Children and AIDS: Fourth Stocktaking Report, 2009

8/14/2019 Children and AIDS: Fourth Stocktaking Report, 2009

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Children and AIDSFourth Stocktaking Report, 2009


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contents

Page 1 I. Irdi

Page 4 II. Prvi mhr--hid ramii

Page 10 III. Padiari ar ad ram

Page 15 IV. Prvig ii amg ad adyg pp

Page 21 V. Pri, ar ad ppr r hidr adby HIV ad AIDs

Page 26 VI. Prgramm mirig ad vaai

Page 31 VII. Ivm: Wha wm ad hidr d

Page 33 VIII. ca ai

Page 36 Rr

Page 39 Ax: n h daa

Page 40 Ga 1. Prvig mhr--hid ramii HIV i w- ad midd-im ri

Page 43 Ga 2. Prvidig padiari ram i w- admidd-im ri

Page 47 Ga 3. Prvig ii amg ad adyg pp

Page 50 Ga 4. Prig ad pprig hidr adby HIV ad AIDs

cHIlDRen

AnD AIDs:

FouRtH

stocktAkInGRePoRt, 2009

cvr ph: unIceF/nYHQ2009-0332/nbi

unAIDs, h Ji uid nai Prgramm

HIV/AIDs, brig ghr h r ad rr

10 un ym rgaizai h gba AIDs

rp. c-pr id unHcR, unIceF,

WFP, unDP, unFPA, unoDc, Ilo, unesco, WHo

ad h Wrd Ba. Bad i Gva, h unAIDs

raria wr h grd i mr ha

75 ri wrdwid.

Fr ay rrigda d bq

priig, pa vii r wbi a

.

Fr ay daa pda bq priig,pa vii .

IsBn: 978 92 806 4474-6

sa .: e.09.XX.23


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Yar ag, wh h dvaaig impa h AIDs pidmi hidr wa j bmig appar, hr wa way imagi a AIDs-r grai i h rab r.

I 2005, h pidmi q prmpd unIceF, hJi uid nai Prgramm HIV/AIDs (unAIDs) adhr parr ah Unite or Children, Unite againstAIDS, a gba ampaig ai ad rr

miigaig h wr HIV ad AIDs hidr adyg pp.

Fr yar i hi r, may iv hav b avd rimprvd ba aia gvrm, -gvrmargaizai, a mmii ad iraiargaizai hav b xamiig h vid adrpdig. th prvi mhr--hid ramii HIV i a gba bjiv.

cmbiai prvi igraig bhavira, rra/ia ad bimdia apprah a hp rd HIVprva amg yg pp. AIDs-iiv, rahr haAIDs-xiv, irvi ar big mbrad i maypa b hidr ad by AIDs.

I h a vid hwig hw ria i i r avigyg iv, ary ia diagi ha b abihd aa pririy ad i w avaiab mr ia ha vr.Wih w vid ggig ha pa AIDs mraiy iia may m a a vry yg ag w hr mhi dy1 hr i v mr rgy impmh rmmdai.

Airrvira (ARV) rgim r h prvi mhr-

-hid ramii (PMtct) HIV ar w rahig 45 pr HIV-piiv prga wm gbay. cvrag HIV ig amg prga wm i 78 pr i shAria, 87 pr i Bwaa ad 90 pr i namibia a ri wih high HIV prva.2

Ai h d hidr ad by AIDs wgr prmiy i prgrammig. I i a drivr dig,ry prmpig h Gba Fd Figh AIDs, tbriad Maaria, r xamp, rviw i pri ad irappr r mr ai rgim r PMtct. chidrad amii ar highighd i h unAIDs omFramwr. A hi wd hav b h a y a w

yar ag.

A generation o children ree rom

AIDS is not impossible.

I. IntRoDuctIon

1UNITE FORCHILDREN UNITE AGAINSTAIDS


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rivig PMtct rvi wd ar ram r hirw hah.

I PMtct wr , hr wd b w w iiamg wbr, b ha ga rmai ar . PMtctvrag i p, b ar may wm hidbarigag ar i bmig id wih HIV ad ar wHIV-piiv prga wm ar rivig pima rgim.

Ahgh hr ha b prgr i HIV ig mhrr PMtct, h ig mhr r hir w hahrmai pradi.3 exiv bradig, whih a rdh ri HIV ramii rm mhr hid, i widy praid.

th mbr hidr rivig padiari ARt i ira. B h i-avig impraiv ary ig adiiiai ram ar y adard i m ri.I h ara PMtct ad padiari ar, h mbr wm ad hidr w-p i ragiay high.

Prgr may prvi idiar rad ygpp ha b w. Whi wr ai rpha adhr vrab hidr i iraigy dd, i i raid by wa ym ad pr rdiai.

Prgr da i PMtct ad padiari HIV ar adram ha b v, drrig iqii a HIV ig ad ig, ARV r PMtct ad ARtr mhr ad hir hidr ad gap i rvi vrag.thr wi b vari pah ig h gap.

Improving the uptake o AIDS-relatedinterventions requires enhancing health

systems and linking them with communities

ky idiyig, diagig ad arig ram rh va majriy hidr wh ar id wih HIV arimprvd hah ym ad br iag wih hid hahad rviva prgramm. th ar wi a b ria aaiig h Miim Dvpm Ga (MDG).

Igraig h divry HIV-rad rvi r bhmhr ad hir babi rmai a hg hag. Amprhiv paag h rvi id HIV igad ig drig h aaa prid; PMtct rvir HIV-piiv wm; ary ia diagi ad ram babi i h r yar i; ad ar ad ppr rad ivig wih HIV wh may a dr hprviw ay pariar ym.

I i y hah-rad ym ha ar impiad.Bhavir hag hr m mbiaiprvi rqir hard ia rm ha ppr arbhavir ad ar drd by h mmiy. Rahig

The world is not yet on trackto meet targets or prevention,treatment, care and support

th adva ha hav b mad ar, r, mprd by hma, piia,ia ad mi raii. Mri wi m h ga ah ipi Unite or Children, Uniteagainst AIDSby h arg yar 2010.

th mi rii ha mrgd i20082009 ha raid r abhw aia r wm ad hidrwi b aid ad xpadd rahivra a arg. I mirai wr ddy p a ha xdig airrvira hrapy (ARt) w ripi, hi wd ma iawd riv ram ad mhr

U

NICEF/NYHQ2004-1217/Vitale

2 UNITE FORCHILDREN UNITE AGAINSTAIDS


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Jdii ivm rqir br aayi hiv i hagig bhavir prgramm rdhrgh h, hah ad ia rvi, h ma mdiaad h mmiy. Avaiab daa prvid a gid, b hrha b ar i marm prgramm impa.

A human rights-based approach to children andAIDS means addressing issues o equity o access

uivraiy ad qiy ar rr hid righ adm b r-mphaizd i hi 20h aivrary yar hcvi h Righ h chid. thi ma ig aqiy rviw prgr ward ivra aga, phdig a adard ar ad ram r aad wrig ward a qiab diribi rr.t d hi, i i impra drad xay wh ibig rahd.

Daa diaggrgad by ag ad x a hp awh i big mid ad whhr a rvi i

qiab. Whi m prgr ha b mad i igdiaggrgad daa, i may pa hr i ar ghdai ragiay arg prgramm r a hiray. eqiy hd b bh a prmi ad a m prgrammig.

srvi may xi, b hidr ad amii ar di rah. uivra a arg m prpa aadard whrby h am hidr ad amii paig hrgh h ra r a rvi. o r aayi m-a-ri ppai i rad pidmi ad ha y 4.7 pr prvi pdig waaad prgramm r irav drg r, 3.3 pr

prgramm r m havig x wih m ad1.8 pr prgramm r x wrr.7

W w ha vid h a hi a raa i mriv ai. B hr i aiai i ba haw. Famii, a mmii, aia gvrm, -gvrma rgaizai ad iraia iii havhw hy hav h wi ad apaiy rvr h pidmi.I i w im w hrgh h mmim.

h pp m a ri rqirdvpm pii ad garamwr addr dirimiai.

Adqa ppr r hidr adby HIV ad AIDs ma imprvig iawar ad ia pri ym idig h r im rar,

araiv iiia ar, admmiy ad amiy-bad ar ra hidr. A h ym hah,piia, ga ad ia war d ip ad ppr rm admmii, ad i bw adamg hm.

Judicious investment isneeded to ensure sustainableservices and systems

t iv wiy i HIV ad AIDsprgramm r hidr a h ryv, i i impra w h pidmi,h rp, h ad h rahivd ar. A b ima by unIceF h rr dd ivyaddr h rqirm wm,hidr ad yg pp i us$5.9 biipr yar rah ivra a argr h r P: prvig mhr--hid ramii, prvidig padiariar ad ram, prvig iiamg ad ad yg pp,

ad prig ad pprig hidrad by HIV ad AIDs (see Chapter VII).

thr i mpig vid h -iv prvi. A rdy bad mdig daa prjdha xpadig prvi prgrammd mr ha hav h mbr HIVii by 2015 ad av us$24 biii ram .4 Ahr dydd ha i i iapab haprvi m b h y ay g-rm rp, giv h vrwhmigd r ram by h yar 2030(55 mii pp) i rr rd pri.5ohr vid dmra ha primaryprvi i pariary -iv iavidig mhr--hid ramii.6



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PRoGRess AnD AcHIeVeMents

cvrag rvi r PMtct ha irad adiy. I2008, 19 ri had rahd vrag ra 80 pr r HIV ig ad ig amg prgawm i d rvi prv ramii HIV hir ia.8

ovra, i 2008, 21 pr h imad mbr prga wm ivig i w- ad midd-im riwr d r HIV, mpard wih 15 pr i 2007ad 13 pr i 2006 (Figure 1). sm 45 pr prga wm ivig wih HIV i h ri rivdairrvira (ARV) rgim idig airrvira hrapy(ARt) r hir w hah prv h ramii hvir hir ia, mpard wih 24 pr i 2006 ad35 pr i 2007 (Figure 2).9

th prpri ia rivig ARV r PMtct iradbw 2005 ad 2008 i may ri wih vry high

v HIV ii pariary h cra AriaRpbi, Mzambiq, swaziad ad h uid Rpbi tazaia ad i m w-prva ri, pariarychia, Idia ad sga. o avrag i 2008 i w- admidd-im ri, 32 pr ia br HIV-piiv mhr wr giv ARV prphyaxi r PMtct abirh (Figure 3), p rm 20 pr i 2007 ad 18 pr i 2006.10

Y, dpi rg gba prgr ad may a ad aia iiiaiv, may w- ad midd-imri ar i ra rah h un GraAmby spia si HIV/AIDs (unGAss) arg.

th majriy wm ad hidr d y hav a

Decentralizing and strengthening

health systems is essential tourther expand services to prevent

mother-to-child transmission

o HIV.

II. PReVentIon

oF MotHeR-

to-cHIlD

tRAnsMIssIon

Figure 1. Trends in percentage o pregnant women who received an HIVtest, by region, 20042008

0%

10%

20%

30%

40%

50%

60%

Total low- andmiddle-income

countries

CEE/CISLatin Americaand the

Caribbean

South AsiaEast Asia andthe Pacific

West andCentral Africa

Eastern andSouthern Africa

20072008

200620052004

11

15

23

28

43

2 3

67

16

2 2

6 7

11

19

29

3840

54525150

40

35

7 7

1315

21

4 3

9 913

Note: Figures on the coverage o HIV testing among pregnant women were recalculated or previous years based on the revisedestimates available. CEE/CIS, in this gure and others, is an acronym or Central and Eastern Europe and the C ommonwealth oIndependent States, a UNICEF region.

Source: UNICEF calculations based on data collected through the PMTCT and Paediatric HIV Care and Treatment Report Card processand reported in Towards Universal Access: Scaling up HIV services for women and children in the health sector Progress Report 2009(WHO, UNAIDS, UNICEF). Regions were recalculated according to UNICEF classication o regions.



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a r am dd i igh pbi hah ri laa Diri d ha igraig divry ARt iaaa ar ig dbd h prpri ARt-igibprga wm iiiaig ram drig hir prgay.15

I ri wih high HIV prva ad imid rr,a igrad apprah prvidig rvi i bh praiaad aib. thi ai h dvpm apprpriapii, qippig abrari, prvidig bh iia adimmgia am r HIV ad iiiaig ARt a hrvi-divry v. A igrad apprah a rqirbidig apaiy rpa ig-d virapi wih mrai ARV rgim r PMtct ad abihig iwih a mmii.

