The scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services, led by UNICEF and partners, is one of the greatest public health achievements of recent times. In 2016, Armenia, Belarus and Thailand were certified by the World Health Organization for the elimination of mother-to-child transmission of HIV (EMTCT). Cuba was certified in 2015. Achievements such as these help to explain why 2.4 million new infections among children (0–14 years old) have been averted since 2000.
While we are closer than ever to achieving EMTCT of HIV, gaps continue to exist. The majority of new HIV infections among children occur during the breastfeeding period. This requires greater focus on adherence to medicines and retaining mothers and infants in care to the end of the breastfeeding period and beyond. At the same time, treatment gains for children have not kept up with prevention. Less than half of the 2.1 million children (aged 0–14) living with HIV around the world in 2016 did not receive ART, and when they did receive it, often it came too late. Without timely treatment, one third of children with HIV die before their second birthday. On average children living with HIV started treatment at the age of 3.8 in sub-Saharan Africa.
Between 2000 and 2016, annual AIDS-related deaths declined for all age groups except adolescents (aged 10-19), where the number of AIDS-related deaths more than doubled, from 24,000 to 55,000 cases. Most concerning is the unacceptably slow progress made in preventing new infections among adolescents aged 10-19.
Globally, 2.1 million adolescents were living with HIV in 2016, a 30 per cent increase from 2005. High population growth in many lower- and middle-income countries (LMICs) has created a ‘youth bulge’ that makes it difficult to slow new infections among adolescents, or to keep them from rising. Projections show that even if we maintain current rates of progress in reducing the adolescent HIV incidence rate, the number of new infections would still rise from 260,000 in 2016 to nearly 300,000 per year by 2030.
The situation is particularly dire for girls and members of key populations. Adolescent girls are disproportionately affected by these trends, accounting for about 67 per cent of all new HIV infections in the 15–19 age group worldwide. Approximately 1,000 young women aged 15-24 are newly infected with HIV every day. While adolescents, girls and members of vulnerable populations tend to be most at risk of contracting HIV, they are least likely to have access to treatment and other services.
As we reach the last mile towards ending AIDS for every child, we must not grow complacent. We must remain committed to refining our response to ensure that all children and adolescents, especially the most vulnerable, are not forgotten as we approach the finish line.