For the past four months, Benjamin Sana has been regularly attending the Oasis Clinic in Ouagadougou, Burkina Faso, where he sees a doctor who gives him a full check-up.

The doctor and peer educators also check whether Mr Sana has any questions regarding his pre-exposure prophylaxis (PrEP) regimen. PrEP is taken by people who are HIV-negative but at higher risk of infection, and has proved to be very effective at keeping people free from HIV.

“Two plus one plus one,” answers Mr Sana, referring to when he needs to take the pills—two pills two hours before sex, then one the day after and one again the following day or one a day until his last sexual encounter. After his check-up, the 34-year-old gay man said, “PrEP protects me and I feel reassured.” He still uses condoms and lubricant, but when he doesn’t he said he feels safer.

Mr Sana is one of 100 men taking part in the PrEP pilot project at the Oasis Clinic, run by the Association African Solidarité (AAS). Health clinics in Côte d’Ivoire, Mali and Togo are also taking part in the pilot project, which has been running since 2017.

Camille Rajaonarivelo, a doctor at AAS, said that PrEP is part of a combination prevention approach that also involves trained peers from his community. The project will gauge adherence to treatment and whether participants take PrEP correctly, she explained.

“The final aim of this pilot project is to scale up and roll out PrEP nationally once the authorities give the green light,” she said. 

The study aims to evaluate whether the preventive option gains traction and how feasible it would be to roll it out nationally and regionally. Financed by the French National Agency for Research on AIDS and Expertise France in partnership with Coalition PLUS and three European health institutes, the pilot project will provide data and ascertain if the treatment lowers the number of new HIV infections among gay men and other men who have sex with men.

Burkina Faso does not penalize homosexuality, but stigma against it is high. As a result, gay men and other men who have sex with men often hide their sexuality and tend to avoid health services. HIV prevalence in Burkina Faso among gay men and other men who have sex with men stands at 1.9%, more than double the rate among the general population.

The first definitive results of the PrEP pilot project in Ouagadougou should be available in 2020. Mr Sana said that many of his friends had shown interest in taking PrEP. “Because the pilot project has limited participants, a lot of people have been turned away,” he said.

He believes that PrEP will save lives, especially those of young men. “Nowadays, young men take a lot more risks and they don’t protect themselves,” Mr Sana said. Ms Rajaonarivelo agreed and added that this applies to young men and young women. “I am stunned to see new cases of HIV every week,” she said. “We have to beef up HIV prevention and awareness again.”

Ending the AIDS epidemic among children, adolescents and young women requires ambitious targets and a Super-Fast-Track approach. Building on the successes of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partners* launched Start Free Stay Free AIDS Free in 2016 to provide a framework for the urgent work ahead.

Start Free Stay Free AIDS Free prioritizes action in 23 countries** that account for 87% of new HIV infections among children aged 0–14 years and approximately 87% of all children and adolescents living with HIV globally. In 2016, 2.1 million children were estimated to be living with HIV.

In its first progress report, Start Free Stay Free AIDS Free reflects on the achievements made during the first year of implementation and highlights areas where urgent action is needed.

“The world is on the Fast-Track to eliminating new HIV infections among children and ensuring that their mothers are alive and healthy, but we need to do more to ensure that all children living with HIV have access to treatment immediately,” said Michel Sidibé, Executive Director of UNAIDS.

The report shows that globally in 2016, there were 160 000 new HIV infections among children and that 140 000 occurred in the 23 priority countries. Although there was an overall decline in new HIV infections, the decline was at a much slower rate than in previous years.

The report highlights concerns around new HIV infections among young women and girls. In 2016, around 200 000 adolescents between the ages of 15 and 19 years were newly infected with HIV in the 23 priority countries, 72% of whom were young women.

Most—more than 70%—of all new HIV infections among young people are in sub-Saharan Africa, which also has the fastest growing youth population in the world.

“A high number of new HIV infections among adolescents and a fast-growing population could make for an HIV explosion among young women in Africa,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “The United States Presidents Emergency Plan for AIDS Relief is driving harder and smarter to prevent HIV infections and ultimately help end AIDS among children, adolescents and young women. Every person deserves the chance to survive, thrive and pursue their dreams.”

