In the 15 years following the initial description of Acquired Immune Deficiency Syndrome (AIDS) and discovery of Human Immunodeficiency Virus (HIV), the virus that causes AIDS by destroying infection-fighting CD4 positive T-cells), the outlook for those receiving a positive HIV diagnosis was bleak.
No treatment to effectively stem the immune system’s decline was available and many millions of people died. In the mid-1990s, along came a real game changer– Highly Active Antiretroviral Therapy (HAART), a combination of drugs that supress replication of the HIV virus, thereby preventing the destruction of CD4 positive T-cells, and preserve the individual’s immune competence. The impact of HAART cannot be overstated. Today, a young adult diagnosed early in their infection who receives quality care and treatment can expect to have essentially the same life span, enjoyed in good health, as someone without HIV.
Despite the arrival of HAART in the 90s, there remained a major problem – that of equity to access. The vast majority of HIV infections occur in sub-Saharan Africa with significant epidemics also existing in South and Southeast Asia and Latin America. In the early days, HAART was expensive, required high-functioning health care systems to implement, and consequently, was largely limited to patients in the high-income regions of North America, Western Europe and Australasia.
Today, a young adult diagnosed early in their infection who receives quality care and treatment can expect to have essentially the same life span, enjoyed in good health, as someone without HIV.
The second game changer, or perhaps the first game changer for the global outlook on HIV/AIDS, came with the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in 2002, followed by the establishment of the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR) in 2003. The formation of these organisations, together with bold and ambitious goal-setting by multilateral agencies, helped focus global attention on HIV as a global health emergency. Critically, these organisations and initiatives brought huge financial resources to bear on addressing the crisis. The results have been nothing short of remarkable: access to HAART has clearly had a massive impact on reduction of the number of AIDS-related deaths despite the continued increase in the number of new HIV cases.
However, despite these tremendous successes, we must not be blind to past failures and remaining challenges. One such challenge is the disproportionately low HAART coverage for infants and children1 compared to adult populations. In 2011, UNAIDS and partners established the Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive,2 which included clear goals such as reducing new HIV infections in children by 90% and directional guidance on increasing access to early infant diagnosis (EID) and HAART coverage for infected infants and children. However, despite advances in infant-friendly pharmaceutical formulations and improved technologies for point of care diagnosis, there has been only a modest increase in EID coverage within the first two months of life (as recommended by the World Health Organisation) from 40% in 2009 to 49% in 20151. More troubling still is the fact that only one third of children under 15 living with HIV were accessing therapy in 2015. This is a modest increase since the 2009 baseline of 27% and falls far short of the equivalent rise from 22 to 46% increase seen in the adult population between 2010 and 2015.
We should remind ourselves of the 2016 AIDS Conference theme of “Access Equity Rights Now.” Although more resources will surely be needed, we must recognise that large tranches of global funding for paediatric HIV prevention and care are available now. Critical pharmaceutical, diagnostic and programmatic tools are available now. The political will to eliminate paediatric HIV and AIDS exists now. What is remaining to address the disparity infants and children face? With all that is available we need to focus on galvanising action and doing it now.
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