Children, HIV and AIDS:

The world in 2030

1.9 million 270,000

CHILDREN AND ANNUAL NEW HIV
ADOLESCENTS INFECTIONS

O
living with HIV* among children and

G
adolescents in 2030*

B AR 2018
E OVE M B ER
R
DE 9 N
M

UN 01 G M T 2
0 8:

56,000
ANNUAL
AIDS-RELATED
DEATHS
among children and
adolescents in 2030*

* According to UNICEF global projections based on current trends in the HIV response and population estimates.

A UNICEF special report I December 2018

 Introduction
As populations change, recent progress in the HIV response
for children and adolescents might not be sufficient to end
HIV as a threat to individuals or the public health. Yet, UNICEF
believes it is possible to reverse HIV epidemics among all
people – including children and adolescents – regardless of
their specific risk factors or challenges.
Globally, the population of children and adolescents aged
0–19 is expected to increase by 5 per cent between 2018
and 2030. The increase will be greatest in sub-Saharan Africa,
the region in which the HIV burden is highest: The child and
adolescent population is projected to grow by 23 per cent
in Eastern and Southern Africa and 30 per cent in West and
Central Africa. The bulk of the population growth will be in
the adolescent age group (10–19 years old). The adolescent
population is also projected to grow in the Middle East and
North Africa (by 24 per cent), in Eastern Europe and Central
Asia (by 17 per cent) and in East Asia Pacific (by 4 per cent)
between 2018 and 2030.
E OVE
R M
Based on these population projections and assuming current
DE 9 N
HIV response efforts continue at the same pace, the number
of children and adolescents aged 0–19 years living with HIV
UN
will be 34 per cent lower in 2030 than it is now. Although
T 2
this is good news, far too many children and adolescents
M
will still be affected: An estimated 1.9 million children and
1 G
adolescents will be living with HIV in 2030, with 270,000
0
0 8:
newly infected in 2030 alone. The bulk of these new HIV
infections will occur in Africa.
This downward trajectory in new HIV infections is too slow.
Children, adolescents and all others living with HIV who
have access to consistent, high-quality antiretroviral therapy
(ART) lead their lives and never risk transmitting the virus
to others. Slightly more than half of all children (0–14) living
with HIV are now on treatment; 48 per cent are not. Scaling
up programmes to achieve universal coverage of treatment
is a huge logistical, financial and structural challenge for
any country. Anything less than continued attention and
increasing commitment of resources could lead to the failure
of existing prevention and treatment programmes.
A turning point can be dramatic improvements in
preventing new HIV infections. Children and adolescents
should be at the centre of such efforts. Extraordinary
global progress in combating vertical transmission of
HIV suggests that renewed attention and the adoption of
2
innovative programmatic solutions, including the use of new
technologies, could lead to elimination of new infections in
children aged 0–14 in the coming years. Slower progress in
reducing HIV infection rates and AIDS-related deaths, and in
increasing access to ART among children and adolescents
in comparison to adults, means a focus on reaching this age
group is critical.
No one solution can overcome obstacles to better
results among children and adolescents. But significant
improvements can be achieved through the coordinated
delivery of multiple interventions to prevent new HIV
infections and to increase access to ART. Recommendations
on how to use these projections as a tool to accelerate
O
progress are discussed in this report.
G
AR 2018
B
Methods
M B ER
Spectrum’s 2018 AIDS Impact Model (AIM) was used
to estimate the number of new HIV infections, AIDS-
related deaths and children and adolescents aged 0–19
living with HIV, by age and sex. Model inputs include
population statistics, survey data and HIV programme
data, reviewed for completeness and quality by UNAIDS,
UNICEF, WHO and other collaborating partners.
Output indicators were projected from 2018 to 2030 in
two epidemic scenarios:
1. Status quo scenario based on trends in new HIV
infections, ART coverage and prevention of mother-
to-child transmission (PMTCT) coverage over the past
five years.
2. Global target scenario based on 2030 Fast-Track
and 2020 Super-Fast-Track targets for ART coverage,
PMTCT coverage and reduction in new HIV infections
among children, adolescents and adults.
For each scenario, output was extracted at the country
level by sex and five-year age group. Data were
aggregated to nine geographic regions. These regional
aggregates may mask important variations among
countries.
A total of 169 countries were included in this analysis,
representing 99 per cent of children and adolescents
aged 0–19 living with HIV in 2017 and 98 per cent of
the same in 2018. Because the analysis represented
less than 90 per cent of children and adolescents
estimated to be living with HIV in Eastern Europe
and Central Asia, North America and Western Europe,
exact figures for these regions are not presented.
Global projections