I w-prva ig h a cambdia ad chia, aid apprah bad a rg rrra ym amghah aiii, pi--rvi divry ad mmiiha b iv. I Gagxi Prvi i chia, whrHIV ig ad vrag wr w ad whr hr wrgap bw aaa ar ii ad HIV ad AIDsar ad ram prgramm, r hp a p amprhiv PMtct prgramm by iig vari hahrvi hav yidd r. High prag wm arw big d ad rd ram i piiv. A y arha b h abihm rgaizaia i bwh Mara ad chid Hah brah h aia hah

ym, h chi cr r Dia cr ad Prvi(whih vr HIV prvi), h naia Fr Airrviratram Prgramm, ad ar ad ppr rvi.16

Bidig hah ym apaiy rqir ppriv piiaadrhip, ivai i prgramm aig, pariarya h b-aia v, ad addrig h hrag hah-ar wrr hrgh praia apprah h a a-hiig ad a-harig.

by mr ha 10 prag pibw 2001 ad 2004 ad i igpai --p baiay.thr wa a a ira i HIV ig,idig p ig, a w aira i amiy paig ad maimmizai vrag.13

Zambia naia sa-p Pa rPMtct ad Padiari HIV car srvir 20072010 i w big rpiad ah diri v, wih ppai-badarg. A par h draizaipr, prviia hah dirr arraid i PMtct piy ad prgrammaii. thir maagm am arxpd rdia ad prvi; mappririi ad igra PMtct aiviii prviia pa; rgaiz diriraiig; maag gii; ad rprgramm mirig ad vaai.14

Further expansion o PMTCTservices depends on buildingcapacity and harmonizingactions, goals and outcomeswithin maternal, newbornand child health services

th r PeARl dy PMtctiv i Aria wd 3,244 HIV-piiv prga wm wh divrd a

hah r rig PMtct rvi icamr, c dIvir, sh Aria adZambia. oy 1,839 mhr (57 pr )ad 1,590 ia (49 pr ) mpda r ig-d virapi.Ra r h -mpi iddha h HIV wa big rd,ig wa did, h r wr giv h mhr ad maravirapi wa dipd (Figure 4).

Imprvig h prrma mara,wbr ad hid hah rvi i

rr-imid ig i ria aaiig unGAss ad MDG arg rad PMtct. th pririy r rvi divryi gap i h im arby rghig i bw PMtctad ARt rvi, xa ad rprdivhah rvi, immizai ad hrhid rviva irvi, ad padiariar, ppr ad ram. I Zambia,

Figure 4. PEARL Study on PMTCT eectiveness in Arica

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Adhered toinfant dose

Adhered tomaternal dose

Receivedmaternal

Receivedpositive

Acceptedtesting

Offeredtesting

DocumentedDeliveries

3,2442,991

2,7182,614

2,3952,279

1,8391,590

Num

berofwomen

Source: Stringer, Je, The PEARL Study: PMTCT eectiveness in Arica Research and linkages to care and treatment, presentationdelivered at the Regional Expert Consultation on Scaling Up Prevention o Mother-to-Child Transmission o HIV and Paediatric HIV Careand Treatment in Eastern and Southern Arica, Nairobi, 21 May 2009, and subsequently published as an abstract or the 2009 HIV/AIDSImplementers Meeting (Windhoek, June 2009) and the 5th International AIDS Society Conerence on HIV Pathogenesis, Treatment andPrevention (Cape Town, July 2009).



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Community-based interventions must beintegral to national scale-up strategies

la mmii, idig aih-bad rgaizai adpr ivig wih HIV, hav payd a adig r i maigPMtct a pririy ri aia rp. I mayrr-imid ig, -radiia rvi prvidrhav a vr y aivii h a HIV ig, pprr adhr ram, ia dig ig,rii ppr ad hm-bad ar. thi ha hpdriv hah-ar wrr a grwig wrad prr.B hr ha b a ai maig h mmiy-driv aivii igra aia a-p ragi, ad rig ha hir impmai i par a mprhivad draizd apprah.

la mmii, r xamp, a prvid ia ppr HIV-piiv mhr wh hav h amg iadig pi. Prmig xiv bradig ad h

imiai mixd dig, whih ira h ri HIV ramii, a r wihi PMtct rvi by ig i mmiy-bad mara ad hid hahad rii prgramm. Bhavir-hag mmiairagi aimd a h mmiy ad divrd hrghmhr ppr grp ad hr xiig mmiyrr a hav a riia r i ririg magdivrd a hah aiii.17

Innovation is increasinglybeing used to addressprogramme bottlenecks,particularly in service delivery

th mbi ph hgy aid PMtct ad padiari HIV ar,

ppr ad ram ha gra piai pa wih imid aia adhma rr ad imid abraryirarr. er da havd ragig wm rr hah r, raig wmad hidr wihi ad amg hahr, ad imprvig mmiai r bw pi rviad abrari. th eizabh GarPdiari AIDs Fdai ha irdd h ivaiv apprah icamr, c dIvir, h Dmrai

Rpbi h cg ad Zambia.

naia prgramm hav adpdivaiv way vrmigb h pa PMtct-rad drg, ia dig igad ppr, a cD4 -ig, ad h gagm maparr. th Zambia Prvi, carad tram Parrhip ha aidh Miiry Hah Zambia iabihig mry-bad raprym r bd amp ira

a ARt-rad abrary ,idig cD4 r HIV-piiv prga wm, ad mmia r.

I Haii, a mmiy wr wm hah ag, ajan anm, ihah r hpia. Ididby mmiy adr, ajan anm viiprga wm i hir hm adrr hm r HIV ig. thy aiHIV-piiv prga wm wihadhr ram ad ry rha wbr ar pad prphyaxiwihi 72 hr birh, ampayigmhr ad baby hpia wh hbirh a pa i h hm.

Innovations in drug packaging lead to use omore efcacious regimens or PMTCT in Lesotho

t ira pa mr ai ARV rgim rPMtct, h Gvrm lh irdd a ayambd mhr-baby pa aiig a h mdiidd r h PMtct prgramm. si J 2007,

h mdii hav b pad i brw vpby hah-ar prvidr a hah aiii ad giv prga wm wh ar HIV-piiv a hir r aaaar vii.

unIceF ad parr ar i h pr dvpig aimiar mhr-baby pa ira vrag PMtctrvi. I i wih Wrd Hah orgaizai (WHo)gidi, h w pa wi ai h ARV adrimxaz dd by mhr drig h aaaprid ad by mhr ad ia drig h abr/ira-parm ad p-parm prid. thr i w a pryp, whih i big d i h d. A rma

am lh iiiaiv i dr way. Fidigwi b d irm h vra dvpm ad r- h gba mhr-baby pa.



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ivig wih HIV wr id hrgh h ijig drgqipm ha wa amiad, ad ab 50 pr aqird HIV hrgh prd x wih drg-ijigparr.22 I h ig, aig p PMtct rqirivaiv apprah rah h m-a-ri wm adrg i wih piid bii ram r.

The current global economic downturn

underscores the need to address the long-term sustainability o PMTCT services

uivra a PMtct rvi i a ahivab gawh i i pprd by aia adrhip, mmimad rr. Wih h r mi dwr, hprbm aia aiabiiy prgramm ha arhighy dpd xra dig ra mr havr br. PMtct prgramm ar pariary dpd xra dig r h prha drg ad hrmmdii, a ara idid by h Wrd Ba i i gbaaia a big piay vrab.23

Fr m rr-imid ri, hr i a rgy drmi h aa ad impa aia PMtctprgramm i rdr gid gvrm i ig apii. sh a aayi d pay pia ai h prdiabiiy ira ad xra dig, hmarr pii ad aig mhaim, i pariara h draizd v. sh piy rrm a abii r r mara, wbr ad hid hah ar,a w a prgriv ia pri iiiaiv adhah ira, ar impra vrmig dmad-idb ad rig qiy. Y h mar m ab ad r hir impa h vra ad-p

PMtct iiiaiv ad r h driv ward ivra aad h imiai mhr--hid ramii.

I lh ad Rwada, mmiymbiizai ha b irmai ivvig ma parr i PMtctpr ad i iraig hpa ig amg h m.18I lh, mmiy mbiizaiad h pariipai m i prppr grp hav a ribd

rdd igma ab PMtct, iradig ia ad imprvd ra xiv bradig.19

Reaching PMTCT goals requiresgoing beyond exclusivemanagement o HIV and AIDSissues among women and children

Imprvig vra mara ad hid hahad rviva i h x HIV rqirha prga wm ad HIV-piiv

mhr ad hir hidr b prviddwih ia prviv ad primaryhah ar r dii hr ha HIVad dii ha ar dagr wm ad hidr id wih HIV.thi id di ad ram maaria, yphii ad bri, aw a maagm ijig drg amg prga wm.

I pa whr maaria i dmi, HIV-maaria -mrbidiy a b addrdivy i aaa ad divry-

ar ig hrgh h diribi iiid-rad mqi ,irmi prviv ram maaria amg prga wm i hird ad hird rimr, h h mm aibii rimxaz aprphyaxi i hidr, ad imprvdmaaria a maagm.

I Zambia, appyig h r PMtct-rad rarh prgramm waaiad wih imprvd aaa

yphii rig (RPR) vrag.

20

I sw, sh Aria, ympmairig r bri (tB) rd aa ri mp ar drig HIVp- ig d h di aiv tB a amg HIV-piivprga wm.21

I ear erp ad cra Aia, ii imad ha 35 pr wm

UNICEF/NYHQ2004-1213/Vitale



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virapi i i giv mhr r PMtct whmbiai rgim ar mr iv. Mrvr, maywm idid a HIV-piiv wihi h x PMtctprgramm ar w-p drig h aad irvi rqird r iv prvi HIVramii hir ia.

Addiiay, may PMtct prgramm d id

ragi idiy wm wh bm id wihHIV ar iiia ar gaiv, ahgh hr i mvid hwig h rr w ii amgprviy HIV-gaiv wm drig prgay ad i hr p-parm yar.25 I viw hi dig, i graizdpidmi ig, ri HIV r-ig hd b idrdr HIV-gaiv wm i h hird rimr prgayr drig abr, ad i h p-parm prid a h 4- ad9-mh hid immizai vii r wm wh brad.A rarh pririy hd b idiy apprpria ARVrgim r wm wh bm id wih HIV drigprgay ad h a ia dig rmmdai rh wh bm id whi bradig.

R vid rm iia ria, brvaia di adprgramm idia ha ARt giv HIV-piiv wmdrig prgay ad aai ad ARV giv hidr ih r mh i d igiay rd h ra HIV ramii hrgh bradig.26 B may rid prm xiv bradig r r igad ppr ia dig a par PMtct prgramm.WHo vd a xpr ai i a 2009 rviww vid ad rvi gidi h airrviradrg ra prga wm ad prv HIV iii ia, wih pia ai h r ARt ad

ARV prphyaxi i rdig bradig-aiad HIVramii.

Maig PMtct rvi widy avaiab h wm,hidr ad amii wh d hm wi rqir iggap i rvi divry, h iv draizai piy, paig ad rdiai h b-aia v,ad brigig ghr hah r, hah wrr admmii. Gba parrhip d b raad ird ai a h ry v, ad aia rrmad avaiab ha ma prj ad pi iiiaiv ab brgh a a aia prgramm.

Pdig qi m a b awrd h iv PMtct prgramm ad h impa prgramm ii avrd ad h HIV-r rviva xpdhidr. Bidig mrgig ii ad prgrammvid ad dig pririi r praia rarhar ria rmvig h rmaiig b PMtct a-p.

Gba hah iiiaiv, h a h usPrid emrgy Pa r AIDsRi (PePFAR), h Gba Fd FighAIDs, tbri ad Maaria, adh Iraia Hah Parrhip arribig rghig xiigym ad aiiaig aia r r aiabiiy. thy d hi byprmig rg piia adrhip,addrig h hrag hah-arwrr, abihig ivaiv hah

aig mhaim, ad pprigaia gvrm i hir r imprv qipm, pimiz wrigdii, ad gag ivi iy, ppivig wih HIV ad AIDs, ma parr wm ivig wih HIV ad mmii.24

ReMAInInG cHAllenGesAnD tHe WAY FoRWARD

emrgig ii ad prgrammaivid pi hag i maig

h ary ym imprvm hawi ab h ahivm ivraa ga r PMtct. Immgiaam ig cD4 i widy avaiab i aaa aiii,whih xpai why may HIV-piivwm d hav a ARt rhir w hah ad pary xpai why

U

NICEF/NYHQ2006-2487/Pirozzi



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th mbr hidr iiiad airrvira ramha irad igiay vr h pa w yar. Whiy 75,000 id hidr dr 15 yar ag wrrivig ram i 2005, ad 198,000 i 2007, h mbrhad rahd 275,700 by h d 2008 r 38 pr a a 730,000 hidr id wih HIV ad i d ram (Figure 5). thi rpr a ira 39 pr rm h d 2007 h d 2008 a. 27

Ira i h prpri ia ad hidr pad ram bw 2005 ad 2008 hav b pariaryrmarab i ri wih vry high v HIV ii,aby lh, Mzambiq, sh Aria ad h uidRpbi tazaia r hidr dr 15 rivig ARt. Iw-prva ri, impriv ira bw2005 ad 2008 wr a d i h Gambia, Hdra,ad Idia.28

Giv w vid ggig ha pa AIDs mraiy iia may m a a vry yg ag w hr mhi dy29 hr i v mr rgy r ary iadiagi. May ri ar i h pr aigp ardigy. I 2008, 83 123 rprig ri hadh apaiy prvid HIV vira ig ia wihiw mh birh, p rm 57 109 rprig rii 2007.30

I addii imprvd a ary ia diagiad ARt, hr padiari HIV ar irvi hav a igia xpai. Iiiai rimxazprphyaxi wihi w mh birh r HIV-xpd

ia, a rmmdd by WHo gidi, irad rma imad 4 pr rprd i 2007 8 pr a hd 2008. I 31 ri rprig daa i 2007 ad 2008,rprig 26 pr h a mbr prga

Signifcant progress in expanding

access to early inant diagnosis isnot matched by progress in linking

it to early treatment.

