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HIV COMMUNITY OF PRACTICE
478 current members of the UNICEF HIV and AIDS Community of Practice.
Letter from the HIV/AIDS Section’s Chief:
Issue Sep-Dec 2012 – World AIDS Day 2012
There is much progress to take note of this World AIDS Day: 8 million people in low- and middle-income countries are on antiretroviral therapy, and new infections in children have dropped 24% in the last two years —from 430,000 to 330,000. In terms of services, the expansion of HIV programmes over the past decade has been substantial, thanks to leadership and resources from countries, the Global Fund and the US government’s PEPFAR programme, as well as from the private and not-for-profit sectors. But are these programmes as effective, efficient and equitable as they could be? How are children and adolescents actually faring?
The answer to the first question, in my opinion, is no. Programmes can do more with available resources to increase their effectiveness and efficiency. Key questions we need to ask: Are the right services in place, at sufficient scale? Are services tailored to the epidemic profile of the country? Are the right policies and laws in place to ensure that services have the greatest impact? Are communities engaged in programme planning, demand creation, service delivery and monitoring and evaluation? Are other development activities that may have an impact on HIV vulnerability, such as programmes to increase girls’ attendance at secondary school , HIV-sensitive in their approach? We could do much more at UNICEF to support countries to be more strategic with the resources at their disposal, especially to achieve better results for adolescents at risk of, affected by or living with HIV/AIDS. Helping countries build investment cases, review and adapt their current HIV programming for adolescents, then closely monitor the results, will be a priority for UNICEF, working with partners, in 2013. We must do better in our programming support for all adolescent girls and boys, especially those most vulnerable, wherever they are. We must not shy away from the work at hand with key affected populations – adolescent males who have sex with males, adolescents who inject drugs and adolescents exploited by the sex industry.
Children living with HIV are faring better than before, but not well enough. The results we are seeing are not equitable. Less than one in three children with HIV (28%) receives antiretroviral therapy, compared to over half of adults (54%). As UNICEF Executive Director Anthony Lake put it in his World AIDS Day video message, this disparity “is morally wrong and it is practically wrong”. Yes, it may be more difficult to diagnose infants than adults, and yes, paediatric drug formulations are slightly more expensive than adult formulations…but that is no excuse. As we scale up testing and HIV services for pregnant women, we must pay greater attention to testing HIV-exposed children, not just at 6 weeks after birth, but again at the end of breastfeeding. The movement for child survival, under the banner of A Promise Renewed, is an opportunity to link HIV testing and treatment of children to expanded community-based and facility-based platforms for child health. Recently, UNICEF hosted a meeting of child survival and HIV paediatric experts to explore how to do this more effectively.
World AIDS Day is an opportunity to take stock of our current situation. We are fortunate that there is renewed momentum for a more strategic, more focused approach to achieve an AIDS free generation. However, much more needs to be done to achieve our vision for HIV in UNICEF’s next Medium Term Strategic Plan: that children, adolescents and mothers are protected from HIV infection and live free from AIDS. Fortunately, the tools are at our disposal and the path is relatively clear to success. Now is the time to gather momentum for the final push towards 2015.
Written by: Craig McClure