Improving HIV prevention and care for children and women

The situation

Children below the age of 15 account for 11 per cent of the 1.6 million Ugandans living with HIV (2013 estimates). With the roll-out of Option B+, there has been a significant drop in new mother-to-child HIV infections, from 8.7 per cent in September 2012 to 7.9 per cent in 2017 (UNAIDS Estimates). Furthermore, preliminary data from the 2016 Uganda Population-based HIV Impact Assessment shows an 18 percent decline in HIV prevalence in the general population (15-49 years) from 7.3 percent in 2011 to 6.0 percent in 2016.

Turning the tide against AIDS will require more concentrated focus on adolescents and young people

However, Uganda still lags behind in attaining validation for elimination of mother to child transmission (eMTCT) of HIV; Uganda’s MTCT case rate is 466 per 100,000 against the validation target of 50 per 100,000. To achieve eMTCT validation, it is required that the HIV prevalence among women aged 15-49 years from 5.9 to 2.5 per cent or the MTCT rate from 7.9 to 0.22 percent by reduced new infections among women and reduced transmission rate by increasing coverage of PMTCT services or improving effectiveness of regimens especially among adolescents and young women (AGYW).

High disparities remain between regions, and HIV continues to affect adolescents, especially girls, disproportionately; HIV Prevalence among AGYW is 4 times higher than boys of the same age group. Two thirds of all new HIV infections are found in adolescent girls (AG) in Uganda and yet only 30 per cent of Adolescent Girls receive HIV testing Services (HTS) at outpatient departments (UNAIDS). While the absolute number of AIDS-related deaths in children below 5 years dropped by more than 50 per cent between 2000 and 2017, the number of adolescents who lost their lives to AIDS doubled during the same period.

Adolescent girls are more vulnerable to HIV infection because their reproductive systems are not fully developed. Gender inequality and patriarchal norms also make it difficult for girls and young women to negotiate safe sex; Transactional sex reported by AGYW is 24 per cent and. cross generational sex among sexually active AG 10-14 is at 60 per cent (Risk Behaviour study 2017). Female SGBV prevalence is 22 per cent predisposing them to early pregnancies and HIV (UDHS, 2016).

Our Strategies

  • Capacity development to scale up elimination of mother-to-child transmission (eMTCT) services, including increasing the coverage of paediatric ART; diagnosis and treatment of TB in HIV-infected children; nutritional counselling for HIV-positive women and infants; and adolescent HIV treatment, care and support.
  • To Contribute to the reduction of the burden of HIV/AIDS deaths among children under 5 by at least 30 per cent in 25 focus districts by 2020, UNICEF will focus on improving social support systems at community and household level as well as on improving health care providers’ technical knowledge, attitude and skills to ensure uninterrupted delivery of quality HIV and TB care services for children, adolescents and pregnant women living with HIV. 
  • Strengthened integration of eMTCT and reproductive, maternal, newborn, child and adolescent health (RMNCAH) services.
  • Intensified evidence-based community mobilization and communication to address low uptake of HIV services for adolescents and women, leveraging all of UNICEF’s supported platforms, including schools and adolescents’ friendly spaces and other community engagement fora.
  • Provision of antiretroviral therapy (ART) to ensure continued access to treatment for HIV positive refugee child or pregnant woman in humanitarian settings.