Equalizing means Prioritizing: Renewing the Call for Leadership in the Fight for an AIDS-free Generation

This year’s World AIDS Day is not only a time to commemorate those we have lost to HIV and AIDS, but is also a critical moment to call for the global health community to demand access and equity in our fight for an AIDS-free generation. While we have made strides in ending AIDS in adults, the pace in which we are reaching children and adolescents is severely lacking. In their annual report appropriately titled, “In Danger,” UNAIDS revealed what we already knew to be true: when compared to adults, children are dramatically left behind in the global AIDS response. 

The report revealed stark inequities between adults and children across all of the 95-95-95 fast-track targets to end AIDS by 2030. Specifically, on average, only 59% of children were tested for HIV (compared to 86% of adults), 52% of children living with HIV gained access to treatment (compared to 76% of adults), and a meager 41% of children living with HIV had achieved viral suppression (compared to 70% of adults). These figures outrage me and should frustrate everyone, because we have the necessary tools to achieve better outcomes for children. And with those tools, I know that if we take strides to meaningfully close the gaps between adults and children we can achieve an AIDS-free generation. However, to reach this goal we must deliberately commit to children and invest the appropriate resources. 

Guaranteeing children are not just simply included – but prioritized – in global health initiatives can lead to vast improvements in public health. I know it is possible. For example, in 1990, while working at UNICEF, I alongside other colleagues, helped coordinate the first World Summit for Children. During the Summit, 71 heads of state and 88 senior governmental officials convened to agree on an ambitious agenda that would lead to a global revolution in child survival and development.  

At the time of the Summit, the majority of the world’s children were not vaccinated for preventable, yet life threatening diseases such as polio, measles, and tetanus. Therefore, a primary goal of the Summit was to get at least 90% of the world’s children vaccinated for these illnesses. This was a daunting but achievable goal as demonstrated by the fact that just 31 years following the Summit – the WHO reported that child immunization for polio, measles and, diphtheria-tetanus-pertussis (DTP3) surpassed 80%.  

This is the kind of significant progress that is possible when political will and resources are focused on prioritizing children. Now as we confront HIV in children and youth, it is unacceptable to wait another 30 years to close the gaps we know we can address right now. We’ve seen how investments in children in the domestic pediatric response has led to a 95% decline in vertical transmission of HIV in the United States. But now that the global AIDS response is leaving children behind, this is the time to equalize the strategy between adults and children. EGPAF calls upon heads of states (regardless of economic status), faith communities, ministries of health, community leaders, and organizational entities to refocus the global AIDS response in a way that doesn’t just include children, but prioritizes them.  

Historically, Africa has disproportionately been impacted by public health crises – including pediatric AIDS. Specifically, the In Danger report reveals that while children between the ages of 0 – 15 make up four percent of all people living with HIV they account for 15% of all AIDS-related deaths – most of which are found in the sub-Saharan region. Working alongside programs such as PEPFAR and The Global Fund, leaders both on the African continent and globally have the chance to end the high rate of pediatric HIV infection in children. Such a commitment in children gives us a viable chance at course-correcting the existing pediatric AIDS response and a realistic opportunity at making the critical inroads needed to achieve an AIDS-free generation.  

The loss of any child to AIDS is not a data point, but a devastating loss to their families and their communities. As leaders in global health, we have a moral imperative of ensuring those among us who do not have the platform to speak for themselves are cared for and heard – that especially includes children. However idealistic it might seem, I am driven by the prospect that we can end AIDS in our lifetimes – but only if we make children the cornerstone of our efforts.