Defeating AIDS but missing children

September 22, 2015

The Coalition of Children Affected By AIDS noted a gaping omission in the recent document Defeating AIDS—advancing global health by the UNAIDS Lancet Commission: within the 48 page document the word child or children appears 44 times. In an article published on they urge policy makers to include structural interventions that take into account children.

We welcome the report Defeating AIDS—advancing global health. The Commission generated four scenarios, providing a blueprint for forward thinking on the AIDS response. However, there is a gaping omission. We note within the 48 page document the word child/children appears 44 times. Ten within the references. Of the 34 mentions in the body of the text, 31 refer to “mother-to-child”. The other three times are rightful lamentations of slow roll out and inadequate treatment formulations for children. But there is more to children than prevention of mother-to-child transmission.

We would be keen to know if the plans for tomorrow have any specific consideration for children or if the strategy advises that child HIV policies are aligned with the adult policy—despite the fact that children will be the recipients and true users of the next policy. The attention to key populations—men who have sex with men, injecting drug users, sex workers, prisoners, and residents in hot spots—are entirely adult referenced. Men who have sex with men, sex workers, prisoners, and drug users may well have children whose needs could be overshadowed. The worrying statistics on adolescents is an important step, but policy needs to dive further down the age span and include younger children in the vision.

The Commission urges investment in research and innovation. There is a growing evidence base that children need more than treatment; they also need combination approaches (eg, cash plus care) to overcome barriers to effective treatment and prevention. Insufficient and narrow programming for children is ineffective at best and detrimental at worst. Sustained, long-term, reliable funding is a crucial foundation—eroded by short-term, quick-fix interventions creating instability when withdrawn. Solid evidence exists about the effects of adult HIV on child development.

We urge policy makers to include structural interventions that take into account children. We note that activism and engagement from and for young children is complex and often reliant on advocates to rally on their behalf. Policy makers, when calculating the associated costs for AIDS response scenarios, need to take into account children and the additional provisions required to cater for them. We find the call to action and the global challenge exciting, but without specific child inclusion the scenario reads like Hamlet without the Prince.

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