World Aids Day 2020: reimagining a resilient response for children, adolescents and pregnant women living with HIV

By Lebohang Schultz and Coceka Nogoduka

Children are often hidden or forgotten in today’s discussions and debates around HIV, including the prioritisation of paediatric HIV prevention and response efforts. This needs to change and be more child focused because HIV- and Aids-related illnesses are the third leading cause of infant mortality in South Africa.

That is why on World Aids Day this year, the UN Children’s Fund (Unicef) and the South African National Aids Council (Sanac) are using the national theme, “We’re in this together, Cheka Impilo”, to call for renewed support from everyone – the government, academia, civil society, individuals and communities – to look out for children and to strengthen the paediatric HIV programme in the country.

The timing is critical because HIV services have also been affected by the Covid-19 pandemic. The Gauteng Provincial Department of Health, for example, reported a 19.6% reduction in HIV medication collection since lockdown started. The figure includes children. In response, the National Department of Health enabled a multimonth dispensing of medications, to reduce the number of visits to health facilities. However, children were not included in the related guidance, further highlighting how the needs of children and young people can fall through the gaps in HIV programmes and policies. Children should be prioritised.

The government’s scale up of the HIV programme has reached many more people and reduced the number of new infections among children, aged 0 to 14-years, from 12 000 a year in 2018 to an estimated 10 000 this year. Aids-related deaths have also declined over this period.

This year is the final one of the “90-90-90” global HIV/Aids strategy that was launched by UNAids in 2014. South Africa signed up and set targets to reach 90% of the population with HIV testing, 90% of those with HIV to receive treatment and 90%percent of those to be virally suppressed. Children form a major component of the strategy but there is much work to be done to reach all the targets.

Data from the Department of Health highlights that only 80% of children under 15 years old know their HIV status, 74% of those infected with HIV are on treatment and only 63% of those on treatment are virally suppressed. This results in poor HIV outcomes and contributes towards the high HIV infant mortality rates.

Communities were the first responders to HIV more than three decades ago and remain essential in advocating for a robust response to the epidemic, delivering services that reach everyone in need and tackling HIV-related stigma and discrimination. Working alongside public health and other systems, community engagement is critical to ensuring the end of children being infected as well as sustainably overcoming the HIV epidemic.

Unicef mobilises political will and leverages partnerships to build HIV prevention and response capacity through appropriate policies and services for children and their families. In South Africa, Unicef works with the government and partners to place children at the heart of the national response to HIV and to integrate HIV interventions into maternal and child health while improving the quality of HIV services for children. At the same time, we are building partnerships with people living with and affected by HIV, especially mothers, children and adolescents. This approach is key to reaching every child.

Sanac findings show that to achieve global targets, South Africa must increase the number of children on antiretroviral therapy (ART) by 58 963. These children are the most vulnerable and we need focused and concerted efforts to find them, test them, put them on ART and ensure they continue treatment and receive the care they need. Unicef is committed to strengthening the national paediatric HIV programme, as well as district health systems with the emphasis on families and communities at the centre of the HIV response.

On World Aids Day this year, as we all do our part to stay safe and protect others during the pandemic, Unicef calls on everyone to remember the children and not forget that paediatric HIV is everyone’s business.

* Lebogang Schultz is HIV-Aids specialist at the UN Children’s Fund South Africa and Coceka Nogoduka, executive manager, NSP Implementation at the SA National Aids Council.

** The views expressed here are not necessarily those of IOL.