-14 continue to be infected with HIV.
“The number of lives saved thanks to the HIV response in this century is remarkable,” says Anthony Lake, UNICEF executive director. “But for the sake of the children and adolescents still affected, and for all future generations, we cannot mistake advancement for attainment. We must do more, and do it faster than ever. That’s the only way to achieve an HIV-free generation.”
Science may well be providing the tools needed to make the end of HIV by 2030 a real possibility, but prevention must become a greater priority. The majority of adolescents, especially those most at risk of new infection — such as young girls and young men who have sex with men, transgender adolescents, and young drug-users — are not given adequate access to proven prevention methods. In addition to this, the number of children on treatment is appallingly low, with less than half tested for the HI virus before they reach the age of two months. The UNICEF report shows that of the 2.6 million children under the age of 15 living with HIV, only one in three is receiving any kind of treatment and, in 2013 alone, a quarter million children and pregnant women living with HIV were affected by emergencies.
New tools, improved experience and innovation — these factors are playing a powerful role in changing how HIV is managed and controlled. Today, simple, more efficient and cost-effective methods to overcome the hurdles presented by HIV exist. However, to achieve an HIV-free generation for children and adolescents there needs to be frontloading investments across both domestic and international frontiers, alongside proven interventions.
“It is clear that we’ve made real progress over the past 10 years, but the number of children receiving HIV testing and antiretroviral medicine is still much too low in Africa,” says Manuel Fontaine, UNICEF’s regional director for West and Central Africa. “We need to push for more innovative, easy-to-access testing and treatment services for those who are hard to reach; otherwise HIV will remain the leading cause of death in adolescents on the continent.”
The statistics only serve to underscore Fontaine’s words. About half of adolescents from the age of 15-19 living with HIV come from just six countries — South Africa, Nigeria, Kenya, India, Mozambique and Tanzania — and only 11% of this age group are tested for HIV across the entirety of sub-Saharan Africa. HIV has become the leading cause of death for children aged 10-19 in Africa and is the second biggest killer of teens across the globe. Adolescent deaths due to HIV have tripled since 2000. What puts these figures into even more stark relief is that seven out of 10 new infections reported in children aged 15-19 are in girls.
Adolescents are not being given enough information to make informed choices and to mitigate the impact and risk of HIV on their lives. Knowledge levels have barely increased over the past 15 years, with 70% of adolescent boys and girls not having comprehensive HIV knowledge or understanding. This is further underscored by the fact that 70% of adolescent girls with multiple sexual partners over the past year did not use a condom when they last had sex.
“Ending the HIV epidemic is dependent on social justice which demands equity in education, employment and health for both girls and boys,” says Michel Sidibe, UNAIDS executive director. “We must make the conscious decision to empower young women and girls to take control of their own health choices.”
HIV remains a global issue, especially when it comes to the prevention of its spread and transmission among adolescents. The figures do not point to infection being limited to sub-Saharan Africa, as almost 40% of new HIV infections among adolescents occurred outside of this geographical zone.
So how can the future be changed? How can the HIV-free vision of 2030 be attained? The first step is to offer early and easy diagnosis for children. Rapid and early infant diagnosis can keep babies alive and provide much-needed support for their parents. Women, children and adolescents need to be actively encouraged to stay on their treatment. UNICEF has reduced the transmission of HIV during pregnancy so much that now most infections among babies are happening after birth during breastfeeding.
High-impact HIV prevention interventions such as male and female condoms, harm reduction, voluntary medical male circumcision and pre-and post-exposure prophylaxis need to be more carefully targeted so as to reach the adolescents most at risk, no matter where they live. Education here is vital, as is keeping young girls in school and giving them the information they need to make the right choices in their lives. Comprehensive sexual education must become more widespread as it plays an important role in addressing the underlying drivers of the epidemic.
For UNICEF, the results of the work done and the impact made are only as successful as the data that informs and supports it. There is a need for detailed age and sex disaggregated epidemiological and service utilisation data from more countries. This includes data that can be used to assess the effectiveness of various models of service delivery for adolescents. Children and adolescents make up one third of the world’s population, but they are 100% of the world’s future. Now, more than ever, it is vital that the youth get the support, healthcare, education and the help they need to achieve an HIV-free generation.