Global projections based on current Children aged 0–9 years are projected to experience the biggest decline in
trends indicate that overall HIV risks number living with HIV
and vulnerability among children FIGURE 1: Number of children and adolescents living with HIV, by age and sex, 2018 and 2030
and adolescents will decline steadily
through 2030. However, gaps seem 2018 2030 Girls Boys 2018 2030

likely to persist in HIV response

Aged 15–19 718,000 544,000 388,000 469,000
effectiveness by age. Broadly
speaking, decreases in the annual Aged 10–14 296,000 190,000 196,000 303,000
number of new HIV infections, the
number of those living with HIV and Aged 5–9 297,000 162,000 168,000 306,000
the annual number of AIDS-related
deaths are all projected to be much Aged 0–4 265,000 140,000 146,000 275,000

lower among those aged 10–19

800,000 600,000 400,000 200,000 0 200,000 400,000 600,000 800,000
years than among those aged 0–9

O
years.

G
If trends continue, there could by one-third fewer annual new HIV

AR 2018
The widening age-specific gaps in infections among children and adolescents by 2030, with the greatest
decrease among children aged 0–9 years

B
those measures of HIV risk and
impact underscore two recent

M
Annual number of new HIV infections among

ER
Aged 0–9 Aged 10–19
children and adolescents, by age, 2018–2030

E OVE
trends: the relative success of global
efforts to end vertical transmission
B
R M
259,000
260,000

DE 9 N
of HIV and the comparative failure
of prevention among adolescents. It 220,000

UN
is possible to achieve greater, more

T2
180,000 169,000
183,000
sustained success in both of these

M
140,000
critical areas; the data indicate that
G
:01
100,000
more must be done to eliminate

08
89,000
vertical transmission of HIV, and to 60,000

address the specific HIV risks and 20,000

prevention needs of adolescents. 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Gender must be considered as well.

Globally, far more adolescent girls The number of AIDS-related deaths are projected to decrease the most
for the youngest children, those aged 0–4 years
than boys are living with HIV and are
newly infected every year. Although FIGURE 3: Annual number of AIDS-related deaths among children and adolescents, by age,
2018–2030
targeted prevention activities for girls
has been and should remain a high 80,000
72,000
priority, vulnerable adolescent boys, 70,000

including those living with HIV, need 60,000

similar levels of attention, because 50,000

improvements for adolescent 40,000

32,000
boys lag behind improvements for 30,000

adolescent girls. 20,000

19,000
13,000
16,000
10,000 12,000 6,000
5,000
0
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Aged 0–4 Aged 5–9 Aged 10–14 Aged 15–19

3
 Regional projections

Although patterns of inequities across regions Regional differences in the number of children and
will become less stark over time, regional adolescents living with HIV will likely persist until 2030
differences in HIV impact and response for FIGURE 4: Number of children and adolescents aged 0–19 living with HIV,
the 0–19 age group are projected to still be by region, 2018–2030
evident in the year 2030. The differences
will shift and become a bit less stark in 3,000,000
general, however. Eastern and Southern
Africa will still be home to the majority of 2,600,000
those aged 0–19 years living with HIV. But
this region’s absolute numbers of children 2,200,000
and adolescents living with HIV will decrease
over time, and its relative burden will be 1,800,000
smaller. Less progress in West and Central
Africa is the main reason for this shift. A 1,400,000

slower decline in the annual number of new

O
HIV infections in this region, combined with 1,000,000

G
the world’s fastest growing populations of

AR 2018
children and adolescents, suggests the global 600,000

HIV burden among children and adolescents

B
will become increasingly concentrated in 200,000

M ER
West and Central Africa.

E
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

B
R VE M
Latin America and the Caribbean and Eastern

E 29
Europe and Central Asia are also projected Middle East and North Africa Latin America and the Caribbean

O
D N
Eastern Europe and Central Asia West and Central Africa
to contribute more to the global burden of

N T
East Asia and the Pacific Eastern and Southern Africa
HIV among children and adolescents. The South Asia

U :01 GM
epidemics here are relatively small, but in
recent years these regions have made little
progress in reducing the number of new
Note: Western Europe and North America are excluded from the regional comparison.

