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Data: Progress made in the last two decades in combating HIV threatens to be disrupted by COVID-19

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In the last two decades, significant progress has been made around the world in combating the deadly HIV AIDS both in terms of new infections & deaths. The number of new infections & deaths among Children in the 0-19 age group has reduced by 2/3rd between 2000 and 2020. 

The human immunodeficiency virus (HIV) continues to be a major public health issue at the global level. About 36.3 million lives have been claimed by the virus, so far. Infants, children, and adolescents have all been victims of the virus since there isn’t any cure for the disease caused that targets the immune system. 

Effective HIV prevention, diagnosis, treatment, and care are pivotal in reducing the spread of the disease and enabling the persons living with HIV to lead a long life. One of the targets of the United Nations Sustainable Development Goals (SDGs) is to end the HIV AIDS epidemic by 2030. Like in the case of other healthcare issues, the COVID-19 pandemic poses a threat to the decades of progress made in HIV prevention.

In this story, we focus on HIV among children and the progress made in its treatment and spread over the years. Data has been compiled from the UNICEF’s HIV Estimates for children dashboard which is based on estimates made by UNAIDS which in turn is sourced from the data uploaded by countries every year. The data is used for policy formulation to combat HIV both at the global & national levels. In this story, an adolescent is considered a person between 10–19 years old and a child is a person younger than 10 years old, unless otherwise mentioned.

2.78 million Children were estimated to be living with HIV in 2020

Nearly 38 million people were living with HIV worldwide as per the 2020 estimates. Of these, about 2.78 million were children aged 0 to 19 years, accounting for 7% of the total. Of the 2.78 million children living with HIV in 2020, nearly 1.03 million were children and around 90% of them lived in sub-Saharan Africa. Adolescents constituted the remaining 1.75 million.

At the beginning of this millennium, over 3.16 million children (0 to 19 years old) were living with HIV. The number increased to 3.6 million between 2007 to 2009. However, there has been a significant reduction in the number since then with the least number with 2.78 million reported in 2020, the lowest in these 20 years. In other words, the number decreased by around 12% in the last 20 years. 

The number of children aged 0 to 9 years living with HIV, where the infection was mainly caused through mother-to-child transmission, has dropped from 1.88 million in 2000 to around a million in 2020, recording a 45% drop. However, the cases among adolescents have gone up in 2020 as compared to 2000. Around 1.28 million adolescents were living with HIV in 2000, which increased to over 1.84 million children between 2014 and 2016 and has since dropped to 1.75 million in 2020.  

An average of 850 children were newly infected per day in 2020

It has been estimated that an average of 850 children aged 0 to 19 years were newly infected per day with HIV in 2020. On the other hand, an average of 330 children (0 to 19 years old) lost their lives to HIV-related causes, per day in 2020. This has been attributed to the lack of access to adequate HIV prevention, care, and treatment services. 

The number of new HIV infections reported annually among children has reduced by 66% over the last two decades. In 2000, nearly 0.89 million new infections were reported which has now reduced to 0.3 million in 2020. Further, the reduction is different among the two age groups considered. New infections in the 0-9 age group children dropped from 0.52 million in 2000 to 0.15 million in 2020 (by more than 70%) while that among the adolescents dropped from 0.37 million in 2000 to 0.15 million in 2020 (by nearly 60%). 

One of the targets countries globally was to reduce new child (aged 0–14 years) HIV infections to less than 40,000 by 2018 and to 20,000 by 2020 so that children can start their lives HIV-free. However, children aged 0-9 years alone accounted for 50% of the 0.3 million new cases reported in 2020 which by itself is almost four times the 2018 target and 9 times of the 2020 target.  

Deaths among children have reduced but that among adolescents continue to remain the same

Since their immunity is affected, children are more vulnerable to diseases like HIV, Tuberculosis, and staphylococcal and pneumococcal infections. In 2020 alone, about 116,000 children (0 to 19 age group) lost their lives due to HIV-related causes. In the last 20 years, the most deaths were in 2004 with over 371,000. Since then, the total number of deaths in the 0-19 age group reduced by 69%. 

Among children aged 0 to 9 years, the number of deaths has dropped from 333,000 deaths in 2001 to around 84,000 in 2020, marking a reduction by 75%. However, among adolescents aged between 10 to 19 years, the number of deaths increased from 23,000 in 2000 to 52,000 in 2008 and reduced subsequently to 32,000, in 2020. The data indicates that the efforts in early childhood survival have been fairly effective. 

Antiretroviral drugs are used in the treatment of HIV infection but do not cure the disease

Among newborns, the prime cause of HIV infection is the transmission from the mother. Identification of infection and timely use of effective interventions and treatment helps prevent the transmission. Antiretroviral drugs, ARVs in short, refer to the medicines that are used to treat HIV. These drugs are mainly administered to mothers or infants to prevent mother-to-child transmission. Lifelong treatment using a combination of 3 or more ARV drugs for the treatment of HIV infection is referred to as antiretroviral therapy, abbreviated as ART. 

More pregnant women are now covered under ART reducing infection among infants

The ‘Global Plan towards the Elimination of New HIV Infections among Children and Keeping their Mothers Alive’ was introduced in 2011 to bring down the mother-to-child transmission of HIV. There has been significant progress in this endeavour since the number of children with HIV below 5 years of age has reduced to half from 0.32 million cases in 2010 to 0.16 million cases in 2020. This is due to the increased coverage of pregnant women under treatment for HIV. Data indicates that the percentage of pregnant women under ARVs has increased from 44.7% in 2010 (0.6 million) to 84.8% (1.1 million) in 2020. On the other hand, 17.3% of pregnant women (0.24 million) were under lifelong ARTs in 2010 which has increased to 84.7% (1.1 million) in 2020. Since the introduction of the ‘prevention of mother-to-child transmission programmes’, 1.2 million deaths and 2.5 million HIV infections have been prevented among children. 

However, regional disparities exist in access to drugs and treatments. For instance, access to ARV medicines for pregnant women ranges from 95% in Eastern and Southern Africa to 41% in the Middle East and North Africa. 

Only about half the children below 15 years receiving treatment for HIV

The estimated number of children under the age of 15 years living with HIV has reduced from 2.53 million in 2010 to 1.72 million in 2020. While the number of children living with HIV has reduced over the decade, the number of children receiving ART has gone up from about 0.42 million in 2010 (16.5% of infected children) to 0.92 million children (53.8%) in 2020 indicating progress in treatment among children. However, despite the progress, only about half the children living with HIV are receiving treatment, which is a cause for concern.

About 79,000 children were living with HIV in India in 2019

In India, according to the latest India HIV Estimation 2019 report, there were an estimated 2.35 million persons living with HIV in 2019. Children (those aged below 15 years) living with HIV comprised 3.4% of the total which is around 79,000. Since 2010, the number of new HIV infections in India declined by 66.1%, and deaths dropped by 65.3%.  

COVID-19 might impede the progress made over the years

While the numbers indicate significant progress over the last two decades, public health experts around the world fear that COVID-19 might aggravate the situation and impede the progress made. People living with HIV experience more severe outcomes and have higher comorbidities from COVID-19 as their immune systems are already compromised. Furthermore, COVID-19 lockdowns and other restrictions may have disrupted HIV testing, diagnoses, and access to hospitals for drugs and HIV treatment. As in the case of routine immunization and other chronic diseases, the need of the hour is to put in place a robust system to ensure little or no disruption because of COVID-19. 

Featured Image: COVID-19 impact on combating HIV AIDS

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