Child treatment, HIV prevention top UNAIDS priorities as it eyes SDG target

ABIDJAN — In an ambitious effort to end the AIDS epidemic by 2030, as set out by the Sustainable Development Goals, the United Nations has adopted a strategy that focuses on fast-tracking ending the disease among children, adolescents, and young women by 2020 through increased access to HIV prevention, treatment, care, and support services.

Under the framework, “Start Free, Stay Free, AIDS Free,” this three-tier initiative led by the Joint United Nations Programme on HIV and AIDS and the United States President's Emergency Plan for AIDS Relief met during the International Conference on AIDS and STIs in Africa, or ICASA, earlier this month to share global progress updates and hear from those impacted by the programming provided.

The current five-year agenda follows on the heels of 2011’s Global Plan, whose purpose was to move towards eliminating new HIV infections among children by 2015 and keeping their mothers alive. In doing so, two global targets were emphasized: Reducing the number of new childhood HIV infections by 90 percent and halving the number of HIV-related maternal deaths. While the Global Plan showed relative gains by reducing new HIV infections among children by 60 percent in 21 of the most affected countries in sub-Saharan Africa, it missed the overall targets, demonstrating the difficulty in reducing the prevalence of HIV among Africa’s youth.

“The epidemic is shifting more towards the younger generations,” Luiz Loures, deputy executive program director of UNAIDS said at the meetings. “Where there remain critical gaps is in engaging adolescents, the perception of HIV among this group, and getting children treatment is an even bigger challenge,” he said.

Alongside certain 2020 targets are 2018 benchmarks to ensure the accelerated reduction of new infections in children aged 0 to 14 to less than 40,000 by the end of next year, along with an increased adoption of antiretroviral therapy of 1.6 million children up to age 14, and 1.2 million adolescents between 15 and 19 years old by then as well.

“Most high-level meetings target 2020 goals, but for children we said that’s too long,” Deborah von Zinkernagel, director of Start Free, Stay Free, AIDS Free told a full room during the ICASA conference. “There is a lot of work and energy being put into the adolescent agenda, new innovations coming around that are being tested out with more broader, multisectoral approaches not just the narrow approach focused on education,” she said.

Recent efforts under this plan have considered how to engage adolescents by making the concept of HIV treatment and prevention safe, interesting, and relevant for youth.

Under the Start Free framework, the objective is to reach and sustain 95 percent of pregnant women living with HIV with lifelong HIV treatment by 2018. This would reduce the number of children such as Robinah Babirye, of Uganda, who was born with HIV after it passed through the prenatal fluids of her mother.

“People always question whether I hate my mom for passing this on to me, or for making me be born this way, especially with the complications I’ve faced, and I don’t,” Babirye told Devex. Instead, she has become a peer educator and has dedicated herself to HIV-related advocacy and awareness activities. She has also begun songwriting and performing as a way to express herself and educate others.

A component of the Stay Free framework includes providing voluntary medical circumcision for HIV prevention to an additional 25 million men by 2020, with a particular focus on young men aged 10-29. The AIDS Free campaign seeks to provide 1.4 million children and 1 million adolescents with HIV treatment by 2020 to prevent the virus from advancing to AIDS.

In terms of progress, HIV is no longer the leading cause of death in Africa, according to the most recent WHO data, being surpassed by lower respiratory tract infections. Overall, over the past decade HIV/AIDS mortalities have nearly halved from 1.5 million deaths in Africa in 2005 to an estimated 760,000 deaths from HIV/AIDS and related complications in 2015.

However, without treatment, children born with HIV are particularly vulnerable; half die before their second birthday, and more than 75 percent will die before age five.

“By any means, be it with cooperation through our society leaders, we have to engage more in our communities to get our youth to treatment and this is the fundamental point: We have to reach the new generations,” Loures said.