08
infections.

The outlook for boys and girls living with HIV differs greatly by region, especially for adolescents
FIGURE 5: Number of children and adolescents living with HIV, by age, sex and region, 2018 and 2030

Eastern and Southern Africa West and Central Africa Outside sub-Saharan Africa

Aged 15–19 302,000 182,000 162,000 103,000 80,000 102,000

Aged 10–14 119,000 120,000 51,000 55,000 20,000 21,000

Aged 5–9 99,000 101,000 49,000 52,000 14,000 14,000

Aged 0–4 83,000 86,000 48,000 51,000 9,000 10,000

400 300 200 100 0 100 200 300 400 150 100 50 0 50 100 150 150 100 50 0 50 100 150
Thousands

2018 2030
Note: Outside sub-Saharan Africa grouping includes the following geographical regions: East Asia and the Pacific, Eastern Europe and Central Asia, Latin America and the
Female
Caribbean, Middle East and North Africa, South Asia, Western Europe and North America.
Male

4
The majority of new HIV infections among adolescents aged 10–19 years could tilt from Eastern and Southern Africa
to West and Central Africa
FIGURE 6: Annual number of new HIV infections among children and adolescents, by region, 2018–2030

Children aged 0–9 Adolescents aged 10–19

260,000 260,000
240,000 240,000
220,000 220,000
200,000 200,000
180,000 180,000
160,000 160,000
140,000 140,000
120,000 120,000
100,000 100,000
80,000 80,000
60,000 60,000
40,000 40,000
20,000 20,000
0 0
2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Middle East and North Africa East Asia and the Pacific Latin America and the Caribbean Eastern and
Eastern Europe and Central Asia South Asia West and Central Africa Southern Africa

Note: Western Europe and North America are excluded from the regional comparison.

G O
B AR 2018
M BER
In four regions, more new HIV infections

RE
Eastern and
79% 21%
are projected for adolescent boys than Southern Africa

for adolescent girls from 2018 to 2030

E M
DE
West and Central Africa 67% 33%

V
NO
FIGURE 7: Percent distribution of total number of Eastern Europe
new HIV infections among adolescents aged 10–19, 63% 37%

UN
and Central Asia
by sex, 2018–2030

2 9 Middle East and

T
47% 53%
North Africa

Adolescent girls
G M Adolescent boys South Asia 41% 59%

:01 08
Latin American and 41% 59%
the Caribbean
Note: Western Europe and North America are excluded from the regional
comparison. Regions are listed by number (largest to smallest) of new HIV East Asia and the Pacific 32% 68%
infections among adolescents.

In 2030, Latin America and the Caribbean 2018

could have the same HIV infection rate 3.0
for adolescent boys as Eastern and
Southern Africa 2.5

FIGURE 8: Annual number of new HIV infections per

1,000 adolescents aged 10–19, by sex and region, 2.0
2018 and 2030
1.5
2030 1.37

Adolescent girls Adolescent boys 1.12

1.0
2018

0.5 0.51
Note: The rate of new HIV infections is expressed as the number of new 2030 0.38 0.36 0.31 0.37
HIV infections per 1,000 adolescents. This indicator helps to compare the 0.26 0.20
0.11 0.05 0.17
annual numbers of new HIV infections in regions of different epidemic and 0.04
0 0.05 0.04 0.04
population sizes. Adolescents already living with HIV are excluded from
this calculation. Western Europe and North America are excluded from the Eastern and West Latin America East Asia South Eastern Middle East Global
regional analysis. Southern and Central and the and the Asia Europe and and North
Africa Africa Caribbean Pacific Central Asia Africa

5
 Scenario analysis

Countries around the world have Global targets from the Super-Fast-Track framework for ending
committed to global HIV targets, including AIDS in children, adolescents and young women by 2020
the UNAIDS Fast-Track agenda and the
START FREE
Super-Fast-Track framework for ending Eliminate new HIV infections among children (aged
AIDS in children, adolescents and 0–14) by reducing the number of children newly
infected annually to less than 20,000 by 2020.
young women by 2020. Meeting those START
STAY FREE
targets would significantly improve all FREE
Reduce the number of new HIV infections among
major indicators of HIV among children adolescents and young women (aged 10–24) to less
and adolescents by 2030, yet progress than 100,000 by 2020.
STAY AIDS
towards them is lagging substantially, FREE FREE AIDS FREE
Provide 1.4 million children (aged 0–14) and 1 million
and the time for effective action is quickly adolescents (aged 15–19) with HIV treatment by 2020.
running out. Meeting global targets could
result in long-lasting positive impacts for Source: Start Free, Stay Free, AIDS Free – A super-fast-track framework for ending AIDS among children, adolescents and young
women by 2020, UNAIDS 2017
children and adolescents.

