World AIDS Day Event: HIV services fail children

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Moderator Smita Baruah, Scott Kellerman, Nandita Sugandhi, Victoria Fan, and Erin Hohlfelder.

Moderator Smita Baruah, Scott Kellerman, Nandita Sugandhi, Victoria Fan, and Erin Hohlfelder.

While the Obama administration commemorated World AIDS Day at the White House and celebrated progress in the fight against HIV, global HIV advocates at a Capitol Hill briefing Monday discussed how that progress has left young people and children behind.

With more than two million children who need antiretroviral drugs not receiving them, HIV treatment coverage for children remains half of what it is for adults, briefing panelists said. Children infected with HIV who make it past five years of age face higher mortality rates through their teen years. While globally, HIV and AIDS death rates have decreased by 30 percent over the past decade, they’ve increased by 50 percent among children living with HIV aged 10-19.

Inadequate diagnostics and insufficient treatment options stand between children with HIV and the treatment they need, Nandita Sugandhi of the Clinton Health Access Initiative said. Testing children requires costly virologic tests which take longer to yield results, while children need more treatment options and new drug formulations, Sughandi said. The recommended regimen requires refrigeration, which “becomes an insurmountable problem in resource limited settings.”

Adolescents, defined as children aged 10 to 19, should be recognized as a distinct, and frequently particularly vulnerable, patient population, she said. The unique challenges adolescents face include often being the head of a household,taking medications on their own while having to care for younger siblings and dealing with how, and to whom they disclose their HIV infection.

While pediatric HIV has been virtually eliminated in the West, Scott Kellerman of Management Sciences for Health said, developing countries are lagging behind, and stale thinking has been a barrier to progress. Strengthening prevention of mother-to-child-transmission is important, he explained, but, he added, so is strengthening antenatal care prior to PMTCT.

“We have to do more with developing case finding for find kids with HIV, then figure out how to link kids to care and have them adhere,” he added.

“This wouldn’t be a meeting on Capitol Hill without a request for more funding,” Erin Hohlfelder of ONE said, noting that a lack of funding remains a barrier to reaching an AIDS-free generation. Turning that corner will require an additional $3-5 billion a year than is currently spent.

It’s not all about getting more money. “Budget transparency is hugely important” — and rare — she said.

Hohlfelder called for a “prevention revolution,” the likes of which treatment advocates have successfully done with expanding treatment.  “Treatment has gotten a lot of advocacy because there are clear treatment goals,” she said, but noted that prevention targets are not so clear.

Rethinking what prevention is, and thinking more in terms of biomedical prevention methods, including treatment as prevention, would help, Kellerman said.  “We can change people’s behavior only to a certain point but if we can change a community’s viral load, we can really make a dent in the pandemic,” he said.

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