Gains seen in access to treatment

The report shows that while important gains have been made in access to antiretroviral therapy for pregnant women living with HIV, much more needs to be done to reach children.

In 2016, around 78% of pregnant women living with HIV had access to antiretroviral therapy in the 23 priority countries.

Start Free targets

Reduce new HIV infections among children to 40 000 by 2018.

Reach and sustain 95% of pregnant women living with HIV with lifelong HIV treatment by 2018.

Stay Free targets

Reduce the number of new HIV infections among adolescents and young women to less than 100 000 by 2020.

Provide voluntary medical male circumcision for HIV prevention to 25 million additional men by 2020 globally, with a focus on young men aged 10–29 years.

AIDS Free targets

Ensure that 1.6 million children (0–14 years) and 1.2 million adolescents (15–19 years) living with HIV have access to antiretroviral therapy by 2018.

The increase in the roll-out and uptake of antiretroviral therapy during pregnancy and throughout breastfeeding is estimated to have averted around 270 000 new HIV infections among children in 2016 alone.

The numbers of children on treatment has also increased, but not on a big enough scale. In 2010, only 17% of children aged 0–14 years had access to treatment. By 2016, that had risen to around 43%, with around 920 000 children accessing antiretroviral therapy. Although this is a marked improvement, access to treatment for children still falls far behind access for adults. In 2016, around 54% of adults living with HIV had access to treatment.

The report cites multiple reasons for the slow growth of access to treatment for children, including poor testing rates. Only nine of the 23 priority countries managed to test and diagnose 50% or more of children who were exposed to HIV in 2016. There are particularly low rates of early infant diagnosis in the first two months of life, when it is most important to test, as HIV-related mortality is at its highest. Without access to testing and treatment, half of all children living with HIV will die before their second birthday.

Ways forward

The report offers a set of important actions countries can take to eliminate new HIV infections among children, to test and diagnose children and young people who may have been exposed to HIV and to ensure that children and young people access HIV prevention, quality medicines and age-appropriate sexual and reproductive education and care and support throughout their lives, free from stigma and discrimination.

Other important actions include accelerating new medicines and diagnostics, promoting community engagement and services, voluntary medical male circumcision, access to information on sexual and reproductive health and access to pre-exposure prophylaxis for young people at a higher risk of HIV.

“The future for children and adolescents depends on actions we take collectively today,” said Mr Sidibé.

The latest estimates, for the end of 2017, will be released in July 2018 and will provide further insight into the progress of Start Free Stay Free AIDS Free.

* United Nations Children’s Fund, World Health Organization and the Elizabeth Glaser Pediatric AIDS Foundation.

**Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Uganda, United Republic of Tanzania, Swaziland, Zambia and Zimbabwe.

Just days after World AIDS Day, the 19th International Conference on AIDS and STIs in Africa (ICASA) has opened in Abidjan, Côte d’Ivoire.

At the opening ceremony, UNAIDS Executive Director Michel Sidibé implored the audience not to let ongoing political and social troubles threaten the many achievements made in the AIDS response. In his speech, he laid out key priorities, including ensuring that women and adolescents be better protected from HIV, and demanded more space for civil society, crediting civil society’s huge impact in the AIDS response.

ICASA, a biennial gathering that this year will be held from 4 to 9 December, brings together people working in the field of HIV, as well as leaders, people living with HIV, activists and representatives of civil society. In addition, researchers from around the world will share the latest scientific advances to develop strategies to further HIV prevention and treatment options. More than 4000 delegates from more than 125 countries have gathered for the event. 

UNAIDS is hosting several sessions during the conference to discuss the western and central Africa HIV catch-up plan. Other events organized by UNAIDS at ICASA include sessions on reinvigorating HIV prevention following the Prevention Coalition initiative, innovative partnerships to drive male engagement, ending the AIDS epidemic among children and young women under the Start Free, Stay Free, AIDS Free framework and achieving the Fast-Track Targets in cities.