O
The world is off track to end AIDS for children and adolescents by 2020 and 2030, but reaching global targets would

G
avert 2.0 million new HIV infections

AR 2018
FIGURE 9: Annual number of new HIV infections among children and adolescents, status quo and global target scenarios, 2017–2030

Children Adolescent boys

M B BER
Adolescent girls

RE
180,000 172,000
168,000 159,000
153,000 480,000 infections 567,000 infections 973,000 infections

M
160,000 would be averted would be averted
would be averted

E
DE
V
140,000
118,000

NO
120,000
89,000

UN
9
100,000 86,000 84,000

2
80,000 98,000

T
66,000
73,000

M
60,000

G
57,000
40,000

1
8:0
35,000 39,000
20,000
19,000

0
0

Note: The status quo scenario assumes that recent trends in the number of new HIV infections, ART coverage and PMTCT coverage will remain the same until 2030. The global
Global target scenario
target scenario assumes that every country reaches 2030 Fast-Track targets and 2020 Super-Fast-Track targets for ending AIDS among children, adolescents and young women by
Status quo scenario 2020. The labels on the charts show the number of new HIV infections that would be averted if all countries reached Fast-Track and Super-Fast-Track targets.

For children and adolescents, reaching global targets in Even with success, a large population of children and
2020 and 2030 would avert 379,000 AIDS-related deaths adolescents living with HIV will need access to services
FIGURE 10: Annual number of AIDS-related deaths among children and well beyond 2030
adolescents, status quo and global target scenarios, 2017–2030 FIGURE 11: Number of children and adolescents aged 0–19 living with
HIV in 2017 and 2030, status quo and global target scenarios
140,000
126,000
379,000 AIDS-related
120,000 105,000 deaths would be averted Status quo scenario Global target scenario
100,000

80,000
56,000
60,000
73,000
40,000

20,000 31,000 1.9 million 1.4 million

0
children and adolescents living children and adolescents living
with HIV in 2030 compared with HIV in 2030 compared
to 3.0 million today to 3.0 million today
Global target scenario Status quo scenario

6
Innovative solutions
to change the course of the HIV epidemic

The projections described in this report point to shortfalls in the HIV
response for children and adolescents. Progress in preventing HIV
in young children, through PMTCT, has slowed; and combination
prevention approaches that address the behavioural and structural
drivers of the epidemic have not succeeded in reducing the
vulnerabilities of adolescents. Many children and adolescents
living with HIV don’t know their status, and among those who
are tested and initiated on treatment, the levels of treatment
adherence are low; their viral loads are too high to break the cycle
of HIV transmission and AIDS-related mortality. Only when all
those living with HIV are identified, treated and retained in care
will the benefits of ‘treatment as prevention’ be fully realized.
Evidence from around the world suggests nine approaches
supported by UNICEF to addressing these persistent gaps
from both prevention and treatment angles. They are
interconnected components of strengthened efforts, centred
on the individual and in the family and community, to reduce
new HIV infections and improve uptake of and adherence to
treatment. Some of these approaches are new and innovative,
while others have been used in local settings but have not
been brought to greater scale. If adopted, these approaches
could have transformative effects in the HIV response among
children and adolescents into 2030.

PREVENTING TREATMENT AND

G O CROSS-CUTTING

AR 2018
NEW INFECTIONS RETENTION IN CARE APPROACHES

1. Digital platforms to improve 4. Family-centred testing

M B ER
7. Adolescent-friendly services

E OVE B
HIV knowledge The targeted, family-centred testing Adolescent-friendly services are essential

R M
Digital platforms and new media can be approach aims to identify and treat children to the effectiveness of programmes in

DE 9 N
used to increase adolescents’ awareness living with HIV but not yet diagnosed and areas such as sharing knowledge about
of HIV and their inclination and ability link them to antiretroviral treatment. It HIV, getting tested for HIV and other
to get tested and take other measures applies an indicator of high risk within the sexually transmitted infections, and

