One thing was clear at AIDS 2024, the 25th International AIDS Conference, which wrapped up last month in Munich, Germany: you can cut the numbers multiple ways.
Daily news headlines swung from hope to crisis—sometimes even when referencing the same reports.
Childhood AIDS is a health equity crisis.
UNAIDS’s always-anticipated annual report on the global state of HIV marked the fact that in 2023 for the first time in sub-Saharan Africa, more new infections occurred outside the region than within. But at 1.3 million new infections, the global community is still far from reaching its goal of 370,000 by 2025. Notably, new infections among young women and girls is four times higher than UN goals set for 2025.
For children, UNAIDS showcased how far we’ve come but also how far we have left to go. HIV infections among children under the age of 14 have dropped by 38 percent since 2015. AIDS-related deaths have fallen by 43 percent. However, 76,000 children still die from AIDS-related illnesses annually. Mother-to-child transmission, particularly in Western and Central Africa, remains high and global treatment coverage among children has stagnated.
Children continue to be left behind. We talked about it two years ago at the conference in Montreal, and again last year in Brisbane.
Eighty-six percent of children who die AIDS-related deaths do so in sub-Saharan Africa. This is a health equity crisis. But it doesn’t need to be this way. We have the testing, treatment, and prevention tools to prevent these deaths. And we continue to add to the toolbox.
There is no excuse—we have the tools we need to protect children.
When pediatric DTG began rolling out to countries in 2021, it was a game changer. This was an affordable, highly-effective drug that dissolved in water and was strawberry flavored to appeal to children’s palettes. Today, 7.6 million packs of the product have been supplied to 95 countries.
As we heard during the conference, the success of pediatric DTG has provided many lessons. Lessons that countries, manufacturers, donors, and NGOs like CHAI, can apply to new product introductions moving forward.
Following a similar development and introduction model, in 2023 a new generic product, pediatric ABC/3TC/DTG (pALD), was approved. Zambia received the first shipment this year. This product combines the three WHO-recommended drugs to treat children living with HIV into a single pill that can be dissolved in water.
And as CHAI announced during another conference session, a best-in-class generic medication (pediatric darunavir/ritonavir, or pDRV/r) for children who fail first-line treatment has been submitted to US FDA in June 2024 for review for tentative approval.
“We have the tools. There is no excuse,” declared Christine Malati, a senior pharmacist with USAID, during that same session.
While we’ve seen children in care switched to many of these new, optimal drugs in record time, the overall proportion of children on treatment is stagnating. Only 57 percent of children living with HIV are currently on treatment. Up just a single percentage point from 2022. We need to do business differently to reach children not yet on treatment. This includes meaningful investment in and engagement of affected communities.
The global community has been talking about children being left behind in the AIDS response for years. We are seeing strong political commitment to this agenda through the Global Alliance to End AIDS in Children by 2030. However, progress is too slow, and time is running out. It’s time to put our money where our mouth is and fund the scale-up of these existing tools to cross the finish line.
Otherwise, children will continue to die needlessly.