Abidjan is playing host to ICASA for the second time. In the ICASA held in 1997, the then French President, Jacques Chirac, denounced the injustices experienced by people living with HIV in Africa. 

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Mediaplanet has today launched a new campaign to raise awareness about maternal health around the world.

Created in partnership with UNAIDS and other international organisations, the campaign looks at a range of case studies on issues affecting pregnant women and mothers, and draws on insights from community health-care providers, as well as public health advocates.

Participating in the campaign, UNAIDS Executive Director Michel Sidibé said: “We need to reinforce the interface between health service providers and the community to better monitor what is going on in each community. That way we can quickly make sure that pregnant women have access to health services and monitor them not only for HIV, but for all health issues.”

According to UNAIDS’ latest report, Ending AIDS: progress towards the 90-90-90 targets, around 76% of pregnant women living with HIV had access to antiretroviral medicines in 2016, up from 47% in 2010. In addition, five high burden countries—Botswana, Namibia, South Africa, Swaziland and Uganda—have met the milestone of diagnosing and providing lifelong antiretroviral therapy to 95% of pregnant and breastfeeding women living with HIV. Nonetheless, AIDS-related illnesses remain the leading cause of death among women of reproductive age (15–49 years) globally.

“People have to be courageous and speak up for sexual education and highlight just how critical it is,” said Mr Sidibé. “We have to make sure that girls have access to information early and give them the skills to help them deal with their sexuality in a more empowered manner.”

UNAIDS is working with a broad range of partners, including governments, civil society, the United States President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to ensure that women and girls everywhere are empowered and enabled to protect themselves against HIV and that all women and girls living with HIV have immediate access to treatment.

The campaign is available online and will be distributed as a printed supplement in today’s edition of the Guardian.

Naomi Watts, UNAIDS Goodwill Ambassador, visited Nyumbani Children’s Home in Kenya on 11 July to learn about Kenya’s prevention of mother-to-child transmission of HIV programme and the work done in the home to care for children living with HIV.

In the space of just a few years, as the result of a strong partnership between political leadership, programme implementers and the community, new HIV infections among children aged 0–14 years in Kenya have fallen from 12 000 in 2013 to 6600 in 2015. In June, under the leadership of the First Lady, Margaret Kenyatta, Kenya launched a new framework to accelerate the country’s efforts towards elimination of mother-to-child transmission of HIV and syphilis. The framework calls for the elimination of stigma and discrimination and the creation of an environment that empowers women living with HIV.

Nyumbani Children’s Home opened in 1992 and is currently home to 124 children living with HIV. The home provides nutritional, medical, psychosocial and spiritual care to the children and to the surrounding community, providing a place of safety in Nairobi for abandoned children living with HIV. In addition, the organization has a community- based programme that supports more than 3100 children living with HIV who reside in the informal settlements of Nairobi and 1000 orphans in Nyumbani villages.

Mss Watts and her two sons visited several facilities in the home, including its state-of-art laboratory equipped to undertake early infant diagnosis and viral load testing. Ms Watts congratulated Nyumbani Children’s Home for the impact it makes on a daily basis in the lives of so many remarkable and empowered children. She committed to continue to create awareness of the need to ensure that children living with HIV remain AIDS-free. 

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The steady scale up and improvement of services to prevent mother-to-child transmission of HIV has reduced the annual number of new infections among children globally by 56% since 2010 and by 70% since 2000. Since 1995, an estimated 1.6 million new HIV infections among children have been averted due to the provision of antiretroviral medicines to women living with HIV during pregnancy or breastfeeding. The vast majority of these infections (1.3 million) were averted between 2010 and 2015. Complex challenges remain, however, to achieve the elimination of mother-to-child transmission of HIV.

At the 21st International AIDS Conference in Durban, South Africa, stakeholders came together on 18 July to forge ahead on the Start Free, Stay Free, AIDS Free initiative, which was launched at the United Nations General Assembly High-Level Meeting on Ending AIDS in June 2016. The initiative is designed as a follow-up to the remarkable success achieved by the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.