III. PAeDIAtRIc

cARe AnD

tReAtMent

Figure 5. Percentage o children under 15 years old receivingantiretroviral therapy, 2008

0%

20%

40%

60%

80%


countries

CEE/CISLatin Americaand the

Caribbean

Middle Eastand North Africa

SouthAsia

East Asiaand

the Pacific

West andCentralAfrica

Eastern andSouthern Africa

44

15

65

43

6

7682

38

100%

Source: UNICEF calculations based on data collected through the PMTCT and Paediatric HIV Care and Treatment Report Card processand reported in Towards Universal Access: Scaling up HIV services for women and children in the health sector Progress Report 2009(WHO, UNAIDS, UNICEF). Regions were recalculated according to UNICEF classication o regions.



13/56

wm wih HIV, h mbr iaiiiaig rimxaz prphyaxi wihih r w mh i r by mrha ha, rm 52,100 i 2007 80,500i 2008.31

Ahgh padiari HIV ii i a hid mraiy, pariary i

b-sahara Aria (whr apprximay90 pr padiari ii r),ad-p prgramm prv mhr--hid ramii ad a ira ipadiari HIV ar ad ram rvimay hav ribd diig dr-v mraiy i m ri wih a highprva HIV.32

MAIn Issues

The devastating problems

associated with loss to ollow-up necessitate new approachesand immediate action

Whi rm ivm i aigpa gbay r ha y,ag-apprpria drg ad rvir HIV-xpd ad id hidrar avaiab, hi ivm wi b ivy raizd i hidr whhav b idid a i d adwh hav b rrrd rvi d

a hm. Y ym ab w-p prga wm ad hidr havradiiay b a ara war may ri, rig i mayhidr rivig h rvi hy riiay d.

eary ia diagi HIV, hwvr,i a ria p i h im ar ad a ia i ARt. Whimay ri hav mad rid iprvidig a ary ia diagi,may ia wih a piiv diagi

HIV hav b d i-avig ram.

A r dy 11 i i camrby h Dparm Dia cr,Miiry Hah i ji wih hci Fdai HIV/AIDs Iiiaivd ha y 32 pr ia wiha piiv pymra hai rai (PcR)

r wr aiv ad drgig ram am ad a ha yar ar Dmbr 2007, wh daa ibga h prvii HIV ary diagi rvi.th gra w-p ia i ar (45 pr) rrd v br h mhr rivd hr hidpiiv r (Figure 6).33 simiar r wr di swaziad.34 A para dy arrid by h ciFdai ad bad a ma-aayi pai daa

rm igh ri imad w-p ar igpiiv ab 53 pr .35

l w-p rpr bh igia avidab hiddah ad a maiv ivm i irarr,mmdii ad hah-ar wrr im. th dig icamr ha may hidr wr w-p arig piiv b prir rivig r wa rhraayd: Whi amp rard im (grar ha 30 day,whih i gr ha pima) wa ar, hr iddiia rgaizai ad daa fw r, a argivra irmai, igma ad ig hag, hbrd pai rr r r, ad wa w-pwihi ii r ha argivr rivd r ar hyhad b rrd h ii rm h abrary. camrGvrm i w aig igia p bad haay imprv w-p yg pai.36

t ma r ha hidr xpd r id wih HIV arrivig h rvi hy d, ri ar bgiig dir hir ai ward dvpig ym rbr w-p, idig h prv mhd a igHIV-pi irmai aaa ad hid hah ard aiia iia w-p; igraig HIV irvi ixiig hid hah rvi ad ad HIV-ram r;

rghig abrary apaiy; ad dvpig wr abrari b mhr ad hidr i ara whrh rvi ar avaiab.

Figure 6. Summary o inant retention throughout the continuum:Cameroon study

0

50

100

150

200

Child alive andaccounted for

Child initiatestreatment

Mother receivesinfants test result

Infants with apositive PCR test result

Infants bornwith HIV (est.)

Numbero

finfants 136

75

5444

Note: There were an estimated 36,000 HIV-positive pregnant women in Cameroon in 2008, but ewer than 4,000 inants were tested.The estimate or Inants born with HIV is unavailable.

Source: Department o Disease Control, Ministry o Health, Cameroon, based on December 2007May 2009 data.



14/56

RapidsMs (hr x magig) r mbi daa iad b sMs prm HIV ig amg hidr HIV-piiv mhr wh h hidr arriv a riiprgramm hwig ympm vr a marii.Zambia i prparig a iiiaiv ig prvidigmprhiv hah rvi ad ar r hidr dr vyar d.

Pbi-priva parrhip hav a b irma iiraig apaiy r imprvd w-p HIV-xpdad id hidr. thy hav b pariary iv idvpig h abrary apaiy ha i ria imprvigig ad diagi hidr xpd HIV (see panel).

To be eective, paediatric care and treatmentinterventions need to become an integral part oinant and child survival and health programmes

HIV-r rviva, h p avrig bh HIV iiad dah, i m iy b ahivd i HIV-rad rvi

ar prvidd a h am ai whr hr hid rvivarvi ar rd.40 Primariy i ri wih high HIVprva, prvidig HIV rvi i mara ad hidhah ii h m mm pa whr wm adyg hidr ar ira h iihd ha HIV-xpd ad id hidr wi riv bh h HIV-radar ad h ri hid-rviva irvi ha aria hir hah.41

Bidig h apaiy hah wrr i ria r aigp HIV prvi, ar ad ram rvi. tprvidd by WHo Igrad Maagm Adad Ad I/Igrad Maagm chidhd I

(IMAI/IMcI) impiy way bid hah wrr iiai idiy ad maag HIV-xpd ad idhidr. th arg hah wrr a h primary vad ppr rvi draizai, amiy-d ar,ad w-p HIV-xpd ad id hidr ad hirmhr vr im. IMAI hav b adapd r imr ha 25 ri.

emrgig aayi idia ha HIV ad AIDs hahiiiaiv i m ri hav had a piiv impa h pa ri hah rvi, h a aaa ar,amiy paig ad bri ram.42 unIceF, iji wih h us Agy r Iraia Dvpmad h uk Dparm r Iraia Dvpm, imbarig a w iiiaiv drmi hw HIV-radprgramm a-p a piivy impa mara ad hidhah m i ri highy ad by HIV.

they are al emplying innvaive

apprache enure ha a greaer

prprin HIV-exped inan receive

crucial llw-up. thee include peer--

peer uppr, uch a ha prvided by

mher2mher, a prgramme iniiaed

in suh Arica. the grup ue an early

inan diagni wheel give mher a

pecifc dae reurn r inan eing.37

oher apprache including healh camp d i Idia hav a idid adrrrd r ram arg mbr hidr ivig wih HIV.38

tw ri wih high HIV prva arig mbi ph hgy imprvrvi. A iiiaiv i Maawi

Public-private partnershipenhances laboratory capacity

labrary rvi ar ia hiiiai ad mirig ram.I 2007, h cr r Dia crad Prvi (hrgh PePFAR)

ad B, Dii ad cmpayahd a v-yar, us$18 miiparrhip imprv abraryym ad rvi i Ariari vry ad by HIV/AIDsad bri.

th parrhip, iiiad i cdIvir, ehipia, kya, Maawi,Mzambiq, sh Aria, ugadaad h uid Rpbi tazaia, iigiay xpadig h mbr hah-ar wrr raid prvid

qaiy HIV ig ad tB diagi. Ii a prvidig rria ad rair ai h PePFAR-prd Ariacr r Igrad labrarytraiig i Jhabrg, sh Aria.I ugada, h parrhip i hpigdvp a pim rrra ym ai i bh HIV ad briar ad ram divry. GbaPiiig sym/Gba Irmaisym hgy i big d map abrary i ha a ivraprai wr r pima b impmd.39



15/56

d mbiai ha adhr WHo rmmdai ixpd b avaiab .

A w dy rm h naia Ii Hah hwha r-i ram rgim aiig virapi, hmdii riy d r vra yar prv mhr--hid ramii, may b iv d HIV drgria i d i ia prviy xpd ig-d

virapi a par PMtct prphyai rgim.43 A hidria virapi ri mprmiig impr r-i rgim, iaig h d-i rgimaiig drg ha ar ir ad may b mr di a p d hir mr mpx rag rqirm.

Ahr r dy ivvig a arg hr Aria hrhwd ha 89 pr hidr ard r-iram wr i rpdig ar hr yar. Fir-iram air i h hr 11 pr wa aiadwih pariary high prram vira ad v, r mrvr dia prgri prir h iiiai ram,ririg h d ar ram a ary a pib.44

Mr wr i dd br drad h impa wm ad hidr hagig PMtct rgim i rm hi rgim, id , drg ad h aiad wih mvig ara ram rgim rhidr. th hag drr h d rdbr imia ramii HIV yg hidr.

A better understanding opaediatric treatment and thechallenges hindering its ullimplementation underscores theneed to eliminate transmissiono HIV to young children

ovr h a vra yar, hr havb m ab adva i mdiir padiari HIV ar. By J 2009,hr wr 56 padiari HIV airrviramdii pr-qaid by WHo adavaiab r prrm, a igiaira vr h 42 mdii avaiabj yar arir.

Pri r-i rgim hav drppdidraby. th r raig ahid wih r-i gri mdiir yar i w y ab us$50,

r us$115us$140 i yrp ar d(ahgh d-i ram ari idraby highr). thi rpra maiv imprvm rm ram ha xdd us$20,000 a yarpr hid j a w yar ag. Fixd-d mbiai ar bmig mrwidy avaiab, ad a hr-drg, xd-

U

NICEF/NYHQ2009-0754/Nesbitt



16/56

Y a hidr hav h righ ia hah ar,idig i-avig HIV rvi. I i impra imprva ar r h m vrab ad diadvaagdhidr, ad iiiaiv i m ri ar aivy ig ampih hi. I h rh-a Brazi, whih i argypr, miipaii hav apd a hag imprva h idiar hidr w-big, idigm rad HIV ad AIDs. A a r, may h

1,130 pariipaig miipaii hav imprvd p hiridiar, wih 259 v imprvig a h idiar.

ReMAInInG cHAllenGes AnDtHe WAY FoRWARD

Wih iraig vrag ad pa PMtct irvi,ag wih h mr ai PMtct rgim, hmbr w ii i hidr a b xpd drprapidy. Argm wi b prd ha d hd braad hr pririi; vrh, rm a hid righprpiv, i i impra rira ha a hidr v

h m margiaizd hav a righ rviva. I h a HIV, i i h m margiaizd wh ar m iy rmai a ri HIV ii, v wh padiari iiar i di.

Yg pp ivig wih HIV hav pariar hagrad ram ad adhr, ad i i impra addr ar x bhavir a h yg ppgrapp wih hir mrgig xaiy. Hah-ar divryr ad i bad padiari ad ad-armd wih ig ay i ihr. cri wi bhagd dvp apprpria way arig r HIV-piiv yg ad; hi wi ivv ig h

yg pp r ha h rp prvidd mhir d.

Fiay, a br dradig h ba aiadwih aig p padiari HIV ar ad divry i w- admidd-im ig i ary rah ivra aga. Whi gvrm ad hr parr hav mmid maig drg ad mmdii mr widy avaiab,hr ba pariary h rad hah ym rmai. Ii abrary apaiy, hrag raidhah-ar wrr, ad wa irarr hampr hdivry a hah ar, idig HIV rvi. t r

highr qaiy hah-ar divry ad aiad rdii mrbidiy ad mraiy, h ymi i d b addrd.

There is much optimism thatequity in access to HIV care andtreatment is within our grasp

chidr vra a HIV ar ad

ram ha imprvd dramaiay ih pa v yar, rm a im whhidr xpd r id wih HIVbary rgird h iraia arad ram agda day, wh hprpri hidr i d ramwh aay riv i i igiay mraigd wih ha ad. Dpi himpriv gai r hidr a a grp,prgr ha away b qiabydiribd wihi r ar ri.

A ARt i wr amg ygr

hidr ivig wih HIV ad hidrivig i rra ara ha amg hidrivig i ii.45 Wa irarr adraprai ym, ad grayhighr v pvry, hav ihibidahivig qiy i h iai.

U

NICEF/NYHQ2005-0871

/Noorani



17/56


thr ha b igia imprvm i mprhivad rr wdg ab HIV ad hw avidramii. th v mprhiv wdg amgma agd 1524 ha irad by 10 prag pi rmr i 17 45 ri wih rvy-bad rd daa(19992008); h wdg ha irad i yg m i7 12 ri wih imiar rd daa (Figure 7 and 8).I vra ri, hr hav b di 5 r mrprag pi i h riy bhavir a h iiiai x br ag 15 h 1519 yar d (i 7 rir ma ad 7 r ma), x wih mip parr (i2 ri r ma ad 11 r ma) ad x wihdm (i 13 ri r ma ad 13 r ma).46

Dpi h piiv rd, may yg pp i b id wih HIV. I 2007, a imad 45 pr aw HIV a i pp agd 15 ad dr wr d amgyg pp agd 1524.47

ovra, i i imad ha i 2008, a a 4.9 mii ygpp agd 1524 wr ivig wih HIV i w- ad midd-im ri. I a b w rgi, hr wr a mryg wm ha yg m ivig wih HIV (Table 1). Giri b-sahara Aria ar diprpriay vrab HIV ii, pariary i h hypr-dmi ri ihr Aria, whr prva i grar ha 15 pr .

