HIV and AIDS
Improving HIV prevention and care for children and women
The situation
Children below the age of 15 account for 11 per cent of the 1.6 million Ugandans living with HIV (2013 estimates). With the roll-out of Option B+, there has been a significant drop in new mother-to-child HIV infections, from 8.7 per cent in September 2012 to 7.9 per cent in 2017 (UNAIDS Estimates). Furthermore, preliminary data from the 2016 Uganda Population-based HIV Impact Assessment shows an 18 percent decline in HIV prevalence in the general population (15-49 years) from 7.3 percent in 2011 to 6.0 percent in 2016.
Turning the tide against AIDS will require more concentrated focus on adolescents and young people
However, Uganda still lags behind in attaining validation for elimination of mother to child transmission (eMTCT) of HIV; Uganda’s MTCT case rate is 466 per 100,000 against the validation target of 50 per 100,000. To achieve eMTCT validation, it is required that the HIV prevalence among women aged 15-49 years from 5.9 to 2.5 per cent or the MTCT rate from 7.9 to 0.22 percent by reduced new infections among women and reduced transmission rate by increasing coverage of PMTCT services or improving effectiveness of regimens especially among adolescents and young women (AGYW).
High disparities remain between regions, and HIV continues to affect adolescents, especially girls, disproportionately; HIV Prevalence among AGYW is 4 times higher than boys of the same age group. Two thirds of all new HIV infections are found in adolescent girls (AG) in Uganda and yet only 30 per cent of Adolescent Girls receive HIV testing Services (HTS) at outpatient departments (UNAIDS). While the absolute number of AIDS-related deaths in children below 5 years dropped by more than 50 per cent between 2000 and 2017, the number of adolescents who lost their lives to AIDS doubled during the same period.
Adolescent girls are more vulnerable to HIV infection because their reproductive systems are not fully developed. Gender inequality and patriarchal norms also make it difficult for girls and young women to negotiate safe sex; Transactional sex reported by AGYW is 24 per cent and. cross generational sex among sexually active AG 10-14 is at 60 per cent (Risk Behaviour study 2017). Female SGBV prevalence is 22 per cent predisposing them to early pregnancies and HIV (UDHS, 2016).
With the success of the national HIV treatment programme, many children born with HIV are entering their adolescent years. Uganda now faces an unprecedented HIV and AIDS burden among adolescents, which also comes with opportunistic infections such as tuberculosis (TB) – a major threat to the survival of people living with HIV and AIDS.
Adolescents not only need improved access to screening and continuing treatment but also support to live positively with the disease and not pass it on to others. While adolescents grapple with the reality of living with HIV and AIDS, very young children are also being left behind. Paediatric HIV services lag considerably behind those for adults and pregnant women. While 92 per cent of infected women receive antiretroviral treatment (ART,) only 49 per cent of babies born to HIV-positive mothers are getting HIV medicine for six weeks after birth (2019 MoH PMTCT report). This gap between adult and child access to HIV treatment needs to be closed urgently.
Paediatric TB is also a major cause of death among children with HIV, with TB-HIV co-infection rate as high as 30 per cent; unfortunately, there has not been enough attention placed on TB prevention, diagnosis and treatment in among HIV-positive children.
HIV and AIDS Infographic
UNICEF Response
- UNICEF has a unique comparative advantage to help Uganda tackle the challenges of HIV/AIDS prevention and care among children – especially adolescents – and women, through integrated models, due to expertise across sectors and extensive field presence in working through operational challenges facing health, protection and other sectors.
- UNICEF has the credibility to lead the advocacy dialogue with the Ugandan Government to place the priority of protection of children and women from HIV/AIDS high on the agenda.
- UNICEF’s unique mandate allows the organization to work across the humanitarian-development divide and support the delivery of essential services to the most vulnerable children including refugees, while also building national system’s capacity for a sustainable impact.
Improve quality, access and utilization of prevention of HIV transmission to children and women, and of children and adolescents’ treatment, care and support.
UNICEF aims to contribute to reach 95 per cent of HIV-positive mothers with life-long access to ART, 90 per cent of newborns with access to ARV treatment, and 90 per cent of adolescents (15–19 years) with HIV testing by 2020.
Targets (2019-2020)
- At least 65 per cent or 23,000 newborn babies from women living with HIV are teste within 6-8 weeks of birth.
- Over 90 per cent of health facilities provide pediatric antiretroviral therapy (ART).
- Over 90 per cent of health facilities provide pediatric antiretroviral therapy (ART).
- 559,000 young people are tested for HIV and receive their results.
- 3948 HIV positive refugee children 0-14 years old in humanitarian settings (50 per cent girls) have continued access to antiretroviral therapy (ART).
Strategies
- Capacity development to scale up elimination of mother-to-child transmission (eMTCT) services, including increasing the coverage of paediatric ART; diagnosis and treatment of TB in HIV-infected children; nutritional counselling for HIV-positive women and infants; and adolescent HIV treatment, care and support.
- To Contribute to the reduction of the burden of HIV/AIDS deaths among children under 5 by at least 30 per cent in 25 focus districts by 2020, UNICEF will focus on improving social support systems at community and household level as well as on improving health care providers’ technical knowledge, attitude and skills to ensure uninterrupted delivery of quality HIV and TB care services for children, adolescents and pregnant women living with HIV.
- Strengthened integration of eMTCT and reproductive, maternal, newborn, child and adolescent health (RMNCAH) services.
- Intensified evidence-based community mobilization and communication to address low uptake of HIV services for adolescents and women, leveraging all of UNICEF’s supported platforms, including schools and adolescents’ friendly spaces and other community engagement fora.
- Provision of antiretroviral therapy (ART) to ensure continued access to treatment for HIV positive refugee child or pregnant woman in humanitarian settings.
“Our twins are evidence that the campaign and medication really work. I have no doubt about it.”
#InvestInUGchildren: Realize Uganda's Vision 2040
Resources
Learn more about about work - download our UNICEF Uganda Annual Report 2019