In a session entitled “Start Free, Stay Free, AIDS Free: finishing the job of the Global Plan,” stakeholders reviewed the progress made towards eliminating new HIV infections among children, as well as how to super Fast-Track access to paediatric treatment for mothers and children. The session was organized by a consortium comprising UNAIDS, the United States President’s Emergency Plan For AIDS Relief (PEPFAR), the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO).

The Start Free, Stay Free, AIDS Free framework provides a menu of policy and programmatic actions designed to enable countries and partners to close the remaining HIV prevention and treatment gap for children, adolescents, young women and expectant mothers. Stakeholders discussed how to build a concerted and coordinated country-led action that is backed by global support, so that countries can move quickly forward. The framework recognizes that every country needs a tailor-made acceleration and implementation plan. Each plan should respond to the country context, building on successful strategies for systems strengthening and identifying critical opportunities and actions that can expand access to life-saving HIV treatment and prevention services for all children, adolescents and young women as quickly as possible.

Participants at the session discussed the need to ensure that children are at the centre of an AIDS-free generation and examined the major barriers, gaps and opportunities to achieving this goal. The session also discussed the role of public–private partnerships and women living with HIV.

Speakers included the Executive Director of UNAIDS, Michel Sidibé, Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, Chip Lyons, Executive Director of the Elizabeth Glaser Pediatric AIDS Foundation, Anthony Lake, the Executive Director of UNICEF, and Gottfried Hirnschall of WHO. Speakers also included representatives of private sector organizations, such as the MAC AIDS Fund, Johnson & Johnson and Born Free.

The Start Free, Stay Free, AIDS Free framework establishes three blocks of programme activity that are closely interrelated and should move forwards together. The participants discussed how to ensure that the response takes into account the reality and variability of country, government and partner priorities, and how to create an implementation environment that optimizes partnerships. They discussed the role of accountability and measurement and mechanisms to ensure that countries get timely responses and support. To support implementation, the framework also calls on industry, civil society and international partners to focus on investing in and finding new, efficient and cost-effective solutions that simplify and innovate to maximize programme outcomes.

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Concerted global efforts have led to a 60% drop in new infections among children, which has averted 1.2 million new HIV infections among children in 21 priority countries since 2009

NEW YORK/GENEVA, 8 June 2016—UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced today that there has been a 60% decline in new HIV infections among children since 2009 in the 21 countries in sub-Saharan Africa that have been most affected by the epidemic.

New HIV infections among children in the 21 countries dropped from 270 000 [230 000–330 000] in 2009 to 110 000 [78 000–150 000] in 2015. Equally impressive are gains made in bridging the treatment gap among children. In 2005, fewer than one in 10 children had access to antiretroviral treatment—this gap has now been reduced to one in two. In the past five years alone, treatment scale-up for children grew twofold. The impact is that AIDS-related deaths among children were reduced by 44%.

“These astounding results show that the world is on the Fast-Track to eliminating new HIV infections among children and ensuring that their mothers are alive and healthy,” said UNAIDS Executive Director Michel Sidibé. “It’s beautiful to know that we could soon have a new generation free from HIV.”

The results were published in a new report, On the Fast-Track to an AIDS-free generation, which was launched at an event hosted by UNAIDS and PEPFAR on the opening day of the United Nations General Assembly High-Level Meeting on Ending AIDS, taking place in New York, United States of America, from 8 to 10 June.

“This shows what is possible through the combined power of science, communities and focused action,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “PEPFAR is building on this success, driving harder and smarter to prevent HIV infections and end AIDS among children, adolescents and young women through our DREAMS Partnership, Accelerating Children’s HIV/AIDS Treatment initiative and other efforts.”

During the event, UNAIDS also released global data for children that showed that new HIV infections among children have declined globally by 50% since 2010—down from 290 000 in 2010 to 150 000 in 2015. It also showed that 49% of children living with HIV around the world now have access to life-saving treatment. On the eve of the event, UNAIDS and partners announced that Armenia, Belarus and Thailand have joined Cuba in receiving official certificates of validation from the World Health Organization for eliminating new HIV infections among children. Thailand is the first country with a major HIV epidemic (450 000 people living with HIV in 2014) to receive such a validation.