A clear understanding o adolescentsexual relations is necessary to shape andfne-tune prevention interventions

Aayi rvy daa HIV prva i igh rihw ha yg wm 1524 yar d wh had hirxa db wh hy wr ygr ha 15 yar dar mr iy b HIV-piiv; h daa wr rdr hr bhavira ad i-dmgraphi ar.48 Im h ri, HIV prva ra ar a high

The basis or eective prevention

actions is a better understandingo local circumstances around

the epidemic.

IV. PReVentInG

InFectIon

AMonG

ADolescentsAnD YounG

PeoPle

Table 1. Young people aged 1524 living with HIV, 2008

Region Female Male Total

Eastern and Southern Arica 2,000,000 850,000 2,900,000

West and Central Arica 770,000 320,000 1,100,000

South Asia 120,000 130,000 250,000

Latin America and the Caribbean 130,000 170,000 300,000

East Asia and the Pacic 120,000 93,000 210,000

CEE/CIS 41,000 29,000 70,000

Middle East and North Arica 45,000 44,000 89,000

Total 3,230,000 1,640,000 4,900,000

Note: The estimates are provided in rounded numbers but unrounded numbers were used in the calculations, thus there may bediscrepancies between the totals.

Source: Unpublished estimates rom Joint United Nations Programme on HIV/AIDS and World Health Organization, 2009 AIDSEpidemic Update, UNAIDS and WHO, Geneva (orthcoming).



18/56

amg wm wh r had irrbw 1518 yar ag.49 thidrr h impra wigh ag xa db r hamprhiv prvi prgrammrah ad brhad.

I rvy i r ri, ary i

r yg wm rprd ha hir rxa irr wa rd.50 thr i agra da vid ha gdr-badvi pariary rap, rd x,xa vi, ad xa ri adxpiai i a ri ri ar rHIV.51 thi highigh h d prmia hag ha a rm viagai gir bm iay apab,ad a ad r aw maig hmpihab a rim. I ai qiigad hagig h ia rm hapri i mmii ad gagig byad m, ad par ad amii, igdr-rarmaiv r.

A aayi Dmgraphi ad Hahsrvy (DHs) ad Mip Idiar crsrvy (MIcs) daa rm 36 riidia ha wr ha i rwm agd 1524 rprd dm a hir a irr drig h12 mh prir h rvy.52 Amghi ppai, dm a a xairr wih a highr-ri parr i w

(32 pr ) ad v wr wih a -highr-ri parr (6 pr ), ahghag ra vary by ry.53

Amg yg wm wh hav hadxa irr, wr ha ha ayhy d g a dm by hmv.thr i a d addr h piyi ad ra ad rigi arad iivii rrdig dmad yg pp. A h am im, abarrir dm avaiabiiy ad bybh yg m ad wm d b

rmvd, whi iig dai h b dm i rdig ri HIV. srg adrhip by gvrmi ia maig hi happ.

Figure 7. Percentage o young women aged 1524 with comprehensivecorrect knowledge o HIV, in countries where such knowledge hasincreased by 10 percentage points or more (20002008)

0% 10% 20% 30% 40% 50% 60% 70%

Jordan

Central African Republic

Armenia

Uzbekistan

Cameroon

Haiti

Gambia

Dominican Republic

Suriname

Republic of Moldova

Sao Tome and Principe

Viet Nam

Cambodia

Guyana

Rwanda

Trinidad and Tobago

Namibia

6531

5433

5123

5036

5037

4425

4411

4219

4127

4118

3915

3415

3216

313

237

175

133

20052008

20002003

Note: Data years are as ollows: Dominican Republic (19992007); Armenia, Cambodia, Rwanda and Uzbekistan (20002005); Haiti(20002005/06); Cameroon, Central Arican Republic, Gambia, Guyana, Sao Tome and Principe, Suriname, Trinidad and Tobago andViet Nam (20002006); Namibia (20002006/07); Republic o Moldova (20002008); Jordan (20022007). The data or the Republico Moldova did not include one component o the indicator. The data or Jordan dier rom the standard denition. For all countriesreporting on this indicator, see Figures 13 and 14.

Source: DHS, MICS and Moldova National Representative Survey on Youth Knowledge, Attitudes and Practices regarding HIV/AIDS,19992008.

Figure 8. Percentage o young men aged 1524 with comprehensivecorrect knowledge o HIV, in countries where such knowledge hasincreased by 10 percentage points or more (20002008)

0% 10% 20% 30% 40% 50% 60% 70%

Indonesia

Benin

India

Haiti

United Republic

of Tanzania

Rwanda

Namibia41

62

54

42

40

36

35

15

20

29

28

17

14

0

20002003

20052008

Note: Data years are as ollows: United R epublic o Tanzania (19992007/08); Rwanda (20002005); Haiti (20002005/06); Namibia(20002006/07); India (20012005/06); Benin (20012006); Indonesia (2002/032007). The data or Indonesia di er rom the standarddenition. For all countries reporting on t his indicator, see Figures 13 and 14.

Source: Behavioural Surveillance Survey (BSS), DHS, National Family Survey (India) and Reproductive Health Surveys (RHS), 19992008.



19/56

gap bw wdg HIV ri ad aa bhavirhag, hwvr, pary d h ravig r a payi ra mr ad xa hi.

Fr xamp, prvi irvi ria i h uidRpbi tazaia ad Zimbabw d dvpigi ad hagig aid amg yg pp. Bhirvi hwd impra prgr i iraig ad

aiig yg pp wdg, wih m if rprd xa bhavir i h uid Rpbi tazaia.th ria, hwvr, did dmra rdi i w HIVr hr xay ramid ii.54

Aayi DHs ad MIcs daa d ha yg ppagd 1524 wh iv i mmii whr pp hi hahidr 1214 yar d hd b agh ab dm armr iy hav d hm (Figures 9 and 10). thi aayirir h impra r mmii i ifigbhavira hi ab dm amg yg pp.th rvy daa a d ha yg pp ar iy hav d dm i mmii ha my agr ha

pp wih AIDs hd b bamd r brigig h diai h mmiy.

sm irvi hav dd i hagig bhavir.R vid sh Aria hwd ha a drai HIV prva amg yh agd 1524 (rm 10.3 pr i 2005 8.6 pr i 2008) wa iy aribab aigia ira i dm ad h wid rah HIVmmiai prgramm amg hi ag grp.55

ohr bhavir rad HIV, h a ig a HIV ,a a hag mardy. o xpri i ugada i 2008d a sMs qiz prmp mbi ph bribr 1745

yar d g r vary HIV ig ad ig ah a hah r. A a iiv, pariipa wrrd r airim, whih d b radd i rry. thr wa a 40 pr ira i i wh am i rig rm 1,000 1,400 drig ix-w prid.56 I i , hwvr, whhr hi w xpri a baid ad whhr i wi rib bhavir hag,r xamp, i dm , abi ad parr rdi.

sdi rm sh Aria highigh h b amiad apprah h da pidmi gdr-badvi ad HIV.57th vid ha hw ha miprgdirvi daig wih bh gdr-bad vi ad

HIV ri, a w a im grai, a y rdbh vi ad HIV ri.58

Countries are using better knowledgeabout the vulnerability o girls to inormpolicymaking and programmes

kwdg h diprpria ii yg wmi hr Aria ha dpd drig h a yar. Y,

The crux o a comprehensiveapproach to HIV preventionamong young people is behaviourchange, without which progresswill be unsustainable

exiv wr vr h r mayyar ha imprvd yg ppwdg HIV ad hr xari, ad h vid hw hamprhiv ad rr wdg hairad i may ig. thr i a ar

Figure 9. Percentage o women aged 1524who used and did not use a condom, by attitudetowards HIV inection in their communities(20012007)

0%

10%

20%

30%

40%

50%

60%

70%

80%

People with AIDSshould be blamed

for bringing the diseaseinto the community

People with AIDSshould be

ashamed ofthemselves

Children shouldbe taught

about condoms

71

59

29

43

35

50

Used condoms

Did not use condoms

Source: Preliminary analysis o DHS and MICS data (20012007) by UNICEF and ICFMacro, 2009.

Figure 10. Percentage o men aged 1524 who usedand did not use a condom, by attitude towards HIVinection in their communities (20012007)

0%

10%

20%

30%

40%

50%

60%

70%

80%

People with AIDSshould be blamed

for bringing the diseaseinto the community

People with AIDSshould be

ashamed ofthemselves

Children shouldbe taught

about condoms

7975

31

40

33

43

Used condoms

Did not use condoms

Source: Preliminary analysis o DHS and MICS data (20012007) by UNICEF and ICFMacro, 2009.



20/56

pariary r yg wm. Pd DHs daa rva hayg wm i adig primary, dary r highrdai hav mh wr ra HIV ha gir wh havdrppd h.60 R di rm vra ridrib vari ar ha ad h drp.61thvra daa gg ha HIV prvi prgrammig d pay r ai h ada par ada drp, wih a pi pig gir i

primary ad dary h.

Whi h ada i ad i i a rg privar agai HIV, iv h-bad irvia hp rai HIV-rad wdg, aid ad i,ribig vra bhavir hag irvi. shirvi a a rpd h addiia d hidr id ad ad by HIV ad AIDs. th wra bjiv ar id i a w pbiai by hunAIDs Ir-agy ta tam (IAtt) edai idA Strategic Approach: HIV & AIDS and Education.

A majr barrir iv HIV prvi i h i

h a vid-irmd aia ramwr wihpi appiai a h a v. th Bwaa Miiry edai ad si Dvpm ha ad hi bydvpig a naia li si Framwr i 2009 ha h drivr HIV i h ry ad rad ri-rdi i r ad. Bad h ramwr,rvii rria ad aia d xamiai idr way.

I lai Amria ad h caribba, a rgia adirra exiv sraria rdiad by hMiiri Hah ad Pbi edai Mxi imvig h mmim i h Miiria Darai

Prvi hrgh edai igd i 2008. th riar abihig a hard vid-bad ramwr rmprhiv xaiy dai m h d ad ad yg pp. Mxi ha rgaizd airra mmi i hr rgi hah, xdai ad HIV ad raiig r rair xa adrprdiv hah. I 2008 h Miiry edai niaraga, wih unIceF ppr, irdd HIV daii h rria primary ad dary h ad iahr raiig g i ix ara h ry.

Interventions that engage young men and

boys are necessary to reduce HIV incidenceamong both males and emales

er prm ivvm by ad m i HIVprvi ad i gdr qaiy hav gaid raii r yar. I 2009, a Gba sympim egagigM ad By i Gdr eqaiy pa i Ri d Jair,hd by a aia -gvrma rgaizai,idig Prmd (Brazi), Ii Papai (Brazi), Whi

avrag, ha 30 pr h giragd 1517 i m ri earad shr Aria wr xay aiv.o r aayi HIV-prva daadiaggrgad by ag ad x d haHIV prva ra amg gir agd1517 wr w raiv ra amgwm agd 2324 i a mbr high-

prva ad hypr-pidmi rii ear ad shr Aria (kya,Maawi, swaziad ad Zimbabw) ad icamr i cra Aria.59

I rp h dig, h Miiry edai, si ad thgy iMaawi ha mbard a iiiaiv wihun parr unIceF, h uid naiPpai Fd (unFPA), unAIDs adh uid nai edaia, siiad cra orgaizai (unesco) adivi iy rgaizai, h Miiry

Wm ad chid Dvpm, hMiiry Yh Dvpm ad sprad yg pp. cad sir sir,h iiiaiv mpwrig giragd 1517. I idi dr ir aa rdib r rprdiv hahirmai ad giv hm a paag irvi ad li si edaiPlus wih ygr gir. sia-hag mmiai addr hygr gir amii i rdr ra amr priv virm r hm. thsir sir md i big xprdi namibia ad h uid Rpbi tazaia, ad i h bai praiararh rry dr way i Bwaa.

I m ri W ad craAria, HIV prva amg adgir rag rm 2 5 im grar haha yg m. I h DmraiRpbi h cg, a igradapprah HIV prvi, a w a hw-big, pri ad mpwrm ad gir wih a

ygr ad gir i pprdby unIceF ad parr i mprvi. th r ha hw prmiby mbiig dai, ri rdi,pri rm vi ad a ivihd pprii.

edai aaim ad hada amg yg pp 1524yar d i highy rrad wih HIV ri,



21/56

The AIDS epidemic will not be halted untilprevention services reach at-risk and marginalizedgroups as a priority, without discrimination

A hma righ-bad apprah prvi ivv

ad ad yg pp, idig h wh ar ma ri ad pariary vrab ii. Y h iad aayi diaggrgad daa by ag, x ad hrhararii ary drad wha i happigwih h ppai ar i iy arrid .

thr ar m xpi. A gig v-ry prji cra ad ear erp, dd i parrhipwih h ld sh Hygi & trpia Mdiiad unIceF, ha bg prvidig daid vid ad ri-aig bhavir ad a harm-rdi rvi; i r ar bgiig if piyad prai i h rgi. Fidig hw ha ad

wh ar m a ri ar a pririy i pa whr HIVprva i w. Ra id imid rr, piiaraiy ad w apaiy.64

Rpraiv rm Bivia, Brazi, cmbia adPr vd i lima i spmbr 2008 marmmdai r rpdig h vrabiiy HIV yg pp ivig ad wrig h r. IAghaia, a whr, xa xpiai ad ab highy vrab ad ma, a w a ama--ma x, xi a igia v b ar argyrgizd.65 sahdr hav raid addr h

i. I Ira, a am ad-ridy rviigrad wihi h rgar hah wr ha hw hd rmd h rvi mr vrabyg pp ad h m a ri r HIV.

chidr ad yg pp ar a pariary vrabdrig mrgi. Fwig w Ir-Agy sadigcmmi (IAsc) Gidi HIV i Hmaiaria sig, wr abihd r mairamig HIV i dai imrgy ig.