UN
to protect themselves and their sexual
partners. These digital options must
be well-designed and reassuringly
2
family unit, such as a sibling or parent who accessing and adhering to PrEP and ART.
M T
is known or has been found to be living
with HIV, as an entry point to promote the
These services are most successful
when shaped by adolescents and

1 G
confidential to be effective, however. testing of all children in the family. communicated in ways they understand,

8: 0 and might include peer educators and

0
2. Biomedical interventions for
HIV prevention for adolescents
Evidence showing the preventive benefits
5. Point-of-care testing
The scale-up of point-of-care (POC)
diagnostic technologies for early infant
outreach to places where adolescents feel
comfortable.

of antiretroviral drugs calls for innovative
models to expand access to biomedical
options, such as pre-exposure prophylaxis
(PrEP) for adolescents at high risk and
others in the pipeline. Such biomedical
interventions must be paired with
essential support services (e.g., repeat
HIV testing, psychosocial support, etc.)
in adolescent-friendly settings.
3. Other emerging
biomedical innovations
Innovative biomedical solutions including
long-acting, injectible ARVs and HIV
vaccines offer potential paradigm shifts in
ending AIDS. Simplified treatment options
and new avenues for prevention could
overcome the access and adherence
barriers faced by children and adolescents
who face a more rapid progression of HIV
and a lifetime of treatment.
diagnosis and viral load monitoring through
provider-initiated testing at multiple entry
points can contribute significantly to efforts
to increase access to antiretroviral treatment,
end AIDS-related deaths and improve
children’s well-being. With POC testing for
HIV, it is possible to receive results and begin
treatment all on the same day.
6. Peer support for improving access
to HIV services and retention in care
Evidence from the HIV response has
demonstrated that people with shared
experiences are those most likely
to influence each other’s behaviour.
Community-based peer support initiatives
include women living with HIV serving as
mentors to other women accessing HIV
services, male role models for partner
engagement, and adolescent leaders
who reach out to peers and support them
in accessing HIV testing, treatment and
adherence.
8. ‘Cash + care’
Cash grants provided as part of broader
social protection interventions can greatly
reduce HIV risk among adolescents and
improve retention in care. They work by
offering cash as an incentive to clinic or
school attendance, or to treatment uptake
and adherence. ‘Cash + care’ seems
especially useful for adolescents living in
poverty, as well as for adolescent girls.
9. Targeted community outreach
for adolescents
Targeted community outreach efforts
show promise for increasing entry points
to HIV services, either as standalone
activities (such as drop-in centres for
adolescents) or when integrated into
a range of community activities (such
as child health days). Such approaches
can help reach highly vulnerable and
stigmatized populations who normally
cannot access health facilities.

7
 Looking ahead

The evolving HIV epidemic and

population changes make clear that
a combination of solutions adapted
to local contexts are needed to
achieve an end to AIDS for every
child and adolescent. The projections
stated in this report are not etched
in stone, but represent an opportunity
to change the trajectory of the HIV
epidemic for future generations.
However, one thing remains clear:
HIV is a chronic disease, currently
without a cure. Thus, along the road
to elimination of HIV, sustainable
programmes that provide access
to testing, treatment and prevention

O
services well past 2030 are more

G
critical now than ever before.

AR 2018
The lives and health of future
generations depend on it.

M B ER
E OVE
For more data about children
worldwide, visit data.unicef.org
B
R
DE 9 N
M

UN 01 G M T 2
0 8:
Published by United Nations Children’s Fund Acknowledgements: The data analysis in this report was made
Programme Division possible by Avenir Health, UNAIDS and UN Population Division.
HIV and AIDS Section Data were analysed by UNICEF’s Data and Analytics Section,
3 United Nations Plaza Data, Research and Policy Division.
New York, NY 10017, USA Photograph: ©UNICEF/UNI182268/Schermbrucker
Email: childrenandaids@unicef.org
Websites: www.unicef.org/hiv Connect with us
www.childrenandaids.org United Nations Children’s Fund (UNICEF)
www.unicef.org
www.childrenandaids.org
© United Nations Children’s Fund (UNICEF)
blogs.unicef.org
December 2018
www.twitter.com/unicef_aids
www.facebook.com/unicef
www.instagram.com/UNICEF

www.google.com/+UNICEF

www.linkedin.com/company/unicef

www.youtube.com/unicef