Ending AIDS in Children by 2020. 21/3/2017

Published by OHCHR

Faith-based organizations have been engaged in accompanying people living with and affected by HIV, in all parts of the world, since the impact of the epidemic first became evident. FBOs also have been active in advocating just and equal access to diagnosis and care for all those who may have been exposed to HIV infection and for an end to all HIV-related stigma and discrimination. Among those efforts, Pope Francis has raised a strong voice for equal access to medicines for all people, not just for a privileged few; the Holy See delegation to the UN in Geneva has played a key role in promoting trade and intellectual policies and practices that will ensure such access.

In April 2016, more than 100 professionals and advocates, especially those engaged in the response to children living with or affected by HIV, including persons living with HIV, were convened in Rome and came from Africa, Asia, Europe, Latin America, and North America. The convenors were Caritas Internationalis, UNAIDS, and PEPFAR. The aim of the meeting was to share knowledge, experience, and good practice models as well as our grave concerns, with special attention to the wellbeing and future of children vulnerable to, or already living with, HIV. Dr. Luiz Loures, Deputy Director of UNAIDS summarized the goal of the meeting as follows, “We need to bring our minds and our hearts together to face the future to take us to the end of AIDS.”1

Concluding this Consultation, the participants committed themselves and their respective organizations to several actions, including the following:

• Increase partnership and collaboration with government and other civil society actors;

• Assume a critical role in implementing, and monitoring progress in achieving, the Sustainable Development Goals (SDGs) and other international commitments and to safeguard respect for human rights;

• Assure access to treatment and provide social, emotional and spiritual support for arriving migrants and refugees;

• Maintain focus and concern on marginalized, low-prevalence, and/or hard-to-reach populations within our respective countries;

 

Contribute to ethical and theological reflection, and ecumenical and inter-religious dialogue, on overcoming obstacles and barriers to effective Early Infant Diagnosis and Treatment of Children living with HIV.

Immediately following this Consultation, two special private meetings were convened by the Vatican’s Pontifical Council for Justice and Peace, Caritas Internationalis, UNAIDS, and PEPFAR with Chief Executive Officers of pharmaceutical and diagnostics manufacturers to discuss the obstacles to early diagnosis and treatment, especially of children living with HIV. An open and honest dialogue was held; identified needs included:

• more child friendly medicines and diagnostic tools, additional research and development;

• de-blocking some processes of approval of new medicines and diagnostic tools;

• engagement of FBOs in research on new medicines and diagnostic tools;

• changes in pricing structures, especially for second- and third-line medicines and for the markets in so-called middle-income countries and among poor and marginalized populations in high income countries;

• strengthening of health and community systems to insure more timely delivery of test results and initiation and retention in treatment.

These meetings led to the plans to the formulations of new targets for early diagnosis and treatment of pregnant women living with HIV and for their newborn children and launch of the “Super-Fast Track for Ending AIDS among Children, Adolescents, and Young Women living with HIV”, so that the HIV-related SDGs and the overall elimination of HIV as a public health threat could become a reality to 2030.

This brings us to today’s gathering. We know that scientific and technical knowledge alone will not solve the challenges posed by HIV disease. We need political will, the resources to be provided by the international community, governments, and the private sector, as well as the determination of civil society (including FBOs), the strong voice of activists, the respect and promotion of universally declared human rights, including the right to health and the adoption of responsible behavior to accomplish this goal.

Summary of major points and challenges emerging from today’s session:

Ambassador of Namibia:

• Significant number of AIDS orphans (Vitillo note: FBOs played an important role in the response – especially Catholic AIDS Action and Lutheran church services)

• Country success in reaching Global Plan and even Fast Track goals for ending AIDS among children

• Communities empowered to take responsibility for epidemics at local level – effective responses

• Government – sponsored social protections system

UNAIDS:

• Progress in many countries

  • 60% decrease in vertical transmission
  • 90% decrease in HIV-related deaths among children in South Africa

• need Early Infant Diagnosis (EID) and early treatment with ARVs – otherwise the child presents symptoms when the disease is far advanced and ART is not effective; yet many children are not diagnosed until 4 years old and many HIV-infected children die before 2nd birthday if they are not diagnosed and treated early

• When children are initiated on treatment by 12th week of life, they have a 75% survival rate

• Fast Track Framework:

  • Political commitment and policy change
  • Service delivery
  • Community engagement
  • Innovation and new products
  • Accountability for progress

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF):

  • Organization motto: “Until no child has AIDS”
  • Super Fast Track has very ambitious targets – why? The old targets were based on the assumption that many young children living with HIV would die before their 2nd birthday
  • Serious challenge is EID - if ART is started before 12 weeks, child has 75% of survival
  • Retention challenges – technical, social, and human rights-related
  • Human rights-related actions to promote and achieve Fast Track:
  1. Keep the health of the on the human rights agenda
  2. Vitillo question: could the Special Rapporteur for Health be requested to do a special report on issue of HIV among children and lack of access to early diagnosis and treatment in the context to the right to health
  • Vitillo comment: FBOs, in addition to other civil society organizations like EGPAF, could play key roles in the successful implementation of Fast Track for Children

UNICEF:

• Excellent progress with decreasing vertical transmission of HIV

• We need special programmes that are sensitive to young women living in adverse circumstances – poverty, abuse, being forced into prostitution by adverse circumstances, being an adolescent single parent all contribute to vulnerability to drug use and HIV infection for young mothers and thus the risk of transmitting the virus to their babies.

Appeal and conclusion by Vitillo:

At the end of this stimulating session, there is no doubt about the urgency ensure enjoyment of the right to health for the youngest of children, especially among those living with or affected by HIV. We must insist on achieving this goal since they do not have their own means to advocate at global, national, and local levels. Yet I am left with a burning question: Why do we spend so much time on slogans, themes, road maps, and strategies but still seem to be challenged with moving to effective action? Why do we seem to dedicate little time or effort to really listen to the pain and cries of those millions of people living with HIV, especially the children, who still have no access to life-saving medicines? Certainly, they are judging us on how and why we – at global level – we Heads of State, diplomats, national and local government officials, business and NGO executives, religious leaders, and many others - continue to talk about commitment but never seem to arrive at effective and inclusive action!

During a visit to Bolivia in July 2015, Pope Francis shared his impatience with such systematic deprivation. “Working for a just distribution of the fruits of the earth and human labour is not mere philanthropy. It is a moral obligation … It is about giving to the poor and to peoples what is theirs by right.” At the same time, during his address to the UN officials and staff in Nairobi, December 2015, he offered a roadmap that could result in success if we all are willing to put aside our self-interest and open ourselves to true solidarity: “What is needed is sincere and open dialogue, with responsible cooperation on the part of all: political authorities, the scientific community, the business world and civil society. Positive examples are not lacking; they demonstrate that a genuine cooperation between politics, science and business can achieve significant results.”

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