Ribb campaig caada, h MegagAia, sav h chidr swd adh uid nai Ppai Fd.th ympim dvpd a a ai ard gagig m ad by irdig vi agai wm ad gir,prmig xa ad rprdiv hah,ad prvig ramii HIV. M

ad by ar a h prvir d rhmig majrprig v (see panel at right).

I addii, ma irmii d b par h vra prvipaag r yg m; pa, hwvr,i b ihibid by hagad rai ad by h 13 earad shr Aria pririy riwhr HIV prva ra ar high adirmii v ar w.62 I kya,hgh, hr ar ragig igha a-p may b ar . Invmbr 2008, a mprhiv pa irmi m wa ahd i hwr prvi nyaza, wih mrha 20,000 m irmid i hr ix mh. Piia mmimwa y, a wa h drmiai adivvm yg pp wh phdr h irvi. I Marh 2009, hMiiry Hah i Bwaa aiiada aiv wrhp r yh mairmii, whr h yg pariipa

hpd rma a a irmiimmiai ragy.

thr i grwig dii iairmii, whih i riy ha ha ad r ad. I pima igwih w raid hah-ar prad adqa qipm, h prdri raivy qi ad a, wih wrmpiai ra ha amg ad.63th impa ia irmii HIVprva, hwvr, wi y b i15 20 yar, wh h ia bm

xay aiv yg m.

Using sports to reach men and boyswith prevention messages

th Aria cp nai, b hd i Aga iJaary 2010, i a vhi r prvi magig haaim miva m i h rgi arm hir ri rpib xa bhavir. I ahr xamp,

drig h FIFA Wrd cp ad r JJy 2010 ish Aria, h aia Brhr r li ampaig wihwa m wh hav hahy xa bhavir a rmd r hr m, ad wi ar ba payr adbrii i h mmiai par h ampaig.



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ri amg gir 1517 yar d i Bwaa ad hr hypr-dmi ri, ad harm rdi amg yg mijig drg i urai ad hr ri wih radpidmi. Impmai yh-rid irviaird a ig, hwvr, i i h xpi.

opraia rarh d g had i had wih aigp prvi irvi ad rvi. li bw

prvi ad ram d b rghd; rxamp, vary ig ad ig may prvid hary i rah ad pr dai rvi, r rma irmii. Pariar ai i a dd rampwrig virm ha prm yg ppara -am ri ad hir mivai rdri bhavir.

thr ar w may yg pp ivig wih HIV wh armaig dii ab x. spprig hm ma wrig igra rvi r HIV-piiv yg pp hrgh h ad xa ad rprdiv hah irvi a gig hag. emrgig prpiv ha payg pp ivig wih HIV a h r prvi r,hrgh a igrad prmig piiv hah,digiy ad prvi, d b xpadd.

Prvi r r yg pp m b a ia par aia prvi ragi ad hy m b dd.la drivr h pidmi (xa par, gdr dyamiad vi) amg yg ma ad ma m bbr rfd i mbiai prvi prgramm. Ri-rdi ragi m b appid wihi a bradr ph addr h ia rm ha gdr ri.

WHo i adig a gba hi i hiig ha a grarribi ram prvi m. omahmaia md gg ha i a vr pidmi ha i hr Aria, wr i pib r varyHIV ig a aa bai r a wd by immdiaARt r h id, HIV iid d b rdd by95 pr wihi a dad ad prva d b rdd bw 1 pr i 50 yar.thr wd b avigmpard wih rr ram ari ar ab25 yar.68

Fiay, yg pp ar impra parr i digi h prbm ha r hm. Yg pp

pariipai y bid wrhip prgramm, bapaiy a w. th pariipai yg pp, ad hirby-i, i ria r imprvd prvi m.

From a child rights perspective,the lives and health o adolescentsand young people living withHIV and AIDS cannot be neglected

th mbr yg pp ivig wihHIV ad AIDs wh wr id priaay

ad wh rviv adhd i hri, a h i-prgig ARtimprv wih br rgim ad grara ram. D irada ig, mr yg pp ww hy ar ivig wih HIV; y m hir amii ad mmii ar i-prpard ppr hm. WHo i rrympig a md ad ivigwih HIV irpra i IMAI raiig.

Rarh dd a a mbr HIVar ad ppr r i ugada

rvad ha y ab hird 1519 yar d had vr ad hirpar r gardia ab hir xa adrprdiv hah d.66 thi d hdig pi irvi r parraiig ad wh wr id wihHIV priaay, ad a rwd h yg pp prvi d.

I Haii, yg gir ad by agd1319 wh ar id wih HIV r ahigh ri bmig id rivqaiy piaizd ar, prvi ad

ram i a yh-ridy ii. Ih ii r yar, h adadhr ram irad rm12 pr 70 pr .67 I Rwada,ivaiv apprah dir adpyhia ppr ar big ad p;yg pp ampaid by par adgardia ar irmd hir a igrp ad ar ragd pariipa iw-p ppr i.

ReMAInInG cHAllenGes

AnD tHe WAY FoRWARD

Gai ar big mad i h i ad ag- ad x-diaggrgad daa idiy yg pp wh ar m iy bm id wih HIV ad digprvi prgramm wih hm haaddr a x. sh prgrammid irvi ig xa



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thr i grwig iraia ppr r ia priapprah ha ar bh hid-iiv ad AIDs-iiv. I obr 2008, i Dbi, h Gba ParrFrm r chidr Ad by HIV ad AIDs rd ia prdd h ar ha advryif hid w-big wihi h x HIV adAIDs. I addii, r high-v rarh ha had hdradig hidhd vrabiiy ad dmd hm apprpria rp r hidr ad by HIV adAIDs.69 chid-iiv ad AIDs-iiv ia prihav b hw hav piiv impa h w-big h hidr.

saig p ppr r hidr ad by AIDs rmai arg pririy. th unGAss ad Unite or Children, Uniteagainst AIDSarg r h prpri hhd wihrpha ad vrab hidr (oVc) rivig r, baixra ppr i 80 pr . Y i wa rprd i Children

and AIDS: Third Stocktaking Reportha vry w hhdarig r h hidr wr rivig bai xra ppr:a mdia 12 pr .

Vrabiiy aay h a w yar hav hw harphahd a vrabiiy, b i a a. thrar may ar ha a if vrabiiy, idighhd wah ad h dai v ad. Immii whr HIV ad AIDs ir wih xrmpvry, fi ad high rai dpd i a hhd,hpig a vrab hidr i a -iv ad -igmaizig ragy.

MAIn Issues

Child-sensitive social protection is a keyintervention to reaching children aected by AIDS

Pvry i a y ar gaivy aig hidr w-big. I ira h impa AIDs hidr by rdighhd abiiy p wih addiia r. thrr mi rii, i prgd, i iy wr hm r ar dra miiga i impa.

AIDs pa a irad mi brd hhd

dig pay r drg ad ra, pig pariarprr wm ad gir arig r AIDs pai.chidr may hav drp h. I mmiiad by pvry ad AIDs, h h pidmiar mpdd by a waig apaiy amii admmii ar r ad ppr hidr.

Strengthening social protection

in times o economic hardship isnecessary to support amilies and

communities in caring or children

aected by AIDS.

V. PRotectIon,

cARe AnD

suPPoRt FoR

cHIlDRenAFFecteD BY HIV

AnD AIDs



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dm dd a rvi r b ab ard h high iida aiad wih igad baiig hm. A par a brad paag iapri, amiy aia ad hid war rvi ar ha AIDs-ad hidr ar idid ad pprdi aig hah, dai ad hr ia rvi.

A grwig mbr ia pri prgramm ararady divrig a a hidr ad by HIV adAIDs, hrgh gvrm-d iiiaiv. Ghaalivihd empwrm Agai Pvry (leAP) prgrammard i 20062007 a a pi ah gra r gardiaad argivr rphad hidr; i ha b xpaddad i w par h aia Pvry Rdi sragy.

leAP rqir ripi hhd mpy wih raidii: pig hidr i h, rgirig wih hnaia Hah Ira shm, brigig babi i rrgar h-p ad pig hir immizai p da,ad bjig hidr h wr rm hid abr.li may hr ah rar prgramm prvidd hrghhhd, leAP b y argivr oVc b adry wm ad yg gir wh ar diprpriayad by h brd arig r h hriay i.

I Maawi, h naia Ai Pa r orpha adVrab chidr (20042009) i prgrammad id gida r h abihm maig

ia pri irvi, ad h Maawi Grwh adDvpm sragy ha ia pri a a y hm.th ar id h dig, impmai ad vaai a ia ah-rar hm id h adhidar r ha rd pvry ad hgr ira-pr hhd. th pi hm i big admiirdi v diri. A Apri 2009, i had rahd mr ha23,000 hhd ad 92,000 idivida biari

th obr 2008 mmiq id byh Gba Parr Frm ad agrd by arag dvpm parr highighia pri a h yai ara ppr r hidrad by HIV ad AIDs. I a rparr ppr h dvpm adimpmai mprhiv aia

ia pri prgramm.70 thirmmdai i grdd i a grwigba vid hwig h piivimpa ia pri r hidr adhhd i AIDs-ad mmii.

Brady, hid-iiv ia primpa ia rar (idigah ad i-id rar ad vhr),ia ira, ia rvi (idigia war rvi h a gappr, ia wr ad araiv-ar rvi), ad ia pii adgiai digd b hidr,idig h ad by HIV ad AIDs.thi hii apprah a ira hiv ivm i hah,dai ad war ad aiai, apar a ia paag rvi ramii, ad i a rah hidr idh amiy virm. chid-iivia pri ivva ad -a ar; i may rr-imidri, ivi iy rgaizai idig aih-bad rgaizai hav

a y r pay i divrig y rvi.

A papr by h Ji larig Iiiaiv chidr ad HIV/AIDs gg ha ahrar pr amii ad by AIDshav h pia imprv rii,hrby wig h prgri AIDsad imprvig h iv ARt.th papr a dm h impa ah rar i sh Aria hidrii, hwig ha h hid pprgra rd i irad hid high,piay i a whr i wa rivd

wh hidr wr ygr.71

th m vrab hhd,idig h ad by AIDs, abarrir i aig ia rvir a mbr ra. srvi mayb pry argd r imid i vrag,ad amii may a h ivi rgirai

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Piy Framwr r Aria ha rmmd aig pia pri, idig im rar, miigah mi ad ia impa h AIDs pidmi hidr ad hr vrab grp. sADc ry aizdi sragi Framwr orpha, Vrab chidr adYh, whih prvid a ramwr r h dvpm a miimm paag ia pri rvi, idigpyhia ppr rvi, ha a b a a.

Investment in social systems is needed to scale upsupport or vulnerable children aected by AIDS

J a PMtct ad padiari ram rqir rgr admr igrad hah ym, ia war ym d b rghd rah mr hidr ad by AIDswih ar, pri ad ppr. saig p a mprhivia pri paag ha i hid-iiv ad AIDs-iiv ai a baia rp rm agirpib r hid pri, a r ay maagdby ia war miiri. Mmm i ia pri,

pariary ard ah rar, ha paradxiay hd igh h imid apaiy ia war iii divraia hidr ad amii ad ha prvidd a riappriy imprv h ym.

A h gba v, unIceF i adig r prm apa dradig a ym apprah hidpri ad dvp adardizd map aiahid-pri ym. A h aia v, a mbr ri highy ad by AIDs ar arady idiyig m h wa pi hir ia war iiiad ar wrig vrm hm.