It was during the High-Level Meeting on HIV and AIDS in 2011 that UNAIDS and PEPFAR joined with partners to launch the Global Plan towards the elimination new HIV infections among children by 2015 and keeping their mothers alive (Global Plan). The focus of the Global Plan was to increase efforts to prevent new HIV infections in all countries, but particularly in the 22 countries that, in 2009, accounted for 90% of pregnant women living with HIV.

The new report released today shows the progress made since the Global Plan was launched. It outlines that seven countries have reduced new HIV infections among children by more than 70% since 2009 (the baseline for the Global Plan), including: Uganda, by 86%; South Africa and Burundi, by 84%; Swaziland, by 80%; Namibia, by 79%; Mozambique, by 75%; and Malawi, by 71%. In Nigeria, however, the decline was much smaller, at just 21%. In India, the only Global Plan country outside of sub-Saharan Africa, new HIV infections in children dropped by 44% and coverage of services to pregnant women increased from less than 4% in 2010 to 31% in 2015. 

The new report demonstrates that treatment or prophylaxis (excluding the less-effective single-dose nevirapine) coverage for pregnant women living with HIV in the countries most affected by the epidemic increased dramatically from 2009. By 2015, more than 80% of pregnant women living with HIV in the 21 countries in sub-Saharan Africa had access to medicines to prevent transmission of the virus to their child—up from just 36% (excluding the less-effective single-dose nevirapine) in 2009.

The World Health Organization recommends that all pregnant women living with HIV should be offered lifelong HIV treatment, extending beyond Option B+ to include all women diagnosed with HIV regardless of pregnancy. By 2015, all of the Global Plan countries, with the exception of Nigeria, were routinely offering lifelong HIV treatment to all pregnant women living with HIV. The massive scale-up of treatment has helped to reduce AIDS-related deaths among women of reproductive age, which declined by 43% between 2009 and 2015.  

Incredible journey

Six countries—Botswana, Mozambique, Namibia, South Africa, Swaziland and Uganda—met the Global Plan goal of ensuring that 90% or more of pregnant women living with HIV had access to life-saving antiretroviral medicines. Six additional countries provided antiretroviral medicines to more than 80% of pregnant women living with HIV—Burundi, Cameroon, Malawi, the United Republic of Tanzania, Zambia and Zimbabwe.

Major successes have also been seen in increasing access to treatment for children living with HIV in the 21 countries: access has increased more than threefold since 2009—from 15% in 2009 to 51% in 2015. However, this is still only half of all children in need of treatment. Major efforts are required to ensure that all children born to HIV-positive mothers are tested for HIV within the first two months of life. Without immediate access to treatment, around 30% of children living with HIV will die within the first year of life and more than 50% will die before they reach their fifth birthday.

The Global Plan also aspired to reduce new HIV infections among women of reproductive age by 50%. The actual decline was just 5%—well below the target. This suggests that women, including young women, continue to be left behind and are not being reached with HIV prevention services. Between 2009 and 2015, around 4.5 million [3.8 million–5.4 million] women became newly infected with HIV in the 21 priority countries in sub-Saharan Africa, and AIDS-related illnesses remain the leading cause of death among adolescents on the continent.

At the launch of the report, UNAIDS, PEPFAR and partners also launched a Super Fast-Track framework for ending AIDS among children, adolescents and young women—Start Free, Stay Free, AIDS-Free. The initiative will build on the progress already made to Fast-Track action to end the AIDS epidemic and sets ambitious targets to eliminate new infections among children, find and ensure access to treatment for all children living with HIV and prevent new HIV infections among adolescents and young women. Together, these steps will put the world on a path to ending AIDS among children.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

PEPFAR

The United States President’s Emergency Plan for AIDS Relief (PEPFAR) is the United States Government initiative to save the lives of those affected by HIV/AIDS around the world. This historic commitment is the largest by any nation to combat a single disease internationally, and PEPFAR investments also help alleviate suffering from other diseases across the global health spectrum. PEPFAR is driven by a shared responsibility among donor and partner nations and others to make smart investments to save lives. Learn more at pepfar.gov and connect with us on Facebook and Twitter.