HIV and AIDS

UNICEF in action: Strategy and priorities

Children dance at a school AIDS club meeting in Lilongwe, Malawi.

For far too long, children have been the missing face of the HIV epidemic.

In an effort to draw attention to the impact of HIV and AIDS on children, UNICEF, UNAIDS and other partners in 2005 launched the global campaign Unite for Children, Unite against AIDS. The campaign builds on the Millennium Declaration and its Millennium Development Goals (MDG) as well as on other promises world leaders have made since the UN General Assembly Special Session on HIV/AIDS in 2001 (UNGASS).

Through Unite for Children, Unite against AIDS, UNICEF has provided programmatic leadership and advocacy to ensure that children and adolescents are put at the centre of the HIV/AIDS agenda.
The campaign introduced a framework for nationally owned HIV and AIDS programmes around four urgent imperatives – the ‘Four Ps’:

The campaign triggered global attention to the impact of HIV and AIDS on children and led to important additional funding being allocated to related programmes. Since its launch, the evidence base around children and AIDS has improved tremendously. Based on the increased knowledge, UNICEF and partners have developed new guidelines and programmes in order to strengthen the quality of services and to reach those which are still excluded.

In 2010, the World Health Organization (WHO) issued new guidelines according to which all children under the age of two who are tested HIV-positive, shall start antiretroviral therapy (ART) immediately. All other patients living with HIV are eligible for treatment when their CD4 count of helper cells falls below 350 per microliter, up from 200. Mothers living with HIV should exclusively breastfeed their infants for the first six months and continue to breastfeed up to 12 months while introducing complementary foods in country settings where breastfeeding is the safest infant feeding option. Breastfeeding needs to be accompanied by ARV treatment.

A nurse draws blood from a woman, who is holding a small child, for HIV testing in Rwanda.

UNICEF is supporting the implementation of the new WHO guidelines throughout Eastern and Southern Africa (ESA). Building on the lessons learned over the past years, UNICEF programmes now focus on and advocate for:

The strengthening of health systems and the establishment of better linkages between HIV/AIDS activities with general mother and child health programmes to close the gap between testing and treatment of pregnant women and their babies.
The promotion and facilitation of early infant testing to ensure that children living with HIV can start ARV treatment as soon as possible.
Targeted prevention programmes for youth informed by a better understanding of what works best for different groups of young people. Prevention programmes now aim for example at reducing concurrent and inter-generational relationships, since unprotected sex with multiple and age-disparate partners have been found to be the greatest risk factor for young women.
The promotion of HIV-sensitive social protection measures such as cash transfers have been particularly successful in mitigating the burden on households with children orphaned or made vulnerable by HIV/AIDS.
The development of programmes for adolescents living with HIV, who need specific care, treatment and psycho-social support, particularly as they start engaging in sexual relationships.

Goals and targets

PMTCT and providing paediatric treatment

Thanks to such innovations and strong donor commitment, achieving an HIV-free generation has become possible. UNICEF in 2009 endorsed the UNAIDS call for ‘virtual elimination of mother-to-child transmission of HIV by 2015’, which aims a) at ensuring that less than 5 percent of children born to women with HIV are themselves positive in order to b) to reduce the number of new infections among young children by 90 percent compared to 2009. To achieve this goal, UNICEF agreed to reach two concrete goals in Eastern and Southern Africa:

Increase coverage of PMTCT interventions to at least 80 percent of HIV positive pregnant women by 2013 (from the baseline of 68 percent in 2009).
Increase coverage of paediatric ART by 2013 to at least 60 percent from the baseline of 32 percent in 2009.

Among the region’s 21 countries, nine account for 90 percent of the estimated 860,000 pregnant women living with HIV in 2009 and seven more than 90 percent of the 1.08 million children estimated to be in need of ART in 2010 (South Africa, Mozambique, Uganda, Tanzania, Kenya, Zambia and Zimbabwe). The HIV prevalence rate (2009) in these countries ranges from 0.1 percent in Comoros to 23.6 percent in Lesotho and 25.9 percent in Swaziland, with prevalence rates between 2 and 4 percent in Angola, Rwanda and Burundi; 5 to 10 percent in Kenya, Tanzania, and Uganda, and between 10 and 18 percent in Malawi, Mozambique, Namibia, South Africa, Zambia and Zimbabwe.

In this group, Botswana, Namibia, South Africa and Swaziland have succeeded in reaching 80 percent or more of pregnant women living with HIV with PMTCT interventions, and none, except Botswana and Namibia have succeeded in reaching 60 percent of children in need of ART (Botswana and Namibia stand at 88 and 87 percent respectively while Swaziland is close, at 55 percent). While not having large numbers of HIV-positive pregnant women or children in need of ART, four additional countries in the region with small population sizes, experience HIV prevalence rates above 10 percent. These include Namibia (13.1 percent), Lesotho (23.6 percent), Botswana (24.8 percent) and Swaziland (25.9 percent).
Of these four, all have already reached either PMTCT or infant coverage goals. These 13 countries are thus at the heart of UNICEF’s efforts in the region to eliminate the vertical transmission of HIV.
In order to achieve the above goals, efforts to scale up PMTCT coverage, promote testing for children, and bridge the gap between testing and treatment will focus on the 9 countries with the highest numbers of pregnant women living with HIV, and Lesotho (as the only hyper-endemic country yet to reach PMTCT or child coverage goals).
In the three hyper-endemic countries that have achieved or are close to achieving both PMTCT coverage of 80 percent and paediatric ART coverage of 60 percent (Swaziland, Botswana, and Namibia), efforts will focus on strengthening the quality of PMTCT and paediatric AIDS interventions.

Prevention among young people

UNICEF supports the global UNAIDS goal of reducing new infections among young people aged 15 to 24 years by 30 percent by 2015.

As part of these efforts, UNICEF increasingly focuses on reducing the risks and vulnerabilities of adolescent girls. These include behaviour change communication components that promote increasing comprehensive knowledge, increasing HIV counselling and testing, promoting consistent condom use, and reducing age disparate sex, as well as multiple and concurrent sexual partners.

In the context of the global UNAIDS goal, UNICEF has established a regional goal of ensuring that by the end of 2013, 80 percent of adolescent girls aged 15 to 19 years, in 11 countries, practice behaviours which reduce their risk of HIV infection. To achieve this goal, UNICEF has identified four key results to be achieved by 2013 in 11 priority countries:

Ensure that 80 percent of adolescent girls of that age group have comprehensive knowledge of HIV;
Reduce by half the percentage of sexually active girls aged 15 to 19 reporting having a partner who is more than five years older;
Double the use of HIV testing and counselling services by adolescent girls; and,
Doubling the use of condoms at last high risk sex among adolescent girls.

Protection for vulnerable children

In order to strengthen support for orphaned and vulnerable children, UNICEF will work to enable the development of coherent social protection systems at the country level.

In the region, UNICEF has established a 2013 goal of supporting 10 countries to develop national child and social protection systems that are child- and HIV-sensitive with a focus on the most vulnerable families, contributing to universal access and the achievement of the MDGs. To achieve this goal, UNICEF will support country progammes to:

Significantly strengthen child- and HIV-sensitive social protection policies, legislation and regulations;
Significantly enhance access to protection, care and support services for vulnerable families; and,
Build an evidence base to inform a coherent approach to child- and HIV-sensitive child protection and social protection systems within the UN and its partners.

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