DAR ES SALAAM, Tanzania – Twelve African nations pledged on Wednesday to end AIDS in children by 2030, focusing on ensuring that life-saving antiretroviral (ARV) medication reaches children.

The pledge – known as the Dar es Salaam Declaration – was adopted at the first ministerial meeting of the Global Alliance to end AIDS in Children. The Alliance was formed during the International AIDS Conference in Canada last July.

Speaking during the meeting, Winnie Byanyima, Executive Director of UNAIDS said that the meeting had given her hope: “An inequality that breaks my heart is that against children living with HIV, and leaders today have set out their commitment to the determined action needed to put it right.”

According to her, today’s advanced medical science dictates no baby needs to be born with HIV let alone get infected during breastfeeding and no child living with HIV needs to be without treatment.

The work will centre on four pillars: early testing and treatment; ensuring  that pregnant and breastfeeding women do not pass the virus on to their babies; preventing new HIV infections among pregnant and breastfeeding adolescent girls and women; and “addressing rights, gender equality and the social and structural barriers that hinder access to services”.

Death every five minutes

Currently, around the world, a child dies from AIDS-related causes every five minutes, UNAIDS said in a statement.

Only 52% of children living with HIV are on ARVs in comparison to 76% adults are receiving antiretrovirals, something that the World Health Organisation(WHO) has described as “one of the most glaring disparities in the AIDS response”.

In 2021,160 000 children were infected with HIV. Although children comprise just 4% of people living with HIV, they account for 15% of all AIDS-related deaths, according to UNAIDS Global AIDS updates 2022.

Tanzania is among 12 countries with a high HIV burden that have since joined the alliance.

Others are Angola, Cameroon, Côte d’Ivoire, the Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, Uganda, Zambia, and Zimbabwe.

Three UN agencies — UNAIDS, UNICEF and the World Health Organization (WHO) — are behind the initiative, along with the Global Network of People Living with HIV (GNP+), the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan For AIDS Relief (PEPFAR).

Tanzania’s Vice-President, Philip Mpango, called upon nations to “commit to moving forward as a collective whole”. 

“All of us in our capacities must have a role to play to end AIDS in children. The Global Alliance is the right direction, and we must not remain complacent as 2030 is at our doorstep,” he said.

Zimbabwean Vice-President Constantine Chiwenga said that governments worldwide had lost ground in the fight against HIV/AIDS because of the COVID-19 pandemic, and he urged global health leaders to continue the fight.

“We got affected, just like any other country, when the COVID-19 pandemic hit us,” he said.

Zimbabweans “completely forgot” about HIV/AIDS as they grappled with COVID-19, and as a result, the country’s mother-to-child HIV transmission rate had increased to 8.9%.

“Let us come up with concrete measures which will make sure the spread of HIV/AIDS is brought to a halt,” he said. 

First Lady of Namibia Monica Geingos said that “this gathering of leaders is uniting in a solemn vow – and a clear plan of action – to end AIDS in children once and for all. There is no higher priority than this.” 

UNAIDS believes that progress is possible as 16 countries and territories have already been certified for validation of limiting mother-to-child transmission of HIV and or syphilis.     

While HIV and other infections can be transmitted during pregnancy or breastfeeding, prompt treatment, or pre-exposure prophylaxis (PrEP) for at-risk mothers, can interrupt the process.  

Last year, Botswana became the first African country with high HIV prevalence to be validated as being on the path to eliminating vertical transmission of HIV, meaning the country had fewer than 500 new HIV infections among babies per 100,000 births. The vertical transmission rate in Botswana is now 2% from 10% a decade ago

Women of reproductive age in sub-Sahara Africa are disproportionately affected by HIV/AIDS, Dr Assery Mchomvu, a senior obstetric and gynaecologist at Dar es Salaam’s Mission Mikocheni Hospital, told Health Policy Watch.

“HIV positive women now have a greater opportunity to pursue childbearing goals, with fewer consequences,” said Mchomvu.

But he said that the fight against HIV/AIDS can only be won if there was a coordinated global response to curb new infections and unlimited access to treatment for those already affected.

Wide support

In 2021, 65,000 people died from AIDS-related illnesses, and 1.5 million people were infected with the deadly virus, according to UNAIDS data. And although deaths are down over the last decade, the number of new infections has essentially reached a plateau.

The UN Children’s Fund (UNICEF) welcomed the leaders’ commitments and pledged the agency’s full support. “Every child has the right to a healthy and hopeful future, but for more than half of children living with HIV, that future is threatened,” said UNICEF Associate Director Anurita Bains.

 Peter Sands, Executive Director of The Global Fund, said no child should be born with HIV in 2023 and no child should die from AIDS-related illness. “Let’s seize this opportunity to work in partnership to make sure action plans endorsed today are translated into concrete steps,” said Sands.

“With our country-led partnership model, we provide funding for HIV programmes in over 100 countries. The Global Fund supports HIV prevention and treatment programmes for children and adolescents, including access to early infant diagnosis, innovative testing approaches and family-focused service delivery.”  

Dr John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that closing the treatment gap for children requires “laser focus and a steadfast commitment to hold governments, and other partners accountable for results”.

“PEPFAR commits to elevate the HIV/AIDS children’s agenda to the highest political level within and across countries to mobilize the necessary support needed to address rights, gender equality and the social and structural barriers that hinder access to prevention and treatment services for children and their families,” said Nkengasong.

“We have ensured that human rights, community engagement and gender equality are pillars of the alliance,” said Lilian Mworeko, Executive Director of the International Community of Women living with HIV in Eastern Africa. “We believe a women-led response is key to ending AIDS in children.”

Image Credits: Peter Mgongo.