I namibia, h Miiry Gdr eqaiy ad chid Warrdia h naia Pa Ai r oVc (20062010).A y arg h pa i ha 50 pr a rgirdoVc riv m rm xra ppr (mi, hm-bad ar, pyhia ad daia) by 2010. siawar gra irad igiay i 20072008, b haddiia brd pad ia wrr admiirigh gra prmpd h Dirra chid War, whiha dr h Miiry, arry a hma rr adapaiy gap aayi i 2008. thi aayi prmpd aapprva by h Pbi srvi cmmii ad h PrimMiir ira h mbr ia wrr by 125pr .74

Maawi ha dra a aayi hma rrapaiy wihi h Miiry Wm ad chidDvpm ad dvpd a pa ai r hi Miiry,whih i w gagig i rgaizaia rfi adym imprvm.

whm, mr ha 48,000 wr oVc. I haahivd baia r i rm hah, dai, a amai adhid pri i biary hhd.72

I chia, vid ha AIDs-adamii wr ivig ha ha ha im ad hhd wad adva r h ry FrFr, o car AIDs piy ad d hirdi ma gra, vaiaad aima hbadry raiig, ad hraia wm ivig wih HIV. Frm2006 2008, pr apia aa im HIV-ad amii i a dmraiy irad by 38 pr , mpardwih y a 20 pr ira i ar grp.73

th Aria ui (Au) ad h shrAria Dvpm cmmiy (sADc)hav iraigy hw hir mmim vrab ad AIDs-ad hidr.I obr 2008, Au miir i harg ia dvpm adpd a sia

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NICEF/NYHQ2006-2860/Pudlowski



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wa.80 chid pam dpd ia wrr, whim i imid, ad iig jdiiary ym.sadard ai a apaiy r vrigh, ipi admirig ha may xi. Wa impmai i ar ii a apaiy ad a a rr.

May ri ar rghig piy ad giai irdr hp hidr ay i amii ad prvid amiy-

bad araiv ar hidr id amii. thchidr A i sh Aria ha b amdd imprvia-rvi ym r hidr, whi imiar haghav b mad h a dra h chid car adPri Bi i namibia. A par h car Rrm Iiiaiv(20062011), Ghaa pdad i Rgai ad sadardr h oprai Ridia car sig, wih h ga maig iiia ar a a-rr pi ad righa h rphaag ha d xi hav adqa rr rmai rdib --hm ar pi.

I Maayia, w gidi prvid a ramwr ar adpri r hidr idig h ad by HIV adAIDs i ar hm r by -gvrma rgaizai.I Gyaa, ppr rm HIV/AIDs dig abd hMiiry labr, Hma srvi ad sia sriy ah h Miimm opraia sadard ad Rgair chidr Hm i 2008.

th Br car nwr aiia irmai xhag adabrai amg h grwig mbr rgaizai,aih-bad grp, gvrm ad idivida rdab hidr wih adqa amiy ar. Wihi hwr, h Faih Ai Iiiaiv prvid irmaiad rr us chriia hrh ad aih-bad

Weak social welare sectorscontribute to poor managemento alternative care orchildren aected by AIDS

Famii ad mmii ar bpad pr h w-big hidr

wh hav r bh par AIDs. I b-sahara Aria, irmahid rig (ihip ar) wihi amiywr i widprad. I Zimbabw, rxamp, m hidr wh hav r bh par ar ivig wih a rvivigpar, a gradpar r hr raiv.75

I kya, ah rar hav abdvrab hidr ay wih hargivr hy w ad v, ad havprvd may hidr i xrmypr hhd rm dig p h

r r i rphaag. th aiacah trar Prgramm r orphaad Vrab chidr, whih vrd12,500 hhd a h d 2007, waad rah 70,000 hhd by hd 2009, a dvpm ha brgha mmra ira i kyaGvrm ribi. th Wrd Baha apprvd us$50 mii rhra p h prgramm, wh ga i rah 100,000 hhd by 2012.76

eima p h mbr hidr

ivig i iiia ig gbaya mr ha 2 mii,77 ad a unIceFrviw dd i 20072008 dha, i vra ri, h mbr iii hig hidr i riig.78 Bv i ri highy ad by AIDs,h vrwhmig majriy hidr iiiia ar hav a rvivig parr hr raiv,79 ad i i aypvry, rahr ha a amiia ppr,ha h dmad r rphaag. thigg ha mr ivm i dd prvid mi ppr AIDs-ad hhd mba h arha driv hidr i iiia ar.

May ri adva r amiy ar,wih ridia ar a a a rr. smri i ear ad shr Ariahav adard r ridia ar. B hunIceF rviw a d ha adardad rgai i hi rgi ar gray

Figure 11. Percentage o children under 18 years old by livingarrangements, in countries with HIV prevalence o 5 per cent or more,20042008

0% 20% 40% 60% 80% 100%

Swaziland

Namibia

Zimbabwe

Lesotho

Uganda

Mozambique

Zambia

Cameroon

Malawi

United Republicof Tanzania

60 19 5 17

20 2 18

18 5 17

19

24

20

24

27

33

38

Living with both parents (%)

Living with mother only (%)

Living with father only (%)

Not living with either parent (%)4

3

6

4

4

5

6

19

15

20

26

29

36

34

59

59

58

58

55

47

40

26

22

Note: Respective data years: Mozambique, 2008; United Republic o Tanzania, 20072008; Zambia, 2007; Namibia and Swaziland,20062007; Cameroon, Malawi and Uganda, 2006; Zimbabwe, 20052006; Lesotho, 2004. Country totals may not add up to 100 per centbecause o rounding.

Source: DHS and MICS, 20042008.



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ReMAInInG cHAllenGes AnD

tHe WAY FoRWARDMay hag aig p ar, pri ad pprr hidr ad by AIDs rmai. cmbiig h variap a ia pri paag rqir ririgh apaiy iii divr ia rvi.erig ha h m vrab hhd i AIDs-admmii a ah rar ad hr hid rvirqir hma rr apaiy i h ia war r,ihr i gvrm r i ivi iy rgaizai. capaiyi pariary dd wihi mmii addr barrir h impmai ia pri hm, idigidiai, argig, divry rar, ad AIDs-rad

igma ad dirimiai, whhr ra r privd.

thr i a d vaa ad har hw impm ad a p pri, pariary i rr-pr b highy AIDs-ad x. lgidia mi-ry di ha idiy ad addr impmaihag rad argig, iiia divry pi,ardabiiy ad aiabiiy ar i rqird.

rgaizai ig addr h d oVc i b-sahara Aria. I advappr r amiy ad mmiy-badapprah, a ppd bidigrphaag a a r rp.

Community- and aith-basedorganizations have an importantrole in delivering, coordinating andmonitoring services or childrenin communities aected by AIDS

th prirai a iiiaiv rhidr ad by HIV ad AIDs ir yar i a xamp h abiiy mmiy- ad aih-bad rgaizai qiy mbiiz ard imprammiy r. I a ix-ry dy ary 700 aih-bad rgaizaipprig hidr, ha had b

abihd i h prdig r yar.81

nw hag, hwvr, hav ari.Mh hid-iiv ia pri iprvidd hrgh -gvrma admmiy-bad rgaizai, whih a dii divrig a a adrig rrra hr gvrm rpriva prvidr. th a r d rm par a aia ragy,pa r mirig ym ad g argyrgizd, rig i imid a rr r hhd i d. I iary i h mmiy-badr bradr aia ramwrad abih ragi parrhipbw gvrm ad mmiy-bad rgaizai ha irvia b rdiad bad mparaivadvaag ad rpibiii.

sm ri bidig ragiparrhip ar baiig rr ad rahig iraig mbr vrab hidr. er h a h

chrh Aia r orpha i namibiaad h Bddhi ladrhip Iiiaiv iVi nam hav b w dmd.ugada ha a mad gra ridmbiizig mmiy- ad aih-badrgaizai wr wih gvrmary agi a h b-yv a par a iig hidpri ym.

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Mirig ad vaai (M&e) i ria r raigprgr ward HIV ad AIDs mmim ad ga. Ah gba v, gra rid hav b mad i h pa yarward rghig M&e apaiy i a r pririy ara h Unite or Children, Unite against AIDSampaig.

unAIDs, hrgh h HIV/AIDs Mirig ad evaaiRr Grp, ha rdiad h dvpm 40 rmirig idiar r a aia v. thy i h 25 idiar r mirig arg a h 2001unGAss, p 15 addiia rmmdd idiar.82

unIceF pbih Children and AIDS: Country Fact Sheetsaay a a mpai h Stocktaking Reports. thdaa prd i h a h ar r mirigprgr h r P ad hw ri ad parr arig unGAss ad hr gba mmim.

MAIn Issuesth impmai h hird h thr o aia M&e ramwr i a rmd hag ary v ba h may ar ivvd, wihmirig rqirm mim igrad i haia M&e ym. evid hw M&e ym addaa ar ifig dii-maig ard h r P ary v i imid.

Frhrmr, dvpm aia ri prgramm-mirig ym, pariary h rad oVc adyg pp, rmai wa, a d dvpm i

bw aiiy-bad ad mmiy-bad M&e aivii.

thr ar hia dii i imaig ppai iz irm prgramm paig ad impmai ad ai iraig prgr i vrag dir irvi. Daaha ar diaggrgad by ag, x ad hr harariiar imid, mpiaig r ra qiab a rvi ad pa.

Fiay, h e i M&e d mr ai. thr i a darh vaai irmai ha a b d a himpa HIV ad AIDs irvi dird mr wm ad hidr. I i ary pririiz rarh impa vaai, a h HIV prgrammad d praia rarh idiy impmai ragi.

Monitoring and evaluating

programmes on HIV and AIDSis critical to providing evidence

or what works and where to

make improvements.

VI. PRoGRAMMe

MonItoRInG

AnD

eVAluAtIon



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rprig rm a a way harmiz daa i admiimiz h rprig brd ri.

th a rpr Towards Universal Access: Scaling up priorityHIV/AIDS interventions in the health sector, id i spmbr2009 by WHo, unAIDs ad unIceF, i bad ryrprig daa ha ma h ji . th pbiaipr h m mprhiv daa avaiab h

hah r r w- ad midd-im ri irp HIV ad AIDs, ad i idd hp p ra hw aia mmim rgardig irad vrag adpa ar big raad i aia ai.

I 2009, WHo, h us Gvrm, unIceF ad parrdvpd rm r mirig HIV i pai ha igraHIV ar ad ARt, mara ad hid hah ad PMtct, adbri ad HIV, hrby prvidig a miimm adard HIV daa. th rm a b adapd by ri xiig pai ard, rgir ad mmary rprig rm.

unIceF, WHo ad unAIDs, i abrai wih Vadrbiuivriy, a hd a xpr ai, whihmad ggi pib idiar r aig h

Monitoring and evaluationo PMTCT and paediatric HIVprogrammes must keep pacewith advances in evidenceand programming

May ri hav xpadd ad

rghd PMtct ad padiari HIVprgramm i arda wih h agida, idig WHo gidi ARV drg r raig prga wmad prvig HIV ii i iaad h gida gba a-p PMtct. B M&e m a b pdad admad i wih h gidi. I2009, h M&e Wrig Grp h Ir-agy ta tam PMtct, -aiiadby unIceF ad WHo, pdad gida mirig ad vaai HIVprvi amg prga wm,

mhr ad hidr, aig i ah a iraia prgrammrmmdai r PMtct adpadiari HIV ar ad ram (Table 2).

May w- ad midd-im rihav abihd aia daaba PMtct ad padiari HIV vrag adar ab rpr h daa aay.si 2006, mr ha 100 ri haviy rprd daa PMtct adpadiari HIV ar ad ram, p rm 58ri i 2004 ad 71 i 2005 (Figure 12).

th rag, mp, ad riabiiy h daa rprd, hwvr, rmaiimid ad ar away adqa rdii-maig. Daa r wr idiar ary ia diagi, rimxazprphyaxi, cD4 am HIV-piiv prga wm r ARtigibiiy, ia dig prai ad hm d r amiy paig ar rprd by ri. Ag-diaggrgaddaa r padiari ARt ad diaggrgad

daa ARV rgim r PMtct ar bhimpra ip r graig ima d ad vrag, b h ar avaiab.

I 2009, unIceF, WHo ad unAIDs mrgdh WHo uivra A rprig wih h PMtct ad padiari HIV rprard. thr i w ji mirig ad

Table 2. Summary o recommended national indicators or monitoringand evaluation o PMTCT and paediatric HIV care and treatment

Core indicators

1. Existence o national policies and guidelines consistent with international standards or the prevention o

mother-to-child transmission.

2. Percentage o health acilities that provide antenatal care services with both HIV testing and ARV or the

prevention o mother-to-child transmission on site.

3. Percentage o pregnant women who were tested or HIV and know their results.

4. Percentage o HIV-positive pregnant women who were assessed or ART eligibility.5. Percentage o HIV-positive pregnant women who received ARV to reduce the risk o mother-to-child

transmission.

6. Percentage o inants born to HIV-positive women (HIV-exposed inants) receiving ARV prophylaxis to

reduce the risk o mother-to-child transmission (by regimen: single- or multi-drug).

7. Percentage o inants born to HIV-positive pregnant women who are started on cotrimoxazole prophylaxis

within two months o birth.

8. Percentage o inants born to HIV-positive women who received an HIV test within 12 months o birth.

9. Percentage o HIV-exposed inants who are exclusively being breasted, replacement ed or mixed ed at

3 months.

10. Percentage o HIV-positive women o reproductive age receiving HIV care and treatment services with

unmet need or amily planning services.

11. Percentage o inected inants born to HIV-positive women.

12. Percentage o HIV-positive children aged 014 who are currently receiving ART.

Additional indicators

13. Percentage o districts that have CD4 testing services available.

14. Percentage o health acilities that provide viral testing services or inant diagnosis, on site or through

dried blood spots (DBS).

15. Percentage o male partners o pregnant antenatal care clients who were tested or HIV.

16. Percentage o HIV service-delivery points prepared (with stocks and trained provider) to provide at least

three amily planning methods.

