absence of HIV testing and timely ART initiation, one third of infants living with HIV die before their first birthday, and more than half die before the age of 2 years.7 A huge effort will therefore be needed to reach the global goal of providing ART to all eligible children by 2015.
Much more attention is needed to prevent and treat HIV during adolescence, so that children remain AIDS-free in the second decade of life As the international community reflects on the gains made in the first decade of a child’s life, it cannot continue to neglect the crucial second decade of childhood. Approximately 2.1 million (1.7 million– 2.8 million) adolescents were living with HIV globally at the end of 2012,8 and approximately two thirds of new HIV infections in adolescents aged 15–19 years were among girls.9 Adolescents experience a second wave of vulnerability to HIV that is driven by many factors, and they encounter numerous barriers to accessing services. As children living with HIV grow older, their treatment, care and support needs also change, and they face new challenges in adhering to medications, taking greater responsibility for their own health and accessing the services and information they need to lead healthy and productive lives. Worldwide, disproportionately high HIV prevalence is reported among key adolescent populations – males who have sex with males, adolescents who inject drugs and sexually exploited adolescents.10 A comprehensive strategy is needed to address these diverse needs.
Social protection and child protection, care and support must underpin efforts to scale up high-impact interventions through the first two decades of life Creating an AIDS-free generation is more than a biomedical endeavour. Economic and social drivers of HIV – such as poverty, food insecurity, drug and alcohol use, social marginalization, gender inequality, violence and sexual exploitation, and
lack of access to education, including comprehensive sexuality education – need to be addressed concurrently as part of a multi-sectoral approach to HIV among children. Efforts to address the needs of children living with HIV, or in households affected by HIV, through comprehensive protection, care and support interventions have not achieved broad coverage.11 Much greater collaboration across sectors is required. Economic and psychosocial support is particularly important for the estimated 17.8 million (16.1 million–21.6 million) children who have lost one or both parents to AIDS.12 These measures not only alleviate hardship but can help reduce the risk of HIV infection and support longterm adherence to medication and continuity of care for children and their families.13
Two decades, many sectors This report highlights both gains and gaps in the response to HIV among children in the first and second decades of life and stresses the urgency of achieving results more quickly with the resources available. While it emphasizes high-prevalence settings, there is no less concern for lower-prevalence settings and the clear challenge to maintain and expand upon progress made. To this end, innovations and new paradigms are presented along with key strategies designed to accelerate the pace of progress. An AIDS-free generation will only be achieved through strong leadership from government, with partners aligning their support to common objectives. The wholehearted participation of civil society and affected communities will also be required, not only as implementing partners but also in planning, decision-making, awareness raising, advocacy and strengthening accountability. The path to an AIDS-free generation is clear. The world must now strongly commit to sustaining the hard-won gains and to addressing the remaining inequities and gaps in the response to HIV among children.
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