Harnessing momentum to achieve progress for children and adolescents affected by HIV

In a small town in Nigeria, 18-year-old Oluleye — Leye for short — is an orphan supporting her family through sex work. Often, she does not have condoms and, upon discovering she’s pregnant, she fears she may be HIV positive, too.

Leye isn’t ‘real,’ but her story is true for many children and adolescents throughout the world. Fortunately, the global community has an opportunity to help children and adolescents, like Leye, living with and affected by HIV if we act now.

While overall AIDS-related mortality is receding, many children and adolescents remain out of the reach of HIV prevention, testing, treatment, information, and services, leading to increased infections and deaths. AIDS is the top killer of adolescents in Africa and the second most common cause of death among adolescents globally. Both the U.N. and UNICEF estimate that HIV infections and AIDS-related deaths will increase without additional investments.

The impacts of HIV/AIDS, particularly on a child or adolescent, go well beyond the physical. There is significant evidence showing that children who are not infected by HIV/AIDS but who live in its shadow — perhaps with a family member who is infected, like Leye’s siblings — are still enormously affected.

Many national governments have increased coverage of HIV prevention, testing, and treatment services. However, weak health systems — and weak connectivity between government and community health systems — remain a challenge. It is these community health systems that are best positioned to provide holistic support, including social interventions. Increased focus and funding must be directed to these community-based services.

The issues facing Leye are not exclusive to sex workers. Though there are pronounced needs for children and adolescents, those from marginalized populations — for example, LGBTQ people or those who inject drugs — also are at higher risk for HIV. Access to services for these populations is limited and, even where available, often provided in a judgmental manner that alienates them.

There is no one-size-fits-all solution.

The Coalition for Children Affected by AIDS has put forth recommendations to address these complex challenges. During this pivotal year, it is calling upon governments and donors to:

Broaden funding parameters to invest in multi-sectoral collaboration, such as joint planning, information sharing, case management, staff and systems, and referral mechanisms. This will ensure that young people like Leye have access to comprehensive HIV prevention, care, and treatment.

Balance universal supports with targeted investments in children and adolescents living with and affected by HIV, including social protection, early childhood development, and psychosocial support. This requires long-term investment in the health and wellbeing of people like Leye, so they may realize their full potential.

Decentralize systems by directing more resources and powers to communities and community-based organizations. By financing programs on the local level, organizations can respond directly to the specific needs of each community, while also reaching the most marginalized people in society. This means young people like Leye and their children can access preventive, curative, and rehabilitative services – at the quality required to be effective – without being exposed to financial hardship.

By championing these calls to action, we can help to transform the health of millions of children and families. Children and adolescents like Leye are relying on us. We must not let this opportunity pass us by.

Cecilia Kihara is the Technical Lead, Adolescents and Young People, Frontline AIDS and Member of the Coalition for Children Affected by AIDS.

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