Source: WHO, UNICEF and IATT on PMTCT Monitoring and Evaluation, Monitoring and Evaluating Prevention o Mother-to-ChildTransmission o HIV: A guide or national programmes (drat, 2009).



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Mr i marr vrabiiy ar hhd waha, ivig arragm ad h dai v adi h hhd83 a dig ha ha hrw i qih h rr gba idiar. th IAtt M&ewrig grp hidr ad by AIDs, -aiiadby unIceF, PePFAR ad sav h chidr Fd, i aivyivvd i dii ab rdig vrabiiy adidiyig way mar h vrag rvi rhidr i h x HIV ad AIDs.

th d idiar, h prag rphad ad

vrab hidr dr 18 wh hhd rivd r,bai xra ppr, ha b di irpr i rm b r m d a ariy ad agrm hw d a vrab hid, ad wha a miimmpaag rvi ai, hw i hd b divrd,ad hw i hd b d. I i i widy rgizd,hwvr, ha hr i a d mar gba vrag ppr amy, ia pri i rdr aprgr ad idiy gap i h rp.

I a amp vrm h gap i mirighidr id amiy ar, h Br car nwrad unIceF i 2009 aizd ad dimiad amaa h marm idiar r hidr iridia ar, whih id 15 qaiaiv ad piy/impmai idiar.84

th impiai h hi rm AIDs-xiv AIDs-iiv prgrammig ar i ar i rm mirigad vaai h r. th hag wi b adapidiar, marm ad mirig ym hiw diri.

impa PMtct prgramm, idigHIV-r rviva a 1824 mh (whiha i a ramii hrghbradig, ri rpam digad hr mraiy ar).

Eorts to capture prevention data atthe community level are still weak

M&e HIV prvi irvi ihagig ba m aivii ardd hrgh mmiy-badmhaim ma-mdia ampaig addai maig i di drmiwh i rahd ad wha h impa i.Daa xa bhavir ad wdgab HIV prvi amg yg pp,whi iraigy avaiab, ar i imid,pariary r h yg pp wh arm a ri. DHs ad MIcs ar digd

daa i h ppai.

si 2008, hrgh h r h M&ewrig grp a unAIDs ad h IAtt yg pp, igia prgr hab mad i harmizig ad rdiaigh M&e HIV prvi amg ygpp a h gba v. Hwvr, imiarr a rgia ad ry v ari wa.

Protection M&E indicatorsare in need o revision

th idiar iiiay by unGAss mar hidr ad by AIDsid h rai h adabw rpha ad -rpha agd1014 ad h prag rphadad vrab hidr dr 18 whhhd rivd r, bai xrappr i arig r h hid.

th r idiar, h ada,wa dvpd bad a ampi

ha rpha ar iy adh ha -rpha. A aayi h m r rd MIcs adDHs daa, hwvr, hw ha big arpha (whhr havig r bhpar) r havig a hriay i r HIV-piiv ad i h hhd d iy idiy hidr wih h wrhah, dai r pri m.

Figure 12. Number o low- and middle-income countries reporting on keydata on PMTCT and paediatric HIV care and treatment, 20042008

0

20

40

60

80

100

120

140


countries*

Latin Americaand the

Caribbean

CEE/CIS*West andCentralAfrica

Eastern andSouthern

Africa

East Asiaand thePacific

Middle Eastand

North Africa

SouthAsia

20072008

2006

2005

2004

16 182020 21

14

22 24 22 24

8 811 13

16

1 17

48

1 14

912

814

2622 21

107

1619 21

58

71

108109

123

* Includes high-income countries: Hungary, Latvia and Poland in 2007 count; and Hungary, Latvia, Lithuania, Poland and Slovakia in2008 count.

Source: UNICEF global databases, 2009.



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20032004

20052006

20072008

Data not available

20032004

20052006

20072008

Data not available

Figure 13. The 87 countries with recent data available on comprehensive knowledge o HIV among young womenaged 1524, 20032008

Figure 14. The 51 countries with recent data available on comprehensive knowledge o HIV among young menaged 1524, 20032008

Notes: Comprehensive knowledge is dened as correctly identiying the two major ways o preventing the sexual transmission o HIV (using condoms and limiting sex to one aithul, uninected partner), who reject thetwo most common local misconceptions about HIV t ransmission and who know that a healthy-looking person c an transmit HIV.

The low- and middle-income countries included in the analysis are only those that have a UNICEF presence. Data reer to any data collected using DHS and MICS during the period 20032008.

These maps are stylized and not to scale. They do not refect a position by UNICEF on the legal status o any country or territory or the delimitation o any rontiers. The dotted line represents approximately the Line oControl in Jammu and Kashmir agreed upon by India and Pakistan. The nal status o Jammu and Kashmir has not yet been agreed upon by the parties.

Source: UNICEF global databases, 2009.



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Monitoring and evaluation: Summary o remaining challenges

Diy i imaig ppai iz ad HIV prva amg h hard--rah, hidd,margiaizd, mbi ad migra ppai, ad i graig riab HIV ima h vrad r ar ad ram.

Variai i idiar dii ad daa i mhdgi, whih ga daa mparabiiywihi ad ar ri.

la marab, adard dii hidr ad by AIDs ad vrab hidr; a dii wha i a adard paag rvi r hidr ad by HIVad AIDs.

la bai daa vrab hidr h dmiar i m ri d h a aadard dii.

limid riab daa hidr id hhd ad amiy ar (.g., hidr ivig h rad i iii) wh ar idid i hhd rvy.

Pia db-ig d mip irvi r rpha ad vrab hidr.

Diy i dig whih m mar r oVc ad hw arib m irvi.

limid diaggrgad daa x, ag ad hr hararii r bppai m a ri,pariary yg pp gagd i ijig drg , x bw ma ad ig x.

th mpxiy mprhiv prvi ad impibiiy iaig r vra ar iavrig ii.

la mparab vid h impa PMtct prgramm HIV ii avrd i iaad hidr ad HIV-r rviva.

ehia i i gahrig daa, pariary iiv daa, rm hidr, idig h r ha daai ad M&e aivii rad vrab hidr ira hir vrabiiy.

limid rag, mp, riabiiy ad qaiy daa d ad rprd.

Wa rdiai ad harmizai M&e r a rgia ad ry v.



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si h ahig Unite or Children, Unite against AIDSi 2005, baia prgr ha b mad i divrig HIVrvi mii pp, pariary wm, hidrad yg pp. Rr m h haghav a irad: th us$13.7 bii ivm i HIVprgrammig i 2008 i ary a 75 pr ira i2005.86 sigia addiia rr, hwvr, ar dd ppr a rg ad aiab HIV rp.

unAIDs ima ha a us$25.1 bii ivm i ddby 2010 ab ri rah ivra a ga.87simpy maiaiig h rr pa irad ivmwi b i. Apar rm h ivm avaiab i2008, a addiia us$11 bii i dd rah h argi 2010.

unIceF ad unAIDs hav drmid ha ab us$5.9bii, r rghy qarr h us$25.1 biiivm dd rah ivra a ga, i ddpiay m ivra a arg r wm adhidr (Figure 15).88 tab 3 i h miimm rrdd r w- ad midd-im ri rah 2010arg h r P.

Preventing mother-to-child transmission o HIV: I iimad ha US$605 million i dd m riivra a ga (wig hir w pr) rPMtct by 2010. th ima id HIV ig adig r prga wm, vari yp drgprphyaxi ad ig ia dig pi. Drgprphyaxi may b a ig-drg rgim, a mbiaiprphyai rgim r a highy aiv rip-drg rgim.Dpdig h ry piy ad x, prgrammmay id h prvii ia rma r a prid

ix mh r gr.

A mother should not have to

choose between continuingAIDS treatment and eeding her

children. Michel Sidib, UNAIDS

Executive Director85

VII. InVestMent:

WHAt WoMen

AnD cHIlDRen

neeD

Figure 15. Global investment needed by 2010 or HIV services orpregnant women and children as a proportion o HIV services or adults

US$5.9 billion

US$19.2 billion

Investment needed

for pregnant women

and children

Investment neededfor the general adult

population

Source: All calculations are derived rom the 2009 UNAIDS report, What Countries Need: Investments needed for 2010 targets.



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h pi a wih h pai r mmbr harg ppai. thy ar ia r h divry bai rvi r irmd prgramm ad diipaig, iv ad i prai, adardizaiad qaiy, ad iraig dmad r rvi.

naia mmim i rp h pidmi hav

b grwig, a hw by h irad dmi pdigi may ri, h arg r aig r HIVprgramm. Mr ha ha h us$13.7 bii ivdi HIV prgrammig i 2008 am rm ri adby HIV ad AIDs. Ab hird wa rm dir biaraprai, wih h r mig rm miara iii(12 pr ) ad h priva r (5 pr ).90

th gba mi rii ha rd may gvrm r-xami hir ivm. A mi adjm armad, i i via ha hy b hrgh a prigh m vrab h hi rii wmad hidr.

Providing paediatric treatment and care:I i imad ha US$649 million idd r aig p HIV ram adar rvi r ia ad hidrdr 15 yar ag.thi hd brgardd a a w ima, bai id y r-i padiariARt ad d id ary

ia diagi.

Preventing inection among adolescentsand young people: A a US$1.4 billioni dd a p HIV prviirvi r yh. th grd id pia rah adyh-ridy prgramm ary ira yg pp a ,ad , may ia prviirvi. Frhrmr, d aa daa rgardig h mbr m-a-ri yh, h rr dd

r yg pp wh x, mwh hav x wih m, ijig drgr ad prir ar idd ihi ima.

Protection and care or children aectedby AIDS: A imad US$2.5 billioni dd ppr rpha advrab hidr.89 Whi pprmay b prvidd i vra way, himad ar h r ahgra qaiyig amii ad hprvii a rag ia

rvi (daia, hah ar,amiy, ad mmiy ppr, aw a rgaizaia r admiiraiv). Mr ha 90 pr himad rr ar dd ib-sahara Aria.

Prevention o violence against women:A imad US$326 million i dd ppr mar addr viagai wm. Prvig viagai wm i r-ig hrgha r P, a prig wm,mhr ad hr ma argivrpay a via r i HIV prvi,ppr, ar ad ram.

Programme support costs orwomen and children: I i imadha US$406 million i dd rprgramm ppr r wmad hidr. Prgramm ardd a h ym-v abv

Table 3. Investments needed by Unite for Children, Unite against AIDStarget areas (US$ millions)

Country-defned targets 2009 2010

Preventing mother-to-child transmission o HIV 458 605

Providing paediatric treatment and care 512 649

Preventing inection among adolescents and young people 1,233 1,428

Protection and care or children aected by AIDS 1,739 2,499

Prevention o violence against women 157 326

Programme support costs 372 406

Total 4,470 5,913

Source: All calculations are derived rom the 2009 UNAIDS report, What Countries Need: Investments needed for 2010 targets.

U

NICEF/NYHQ2005-1895/DeCesaret



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th prgr dribd i hi rpr rpr p aga im vid, ai ad r. I i ar haarg a b rahd b a bvi ha, i mpa, ivra a ga ar y big ahivd. thvid ba r ai i imprvig, b d b br.Ivm d b brd, b i m a b dmr jdiiy.

Amid mi dii ha ar aig a ri, ii impra ha igh rmai xd h g rm adha mmim a i h hr rm ar maiaid adrghd. Bad wha i w day, h wigai m b pririi i wm, hidr ad ygpp ar hav a ppriy iv ad hriv AIDs-r:

1. Accelerate the scale-up o PMTCT services and earlyinant diagnosis to contribute to the elimination o HIVtransmission to young children. expad HIV prviprgramm r wm hidbarig ag ghr wihxpadd HIV ig ad ig prga wmad w-p r; prvid mr ai ARV

rgim r PMtct, idig ARt r prga wmi d ram; ary ia diagi ad w-p h r; ad h immdia ram babidiagd wih HIV. Arad a-p wi rqir adraizd apprah, i whih aia prgrammrar h paig ad impmai rvi b-aia v ad abih ar mhaim rrdiai, aig ad aabiiy. I wi arqir h iv gagm mmii aparr i rvi divry ad h abihm bri bw hah aiii ad a mmii.Pariary i graizd pidmi ig, rg hahym ha aw r h igrai HIV prvi

ad ram r wm ad hidr i MncH rviar ria r pdig h a-p HIV-iiv gbahah iiiaiv. HIV ad AIDs prvid a ppriy rviaiz hah ym ha a ad y imprvdm r h ad by AIDs, b a vraimprvm i hah ar.

2. Continually seek out new evidence to inorm HIVprevention. Bhavir hag h hr ap mbiai prvi wi b iv wiha br dradig h raihip bw whayg pp w ab HIV ad hw hy aaybhav h bai ha wdg. th vid

gap wha xa ar ab yg pp raa wdg ad i i hag i hirbhavir, ad wha ar prv hm rm dig m b d. I ri wih w prva adrad pidmi, h vid ba wdgad bhavir amg h yg pp m a ri ipariary wa. Mh mr rmai b drdab h ry pi bhavir hag i variig hm, h ad mmii ad i

Now is the time to ollow through

on our commitments.

