Editorial
Boy children and adolescents: left off the path that ends AIDS
According to the latest UNAIDS Global AIDS Update,
The Path That Ends AIDS, 2022 saw the fewest new HIV
infections globally since the late 1980s. Countries putting
people and communities first, and investing in evidence-
based HIV prevention and treatment programmes, are
pulling down the curve and reducing new HIV infections
and AIDS-related deaths. Two unequivocal successes of
the global HIV response relate to children. First, vertical
HIV transmission during pregnancy, childbirth, or while
receiving breastfeeding is now highly preventable with
sustained maternal antiretroviral therapy (ART). Second,
some of the first children born with HIV are now reaching
their fourth decade of life on ART—unfathomable in
the early years of the epidemic. Yet, as long as HIV
transmission continues in adults, children remain HIV-
affected. The path that ends AIDS might be clear, but it is
long—especially for adolescent girls and women with HIV
and their children. And older boy children and adolescents
are left off the path entirely.
For pregnant people with HIV, ART coverage is stagnant
at 82% (lower to upper bound: 64% to 98%) globally,
contributing to the stalled progress in further reducing
new child HIV infections. Far from reaching the goal of
less than 20 000 new child infections annually, originally
set for 2020, approximately 130 000 (90 000 to 10 000)
children acquired HIV in 2022. For these children,
substantial gaps exist. While 77% of adults living with
HIV receive ART, only 57% of the 1·5 million (1·2 million
to 2·1 million) children aged 0–14 years with HIV are
accessing treatment. Approximately 81% (63% to >98%)
of children on ART in 2022 had a suppressed viral load
compared to 93% (79% to >98%) of adults on ART. And
although children only account for 4% of all people living
with HIV, 13% of all AIDS-related deaths occur in children.
Mothers with HIV largely carry the weight of
responsibility to prevent vertical HIV transmission
and the duty for their children’s treatment and care.
However, long-standing gender inequalities that result
in discrimination, marginalisation, and lack of economic
autonomy stand in their way of accessing available
HIV prevention and treatment services to support
themselves and their children. Gender equity has become
a central pillar of the global HIV response, including the
Global Alliance For Ending AIDS In Children By 2030.
Although fewer adolescent girls and young women
www.thelancet.com/child-adolescent Vol 7 September 2023
(age 15–24 years) acquired HIV in 2022 than in 2013,
their HIV prevalence remains three times higher than
Godong/Universal Images Group/
among male peers in high-prevalence settings. Efforts
and innovations around HIV prevention are right to
focus on adolescent girls and young women. Indeed,
Getty Images
programmes to promote gender equality as part of HIV
prevention efforts have predominantly addressed the
empowerment needs and rights of women and girls Published Online
July 21, 2023
only. However, a gender-equitable world where HIV is https://doi.org/10.1016/
eliminated cannot be built while ignoring almost half of S2352-4642(23)00194-3
its population, boys and men. For the 2023 UNAIDS Global
AIDS Update see https://www.
The global HIV community has begun addressing the unaids.org/en/resources/
provision and uptake of HIV services for men and the documents/2023/global-aids-
update-2023
need for promoting gender-equitable masculinity for For UNAIDS 2022 HIV estimates
the dual benefit of improving male health outcomes see https://aidsinfo.unaids.org/
and reducing infections in women and girls. But the For more about the Global
Alliance for Ending AIDS in
path to ending gender inequality should start much Children by 2030 see https://
earlier. By around 15 years of age, gender stereotypes www.unicef.org/press-releases/
new-global-alliance-launched-
are well established, and gender social norms become end-aids-children-2030
entrenched. Dominant forms of masculinity harm boys’ For more on including boys in
achieving gender equity see
physical and psychological wellbeing, and mental health
Editorial
challenges are as prevalent in adolescent boys as in girls Lancet Child Adolesc Health 2019;
3: 437
worldwide. Although health programmes campaigning
For the 2023 Gender Social
with men and boys to change norms around masculinity Norms Index see https://hdr.
are increasingly common, they tend to focus on undp.org/content/2023-gender-
social-norms-index-gsni#/
masculinities as an instrument in gender relations. indicies/GSNI
Successful programmes are those that include practical
elements for boys and young men’s own development,
such as economic strengthening skills, and avoid casting
boys and young men as “the problem”.
In HIV-prevalent settings, children often grow
up in fragile and violent domestic and community
circumstances. Acknowledging how boys and
young men’s gender roles are influenced by difficult
environments is not denying the impact of harmful
gender social norms on girls and women. The path that
will end AIDS is one that meets the needs and rights
of children and adolescents of all genders—too many
remain caught at intersections of multiple structural
inequalities and social injustices that put children and
adults at risk of acquiring HIV. Providing safety and
support to children and adolescents of all genders is
imperative to realise a future generation where social,
economic, racial, and gender equity prevail, and HIV is
eliminated. ■ The Lancet Child & Adolescent Health
599