For me, World Aids Day has become a day of quiet reflection and sweet remembrance. I have been working on HIV/Aids for the last 20 years of my life now. For many of those years, I began every single day at my clinic in Lesotho, where I cared for people living with this terrible disease. And no matter how far I am from those early days of the Aids epidemic, my little clinic and the patients I treated there are never very far from my mind. So every year on December 1, I light a candle and think about the patients that we lost. And mostly, I think of Africa’s children.
Earlier this year, I became a grandmother for the first time. Within a day, I could not imagine life without my precious Setsoto. Her birth has made realise all over again just how essential it is that we ensure all of our children, including those living with HIV, have the chance to live happy and healthy lives. So today, I want to say plainly and without hesitation that we have a moral obligation to save the lives of HIV-positive children.
There was a time not too long ago when treating children for HIV was nearly impossible. In 2005, Aids drugs for children—the right kinds, in the right formulations—simply were not available in Africa. As the epidemic spread, more and more infants were born to HIV-positive mothers, and many died without ever being tested. For those who were diagnosed, clinicians were faced with hard choices. We had adult HIV drugs, but no guidance on how they could be used in children. We were forced to take desperate actions, crushing the adult HIV tablets and mixing them in syrup so babies could swallow them without choking. With this treatment, some of these babies lived. For many others, it was too late.
Across Africa, we now have the drugs that we need. Globally, over 750 000 children are presently being treated for HIV. But this is only one quarter of all HIV-positive children. Roughly, 210 000 children still die each year from Aids-related causes. And as more and more children slip through the cracks, our global target of ‘universal treatment access’ for children—once a lofty goal for the end of 2015—now seems like a distant vision of a better world.
Despite these challenges, I believe our future holds great promise. In 2005, we knew that we needed new tools, and the global HIV community responded by developing the right kinds of drugs to keep HIV-positive children alive and well. Now, we know that we need better systems to test and treat more children. If babies born to infected mothers are given HIV drugs, we can prevent them from contracting HIV through breast-feeding. If infants who have been exposed to HIV are given special HIV testing, we can make sure that the HIV-positive children among them receive treatment. And if we can put more HIV-positive children on treatment we can save the lives of many children—many other granddaughters—across Africa.
A powerful consortium of partners, including Unicef, the World Health Organisation, the Elizabeth Glaser Pediatric Aids Foundation, the Global Fund, the ELMA Foundation, the Elton John Aids Foundation, Pepfar, the Paediatric HIV Treatment Initiative, the Vodafone Foundation and others, are now coming together to support these goals.
At the Clinton Health Access Initiative, we are also working with ministries of Health to help support the scale-up of HIV testing and treatment for children. This is not just a moral obligation—it is also a smart investment in Africa’s future. Treating HIV-positive children helps doctors and nurses to find and treat HIV-positive mothers as well. And when mothers receive these treatments, we can help keep families together while preventing new infections.
Every December 1st, I light a candle and reflect on what we have lost. But it is also important to look forward to what we might gain.
I am hopeful for the future of all our children. I am hopeful that by the time my grand daughter grows up, we will have beaten this terrible epidemic we call HIV— and that every member of our next generation of children will live an Aids-free life.
Every December 1st, I light a candle. And on December 2nd, it is time to get back to work.
The author is executive vice-president for HIV, TB and health financing at the Clinton Health Access Initiative.