Around 110,000 children and adolescents (0-19 years) died from AIDs-related causes during 2021, according to the latest UNICEF global snapshot on children and HIV and AIDS. Meanwhile, another 310,000 were newly infected, bringing the total number of young people living with HIV to 2.7 million.

In commemoration of World AIDS Day recently, UNICEF warns that progress in HIV prevention and treatment for children, adolescents, and pregnant women has nearly flatlined over the past three years, with many regions still not at pre-COVID-19 service coverage. This comes on top of an existing and growing gap in treatment between children and adults.

“Though children have long lagged behind adults in the AIDS response, the stagnation seen in the last three years is unprecedented, putting too many young lives at risk of sickness and death,” said UNICEF Associate Chief of HIV/AIDS Anurita Bains. “Children are falling through the cracks because we are collectively failing to find and test them and get them on life-saving treatment. Every day that goes by without progress, over 300 children and adolescents lose their fight against AIDS.”

Despite accounting for only 7 per cent of overall people living with HIV, children and adolescents comprised 17 per cent of all AIDS-related deaths, and 21 per cent of new HIV infections in 2021. Between 2014 and 2021, the number of new infections among children and adolescents aged 0 to 14 decreased globally by roughly 27%, but it rose by 13% in Nigeria. Unless the drivers of inequities are addressed, UNICEF warns, ending AIDS in children and adolescents will continue to be a distant dream.

However, the snapshot points out that longer-term trends remain positive. New HIV infections among younger children (0-14 years) dropped by 52 per cent from 2010 to 2021, and new infections among adolescents (15-19 years) also dropped by 40 per cent. Similarly, coverage of lifelong antiretroviral treatment (ART) among pregnant women living with HIV increased from 46 per cent to 81 per cent in a single decade. In the last seven years, the percentage of pregnant women with HIV who are receiving lifetime antiretroviral treatment (ART) grew slightly from 79% to 81% globally but declined from 57% to 34% in Nigeria.

While the total number of children living with HIV is on the decline, the treatment gap between children and adults continues to grow. In UNICEF HIV-priority countries, ART coverage for children stood at 56 per cent in 2020 but fell to 54 per cent in 2021. This decline is due to several factors including the COVID-19 pandemic and other global crises, which have increased marginalisation and poverty, but is also a reflection of waning political will and a flagging AIDS response in children. Globally, an even lower percentage of children living with HIV had access to treatment (52%), which has only marginally increased over the past few years.

Meanwhile, coverage among all adults living with HIV (76%) was more than 20 percentage points higher than among children. The gap was even larger between children and pregnant women living with HIV (81%). Alarmingly, the percentage of children between the ages of 0-4 years living with HIV and not on ART has been rising over the past seven years, climbing to 72 per cent in 2021, as high as it was in 2012.

Many regions – Asia and the Pacific, the Caribbean, Eastern and Southern Africa, Latin America, the Middle East and North Africa, and West and Central Africa – also experienced drops in treatment coverage in pregnant and breastfeeding women during 2020, with Asia and the Pacific and the Middle East and North Africa seeing further declines in 2021. Except for West and Central Africa, which continues to see the highest burden of mother-to-child transmission, none of the aforementioned regions have recovered to the coverage levels achieved in 2019. These disruptions put the lives of newborn babies at increased risk. In 2021, more than 75,000 new child infections occurred because pregnant women were not diagnosed and initiated on treatment.

“With renewed political commitment to reaching the most vulnerable, strategic partnership and resources to scale up programmes, we can end AIDS in children, adolescents and pregnant women,” said Bains.