Access to HIV prevention and treatment services marred by numerous inequalities according to newly released data

WORLD – Following a newly released report from the Start Free, Stay Free, AIDS Free initiative, the total number of children on treatment declined for the first time, despite the fact that nearly 800 000 children living with HIV are not currently on treatment.

The report further showed that opportunities to identify infants and young children living with HIV early are being missed since more than one third of children born to mothers living with HIV were not tested.

Start Free, Stay Free, AIDS Free is a five-year framework that began in 2015, following on from the hugely successful Global Plan towards the elimination of new HIV infections among children by 2025 and keeping their mothers alive.

It called for a super Fast-Track approach to ensure that every child has an HIV-free beginning, that they stay HIV-free through adolescence and that every child and adolescent living with HIV has access to antiretroviral therapy.

The approach intensified focus on 23 countries, 21 of which were in Africa, that accounted for 83% of the global number of pregnant women living with HIV, 80% of children living with HIV and 78% of young women aged 15–24 years newly infected with HIV.

Although the 2020 targets were missed, the 21 focus countries in Africa made better progress than the non-focus countries.

However, there were major disparities between countries, and these countries still bear the highest burden of disease: 11 countries account for nearly 70% of those living with HIV but not on treatment.

There was a 24% decline in new HIV infections among children from 2015 to 2020 in focus countries versus a 20% decline globally.

Focus countries also achieved 89% treatment coverage for pregnant women living with HIV, compared to 85% globally, but still short of the target of 95%, and there were huge differences between countries.

For example, Botswana achieved 100% treatment coverage, yet the Democratic Republic of the Congo only reached 39%.

The report outlines three actions necessary to end new HIV infections among children in the focus countries.

First, reach pregnant women with testing and treatment as early as possible 66 000 new HIV infections occurred among children because their mothers did not receive treatment at all during pregnancy or breastfeeding.

Second, ensure the continuity of treatment and viral suppression during pregnancy, breastfeeding and for life 38 000 children became newly infected with HIV because their mothers were not continued in care during pregnancy and breastfeeding.

Third, prevent new HIV infections among women who are pregnant and breastfeeding 35 000 new infections among children occurred because a woman became newly infected with HIV during pregnancy or breastfeeding.

There has been some progress in preventing adolescent girls and young women from acquiring HIV. In the focus countries, the number of adolescent girls and young women acquiring HIV declined by 27% from 2015 to 2020.

However, the number of adolescent girls and young women acquiring HIV in the 21 focus countries was 200 000, twice the global target for 2020 (100 000).

In addition, COVID-19 and school closures are now disrupting many educational and sexual and reproductive health services for adolescent girls and young women, highlighting the urgent need to redouble HIV prevention efforts to reach young women and adolescent girls.

UNAIDS and partners will continue to work together to develop new frameworks to address the unfinished agenda.

Under the newly adopted set of political declaration targets, UNAID and partners pledged to end all inequalities faced by communities and people affected by HIV towards ending AIDS.

The political declaration called upon countries to provide 95% of all people at risk of acquiring HIV within all epidemiologically relevant groups, age groups and geographic settings with access to people-centered and effective HIV combination prevention options.

It also asked countries to ensure that 95% of people living with HIV know their HIV status, 95% of people who know their status to be on HIV treatment and 95% of people on HIV treatment to be virally suppressed.

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