COVID-19 and HIV among children and adolescents: Current inequalities

Abstract

A prolonged COVID-19 pandemic is deepening the inequalities that have long driven the HIV epidemic, putting vulnerable children, adolescents, pregnant women, and breastfeeding mothers at higher risk of missing HIV prevention and treatment from life-saving services. The increasing poverty, mental health problems, and abuse are raising the risk of infection for children and women. Alarmingly, two out of five children living with HIV worldwide are unaware of their status, and just over half of children with HIV are receiving antiretroviral treatment (UNICEF, 2021a). In this context, current inequalities in HIV testing and treatment for children living with HIV and trends in historical coverage of services to prevent mother-to-child transmission of HIV are driving annual trends in AIDS-related mortality. Reductions in AIDS-related deaths among children and adolescents are steepest among children between 0 and 9 years (down 60% from 2010), reflecting improved efforts to prevent new vertical infections and diagnose and treat children in the months after childbirth and during breastfeeding. However, among adolescents (10 to 19 years old), progress is slower, with AIDS-related deaths declining by only 37% over the same period (UNAIDS, 2021). Braitstein et al. (2021) observed that living in a street environment versus a family environment was associated with the incidence of HIV and death. Substantial inadequacies with vulnerable young people, extreme poverty, family conflict, child abuse, and neglect are the main reasons why children migrate to the streets and are susceptible to HIV.Current studies highlight that, globally, 1.7 million adolescents are living with HIV in 2019. High population growth in many low and middle-income countries (LMICs) has created a 'youth rise' that makes essential to increase efforts to delay new infections by HIV among adolescents. Projections show that, at current rates of progress in reducing the adolescent HIV incidence rate, the number of new infections would decline from 250,000 in 2017 to nearly 183,000 in 2030 -an improvement but still far from the global targets. The situation is particularly terrible for girls. Adolescent girls are disproportionately affected by these trends, accounting for about 76% of all new HIV infections in the age group between 10 and 19 years worldwide. Girls and members of vulnerable populations tend to be at higher risk of contracting HIV as adolescents, a period when they are less likely to have access to treatment and other services (AVERT -Global Information and Education on HIV and AIDS, 2021; UNICEF, 2021b; Unidet Nations, 2021). Another situation that is important to highlight is that this year -2021marks two decades of progressive reductions in the prevalence of HIV/AIDS, but as a lasting legacy, close to the 14 million children who have lost one or both parents to AIDS remain. Today, the world faces another devastating new pandemic that has left vast numbers of mourning children in its wake at unprecedented speed. The COVID-19 pandemic had, by the e...

Impact of COVID-19 on HIV Adolescent Programming in 16 Countries With USAID-Supported PEPFAR Programs

“…Evidence suggests that the impact of COVID-19 may further exacerbate the barriers to prevention and treatment among adolescents, an already marginalized population. 5–8 Recorded impacts of the COVID-19 pandemic on the lives of adolescents include prolonged school closure, increased economic hardship, social isolation, reduced food intake, increased gender-based violence, and an uptick in teenage pregnancy. 9–12 Furthermore, many adolescents have experienced negative mental health outcomes as a result of COVID-19, with decreased access to psychosocial support.…”

Temporal trends in inequalities of the burden of HIV/AIDS across 186 countries and territories

“…However, slow progress was made in addressing the socioeconomic-related inequalities in the HIV/AIDS burden and related morbidity and mortality, and no substantial strides in HIV-related intervention strategies have been made in recent years, implying that many countries are unlikely to realize UNAIDS 2030 morbidity and mortality targets [ 8 ]. With increased life expectancy, the number of people living with HIV is growing, and HIV carriers are at high risk of COVID-19 complications [ 49 ], which continue to place an increasing burden on health systems, particularly in low-income countries. Further expansion of health assistance for LMICs is urgently warranted to accelerate the pace of progress.…”

Temporal Trends in Inequalities of the Burden of HIV/AIDS Across 186 Countries

“…However, slow progress was made in addressing the socioeconomic-related inequalities in the HIV/AIDS burden and related morbidity and mortality, and no substantial strides in HIV-related intervention strategies have been made in recent years, implying that many countries are unlikely to realize UNAIDS 2030 morbidity and mortality targets [8]. With increased life expectancy, the number of people living with HIV is growing, and HIV carriers are at high risk of COVID-19 complications [49], which continue to place an increasing burden on health systems, particularly in lowincome countries. Further expansion of health assistance for low-and middle-income countries is urgently warranted to accelerate the pace of progress.…”