VIII. cAll to

ActIon



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ar xa ad rprdiv hah rvi r adgir ad aaa ar wih PMtct rvi r ad

gir wh bm prga. Whr rvi divry rad ad yg pp ivig wih HIV i -xi, r i iapprpria r irrva hir pariariai, w md ar, ram ad pprm b dvpd iday wih h pariipai ygpp, wh ar b ab d i h iha r hm.

5. Ensure that adolescents who are in situations o thegreatest risk are reached by HIV prevention, treatment,care and support services. Yg m wh hav x wihm, yg ragdr pp, yg pp ivvd iig x ad yg pp ijig drg ar amg

h ppai wih h high ra HIV, y w HIVprgramm rah hm. th vid iy hwha prgrammai apprah ig pragmaim, h a rdig harm, ar mr ivha mraizig. Rp d r ha yhrvi ad prgramm rp h divriy ygpp ad rpd hir d, whi rgizig hirma m-a-ri grp ad xdig piapri yg pp amg hm.

6. Make sexual violence against girls and women sociallyunacceptable. th hd b rdig h ri HIV by maig xa vi agai gir apab

ad rig aw ha ma i pihab a a rim.Prvi xa vi agai gir hd bprmd a par aia ad rgia HIV prviprgramm. th a ha xa vi agai girad HIV prvi ar addrd by dir miirir dparm i pary bam r hir w pii piy agda. th AIDs rp r a ppriy rd xa vi ad dvp mprhivrp bh xa vi ad HIV prviwihi ad byd h hah r.

raihip wih hr yg pp.I i a ary drad hwbhavir hag a b hada par a aia rp, adwhhr h hag r i rddHIV ii. Frhr, i i impra impm ad vaa prgrammbad praia rarh.

3. Support and empower adolescents,particularly girls, to identiy andrespond to their own vulnerabilities.thr i a rg d addrh ar ha ma gir ad wmmr vrab HIV ii. Ihr Aria, vid par ary xa db, rrparrhip ad irgraia xgg h raiy daig wihh ia ad ra ar drivigh pidmi amg ma, idig

wm a, dirimiai advi agai wm ad gir,ad gdr diparii i dai.sh-bad ad hr prgramm ira ad wdg HIVad AIDs ad impar h i ha wihp rd hir vrabiiy HIVwi b wih pprivvirm i h mmii whrad pariary gir arxpd xri h wdgad i. Frhrmr, adgir rqir irmai xa

ad rprdiv hah rvi ihir mmii. By ad m, adpar ad amii, ar ia maig h ary ia hag, hir ivvm i h prgrammi y.

4. Protect the rights o adolescents andyoung people living with HIV to receivegood-quality support and services.Mig hi grp d r arad ram-adhr m baddrd a a pririy ad wih

dirimiai. A h yg ppgrw i adhd, ppr rvim idr wih iiviy hirmrgig xaiy, h igma aahd hir irma ad hir prraihip. Piiv hah, digiyad prvi ar piay ria rad ad yg pp ivigwih HIV wh ar xay aiv, a

U

NICEF/NYHQ2005-1896/DeCesare



37/56

ar aiii r by mmii, -gvrmargaizai ad aih-bad rgaizai.

9. Strengthen whole systems so that gains made on behalo women and children aected by AIDS can be extendedand sustained. Prgramm ad pii ar y aiv a h ym drpiig hm. liigvari rvi, h a mara ad hid hah ar

wih HIV rvi, ha hw i b a iv way prgr ward ivra a ad imprv hahm r a. thi mid m xd hr araa w: dai, ia war ad ia priym. Hma rr ad h rgaizaia apaiy hah ym m b imprvd ai gai iPMtct ad padiari ar. srvi wihi hah ymm b br id.

10. Improve data gathering and analysis to achieve resultsor children, and identiy gaps in equitable coverage oand access to services. sid daa ha ar diaggrgadby ag, x, maria a ad hr hararii airm piymaig ad prgrammig, ad a bd by gvrm ad hr ig ppr addig. thr ar a adva b mad i h ara praia rarh i r wdg h pidmiad hw i a hidr ad wm, a w a ih iv h rp i a x. shwdg a b had by abihig i bwaia ad a iii ad by rghig pa rarh apaiy. Imprvd daa gahrig adaayi ad gdr awar m b piid ahma righ pririi. thy wi rib mirigprgr ward ivra a ga ad aigwhhr h hidr ad wm wh rmai m

vrab h HIV ad AIDs raiz hb ivm.

uimay, ivm wi b d wiy ad h maygap ha xi i vrag, qaiy ad qiy wi bd i wdg i rd i prai. W m whrgh r mmim, ig h gap i hgba wdg ba, ad i hy awdgig whrr a hr ha wr may b imprvd.

7. Scale up child-sensitive socialprotection, a necessary part o theresponse to children aected by AIDS.eiv ia pri ymad prgramm ha ar hid-iiv wi mpa AIDs-adhidr i hir wp, by pigah ad hr ia aia a h

dipa amii wh d i. thiwi aiia a bai iarvi whr hy may hav biaib ba pvry adigma, ad wi abih ga, piyad bdgary ramwr ha prhidr ad hir amii agairhr vrabiiy. evid hahw ha ah rar rib br m r hidr. siawar miiri ha ar wa mb rghd, ha h bdia rdia r a ad-a prvidr rvi. civiiy rgaizai hav a imprar wihi ia war ym byhpig idiy h m vrabad xdd hidr, idig AIDs-ad hidr ad hir amii. civiiy a bh prvid ad aiiaa ia ia rvi, adrgh mmiy rr ppr amii ad pr hidrrm ab.

8. Strengthen community capacity to

respond to the needs o childrenaected by AIDS by preventing theseparation o amilies and improvingthe quality o alternative care. Baamii ar r h va majriy hidr ad by AIDs, h m b pprig h amii prvid qaiy ar r hidr. Frad ihip ar d b rhrpprd a araiv ridiaar r hidr wh ar paradrm hir amii. Ridia arhd rmai a a rr ha imprary ad p i pa y whhr rm amiy-bad araivar a b arragd. A h, ihd b id h mmiy h x pib. Gvrmhd am rpibiiy r igadard ad mirig ridia



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Scaling up priority HIV/AIDS interventions in the health sector ProgressReport 2009, WHo, Gva, 2009, p. 105.

11. Wrd Hah orgaizai, Ji uid nai Prgramm HIV/AIDsad uid nai chidr Fd, Towards Universal Access: Scalingup priority HIV/AIDS interventions in the health sector Progress Report2009, WHo, Gva, 2009, pp. 96, 98, 99,106.

12. eizabh Gar Pdiari AIDs Fdai ad tazaia Miiry Hahad sia War, Rapid sa-up PMtct srvi Prvii uig aDiri Apprah: th tazaia xpri, eizabh Gar Pdiari AIDsFdai, Dar saaam, uid Rpbi tazaia, 2009.

13. Ra, li, a., Rwada: Prrma-bad aig i h pbir, chapr 10, Perormance Incentives or Global Health: Potentialand pitalls, did by Ra eihr, a., cr r Gba Dvpm,Wahig, D.c., 2009, pp. 190, 193194, 199.

14. unIceF Zambia, B Prai i Prvi Mhr--chidtramii HIV: sharig b prai i 10 ri (dra iradm), Apri 2009.

15. kiam, W. P., Igrad Prvii Airrvira thrapy i Aaa carIra tram amg eigib, HIV-Id Prga Wm, Abra181, Oral & Poster Abstracts, th 2009 HIV/AIDs Impmr Mig,Widh, namibia, 1014 J 2009, pp. 1718.

16. For Cambodia:Iraia tram Prpard caii, FaiigWm, Faiig chidr: HIV, vria ramii ad wm hah o-h-grd rarh i Argia, cambdia, Mdva, Mr,ugada, Zimbabw, Missing the Target 7, ItPc, Gva, May 2009, p. 28. ForChina:ch, l., a., Igraig PMtct i h Rra Hah car sym

i Gagxi Prvi, chia, Abra 445, Oral & Poster Abstracts, th 2009HIV/AIDs Impmr Mig, Widh, namibia, 1014 J 2009,p. 30.

17. Wrd Hah orgaizai, uid nai chidr Fd ad Aadmyr edaia Dvpm, Learning rom Large-Scale Community-BasedProgrammes to Improve Breasteeding Practices, WHo, Gva, 2008.

18. M, M., a., eragig Ma Ivvm i PMtct: nwapprah i diri lh, Abra 1271, Oral & Poster Abstracts,th 2009 HIV/AIDs Impmr Mig, Widh, namibia, 1014J 2009, p. 134; Mgwaza, P., a., upa HIV tig PrgaWm ad thir Ma Parr i Prvi Mhr--chid HIVtramii Prgram i Rwada, Jaary 2005nvmbr 2008, Abra1321, Oral & Poster Abstracts, th 2009 HIV/AIDs Impmr Mig,Widh, namibia, 1014 J 2009, pp. 140141.

19. naia AIDs cmmii [lh] (2008). sa h naiaRp h 2001 Darai cmmim HIV/AIDs: Jaary2006 - Dmbr 2007. lh. naia AIDs cmmii [lh].

20. Pr, Dara, a., D targd HIV Prgram Imprv ovra car rPrga Wm?: Aaa yphii maagm i Zambia br adar impmai prvi mhr--hid HIV ramiiprgram, Journal o Acquired Immune Defciency Syndromes, v. 47,. 1, 2008, pp. 7985.

21. kai, Paa B. n., a., cmbiig PMtct wih Aiv ca Fidig rtbri, Journal o Acquired Immune Defciency Syndromes, v. 42,. 3, 3 Jy 2006, pp. 379381.

22. Ji uid nai Prgramm HIV/AIDs, 2008 Report on the GlobalAIDS Epidemic, unAIDs, Gva, 2008, p. 53.

23. Wrd Ba, Averting a Human Crisis During the Global Downturn: PolicyOptions rom the World Banks Human Development Network, Wahig,D.c., 2009, p. 41.

24. uid sa Prid emrgy Pa r AIDs Ri, Celebrating Lie:The U.S. Presidents Emergency Plan or AIDS Relie 2009 Annual Report

to Congress, PePFAR, Wahig, D.c., 2009. Also see:th Gba Fd Figh AIDs, tbri ad Maaria, Scaling Up or Impact: Results Report,th Gba Fd, Gva, Marh 2009.

25. Wrd Hah orgaizai, Ji uid nai Prgramm HIV/AIDsad uid nai chidr Fd, Towards Universal Access: Scalingup priority HIV/AIDS interventions in the health sector Progress Report2009, WHo, Gva, 2009, pp. 93.

26. See, or example: Marazzi, criia M., a., Impmig Ai-Rrviratrip thrapy Prv HIV Mhr--chid tramii: A pbi hahapprah i rr-imid ig, European Journal o Pediatrics, v.166, . 12, Dmbr 2007, pp. 13051307; Pambi, l., a., tramArai Prgram ad h expri h DReAM Prgram i

1. Br, David e., a., emrg a Pa ieary Ia Mraiy D HIV/AIDs i shAria, AIDS, v. 23, . 1, 2 Jaary 2009,pp. 101106.

2. Wrd Hah orgaizai, Ji uid naiPrgramm HIV/AIDs ad uid naichidr Fd,Towards Universal Access: Scalingup priority HIV/AIDS interventions in the healthsector Progress Report 2009, WHo, Gva, 2009,pp. 145149.

3. Ibid., p. 151.

4. Mr, Miha H., a., th Hiry adchag HIV Prvi, The Lancet, v. 372,. 9637, 915 Ag 2008, pp. 475488.

5. A-Pariamary Grp AIDs, th tramtimbmb: Rpr h Iqiry h A-ParyPariamary Grp i g-rm a HIVmdii i h dvpig wrd, APPG, ld,Jy 2009, pp. 6, 30.

6. swa, Miha D., a., c-eiv nvirapi Prv Mhr--chid HIVtramii i eigh Aria ri, AIDS, v.18, . 12, 20 Ag 2004, pp. 16611671.

7. Ji uid nai Prgramm HIV/AIDs,2008 Report on the Global AIDS Epidemic, unAIDs,Gva, Ag 2008, p. 180.

8. th ri ar: Argia, Armia, Azrbaija,Bar, Biz, Bwaa, ca Ria, cba,Grgia, Gyaa, kazaha, kyrgyza,lihaia, namibia, Rpbi Mdva, RiaFdrai, sa tm ad Priip, thaiad adurai. Wrd Hah orgaizai, Ji uidnai Prgramm HIV/AIDs ad uidnai chidr Fd,Towards Universal Access:Scaling up priority HIV/AIDS interventions in

the health sector Progress Report 2009,WHo,Gva, 2009, pp. 97, 99.

9. Wrd Hah orgaizai, Ji uid naiPrgramm HIV/AIDs ad uid naichidr Fd, Towards Universal Access: Scalingup priority HIV/AIDS interventions in the healthsector Progress Report 2009, WHo, Gva, 2009,pp. 98, 99, 102.

10. Daa ribd by unIceF r Towards UniversalAccess, 2009; Wrd Hah orgaizai, Jiuid nai Prgramm HIV/AIDs ad uidnai chidr Fd, Towards Universal Access:

ReFeRences



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i Aria, Business Action: In brie Ideas and action, Wir/sprig 2008,p. 10.

40. Gba Fd

Documents

Children and AIDS: Fourth Stocktaking Report, 2009