UNAIDS updates pediatric HIV prevention initiative
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UNAIDS updated its HIV prevention initiative titled “Start Free, Stay Free, AIDS Free,” during a press event that coincided with the International AIDS Conference.
The initiative focuses on three areas — preventing vertical transmission, preventing adolescents from acquiring HIV and providing ART to children and adults.
“The reality is now, really over the last 3 years, we started to stall in our progress and we are missing these critical targets of preventing new infections, helping young people stay negative and making sure kids are on treatment,” UNAIDS Deputy Executive Director Shannon L. Hader, MD, MPH, told Healio.
According to Hader, globally, only about 53% of children living with HIV are on treatment compared with the 67% of adults. Hader said this is due to a lack of communication by clinicians in their communities.
“You might be treating everyone who's walking into your clinic, but if you're not connected to the population, or the ways that kids are being identified and tested for HIV so that they can come into treatment, then we need more from you,” Hader said. “We need you to work creatively with the folks outside the clinic, the community, and the planners to [ask] where are we missing these kids.”
Hader said two-thirds of youths not receiving HIV treatment are aged between 5 and 14 years. They are not going to be found in regular immunization clinics and must be tracked through families and communities, she said.
“For a lot of those kids, their parents are on treatment,” she said. “Their parents are being seen by clinicians. But they might have never been told, ‘You know what, your older kids might actually be HIV positive and [have] never been tested.’ And so, even though you think you are doing OK, right now, you need to be brought in for testing.”
to raise awareness in communities, she said.
With regard to vertical transmission, Hader said clinicians must identify what is driving it.
“For some countries and some programs, the reason new infections for kids are still happening is because women aren't coming in for HIV services at all,” Hader said. “And so, they go through pregnancy and birth either not having access to antenatal care or not having access to HIV treatment.”
She said clinicians should become advocates for the “broken system.” They need to go out into the community and make sure women are receiving the services to lower transmissions, Hader said.
Another way to lower transmission is for women who are at risk for new infections during pregnancy and breastfeeding to not just receive repeat HIV tests, but to also receive HIV prevention interventions. They become infected during their pregnancy, leading to the infant becoming infected through pregnancy or breastfeeding.
“[Cases] are being missed,” she said. “For clinicians, I think that has to drive a little bit of curiosity about your own patient population. The solution is to start to understand which women need more intensive prevention services during pregnancy and breastfeeding, to prevent these new infections in mothers.”
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Hader S, et al. Launch of Start Free, Stay Free, AIDS Free. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
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