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Like many complex challenges, the global HIV epidemic looks different from different perspectives and contexts. There has been strong success in prevention of mother-to-child transmission (PMTCT) but progress has stalled, and large numbers of children continue to be infected with HIV. Prevention efforts among adolescent girls and young women – who remain highly vulnerable in most high-prevalence settings – also have shown improved results, but the rate of this positive change is far too slow to substantially reduce their overall risk and vulnerability. HIV treatment results are even less impressive than prevention ones for both children and adolescents overall, as can be seen in the weak momentum in increasing access to and uptake of antiretroviral therapy (ART) among them.
Significant variations in progress are evident across regions and countries. An infant born to a mother with HIV in Eastern and Southern Africa, for example, is more than twice as likely to be tested for HIV within two months of birth than one born in West and Central Africa or South Asia, and fewer than half of all children aged 0–14 living with HIV are receiving ART in Latin America and the Caribbean compared to more than 9 out of 10 children in South Asia.
These wide variations in progress mean that none of the key 2020 ‘super-fast-track’ global targets for HIV responses among children and adolescents will be met. Yet it is important to recognize that the rate of progress is not the same across the targets. A recurring, urgent priority should be to better understand the barriers that continue to hinder greater progress and to introduce catalytic and innovative programming and approaches to move faster toward the changes needed.