First decade – PMTCT and paediatric AIDS

Second decade – Preventing HIV infection among adolescents

Across both decades – Protection and care for children affected by AIDS

Policy briefs



© UNICEF/NYHQ2009-0273/Nesbitt
A six weeks old baby was recently tested for HIV. His mother is living with HIV and is participating in PMTCT programme at a local clinic in Lusaka, Zambia.

With only 5 per cent of the world’s population, Eastern and Southern Africa is home to half the world’s population living with HIV. Today the region continues to be the epicentre of the HIV/AIDS epidemic, with 48 per cent of the world’s new HIV infections among adults, 55 per cent among children, and 48 per cent of AIDS-related deaths [1]. 

The Southern Africa sub-region, in particular, experiences the most severe HIV epidemics in the world. Nine countries - Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe - have adult HIV prevalence rates of over 10 per cent. At an estimated 26.0 per cent, Swaziland has the highest HIV prevalence rate in the world, followed by Botswana (23.4 per cent) and Lesotho (23.3 per cent). With 5.6 million people living with HIV (17.3 per cent), South Africa is home to the world’s largest epidemic.

In the past 10 years, efforts to halt the spread of the epidemic by national governments and development partners have borne fruits: new infections among adults have decreased by more than 50 per cent in Botswana, Ethiopia, Malawi, Namibia, Rwanda, Zambia and Zimbabwe; and by more than 25 per cent in Kenya, Mozambique, South Africa, and Swaziland. Among children, the number of new infections has dropped from 330,000 in 2001, to 180,000 in 2011.

Despite the progress, there are still 17.1 million adults and children living with HIV in Eastern and Southern Africa, and the figure continues to increase as antiretroviral therapy (ART) ensures millions of people with HIV can now live a healthy life. Moreover, most people on ART start treatment late, limiting the overall impact of antiretroviral medicines. 

For many pregnant women living with HIV, such treatment remains out of reach, especially for those living in rural areas, and those fearful of stigma and discrimination if they are tested positive. Of the 960,000 pregnant women living with HIV in 2011, more than 90 per cent of them resided in just nine countries - South Africa, Mozambique, Uganda, Tanzania, Kenya, Zambia, Zimbabwe, Malawi and Ethiopia. Compared to adults, the progress in providing treatment to children is much slower. Out of the 2.2 million children who needed ART in 2011, only 33 per cent were receiving it.

The number of orphans due to AIDS continues to increase [2]. The region now has 10.5 million children who have lost one or both parents to AIDS. Against the mounting needs, care and support to the children made vulnerable by HIV and AIDS are nowhere near adequate. In most countries in the region, only around 20 per cent or less of these children receive some sort of external support. 

© UNICEF/NYHQ2007-1737/Nesbitt
Two young men perform a play for fellow students in Angola. The performers are members of the school's HIV/AIDS and Gender Group, which raises awareness on these issues through peer-education activities.

Girls and young women are disproportionately affected by HIV. Of the 2.7 million 15–24 year-olds living with HIV in the region, 70 per cent are female. In the countries most affected by the epidemic, such as Swaziland, Lesotho and Botswana, more than 1 in 10 females in that age group are living with HIV. Many of those young women appear to have been infected by men who are several years older and therefore more likely to be living with HIV.

UNICEF in action

For more than two decades, UNICEF has been the leading voice for children in the global AIDS response, galvanizing commitment, resources and action to address the impact of HIV on children. 

In collaboration with UN agencies and other partners, UNICEF has championed four priority areas: 

  • prevention of mother-to-child transmission of HIV;

  • paediatric HIV care and treatment;

  • prevention of HIV among adolescents and young people; and

  • protection, care and support for children affected by HIV and AIDS.  

Through Unite for Children, Unite against AIDS campaign, launched in 2005 by UNICEF and our partners, work carried out in these areas have made direct contribution towards the realization of the global HIV commitments, including the Millennium Development Goals (MDGs).

While challenges remain, scientific advances and their implementation have brought the world to a tipping point in the fight against AIDS. An AIDS-free generation is finally within our grasp. To optimize our contribution to achieving an AIDS-free generation, UNICEF has adopted an integrated programme approach, focusing on strengthening the delivery of high impact interventions; while working across sectors to integrate HIV responses into a broader development context.

Today, UNICEF supports pregnant women, mothers, children and adolescents affected by or at risk of HIV at two critical stages - the First Decade and the Second Decade of life, and across both decades in key areas such as child protection, social protection, education, health and nutrition.

The emphasis of UNICEF’s work in the First Decade is on infants, children under five, pregnant women and mothers, through HIV testing and treatment linked to antenatal services, early infant diagnosis, and paediatric treatment and care.

For the Second Decade, UNICEF has shifted away from a broad emphasis on ‘young people’ (15-24 years) to a more targeted group of adolescents (10-19 years). Special attention will be given to adolescent girls in generalized epidemics, adolescents living with HIV, and key adolescent populations.

Across both decades, UNICEF supports countries in expanding HIV-sensitive social protection, care and support for families and communities affected by HIV and AIDS, to mitigate the impact of HIV and strengthen the resilience of vulnerable children. 

[1]  Unless indicated otherwise, all data in the chapters of Children and AIDS are cited from Getting to Zero: HIV in Eastern and Southern Africa. UNAIDS, 2013. 
[2]  Belsey, M. & Sherr, L (2011) The definition of true orphan prevalence: Trends, contexts and implications for policies and programmes. Vulnerable Children and Youth Studies, 6:3.



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