Sub-Saharan Africa is home to nearly 90 per cent of all children and adolescents living with HIV. Yet, the epidemic’s impact among those populations varies widely across the region. Six countries (Kenya, Mozambique, Nigeria, South Africa, Uganda and the United Republic of Tanzania) account for 58 per cent of the children and adolescents (aged 0–19) living with HIV and 61 per cent of all children and adolescents who acquired HIV in 2018. Critical priorities across sub-Saharan Africa are to reduce vertical transmission by retaining women living with HIV in treatment and care throughout pregnancy and the breastfeeding period and to reduce HIV incident infections, particularly in adolescent girls and young women. Key approaches include interventions that engage partners of pregnant and lactating women, the scale-up of HIV self-testing and the use of pre-exposure prophylaxis (PrEP) for both women and their partners at heightened risk.