Africa: The AIDS Response Saved Millions of Children. We Cannot Abandon It Now.

For over four decades, the global AIDS response has been powered by grief, rage, courage, and determination. Families buried loved ones long before their time. Communities confronted discrimination and built networks of care when the silence was deafening. Scientific breakthroughs and community-driven innovation transformed HIV from a near-certain death sentence into a chronic, manageable condition. The result was one of the greatest public health achievements of the past half century. That success is now under threat.

The progress was extraordinary. Since 2010, AIDS-related deaths among children dropped by 69 per cent. The number of adolescent girls acquiring HIV has been cut in half. Twenty-two countries have eliminated vertical transmission of HIV. Last year, the Maldives became the first country to eliminate HIV, syphilis, and hepatitis B as public-health threats - a milestone that once seemed unimaginable. Many others were on track to follow, so long as the world stayed the course.

Then came the shock

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In 2025, abrupt funding cuts undermined the very systems that made this progress possible. Prevention efforts stalled. Pharmacies ran out of essential medicines. Health workers were laid off. Systems that had taken decades to build began to unravel in a matter of months. Community activists experienced the fallout firsthand: Florence Riako Anam, of the Global Network of People

Living with HIV, told me of overwhelmed outpatient departments and chaos which pushed mothers and young people away from care. So dangerous, because children's invisibility in the HIV

response predated this disruption. Even before the cuts, 200 children were still dying every day from AIDS-related causes.

Deadly consequences

A devastating Cost of Inaction analysis from UNICEF and UNAIDS underscored what is at stake. If there is a 50 per cent reduction in HIV interventions for treatment and prevention, we could face a worst-case scenario of three million children acquiring HIV by 2040 and 1.8 million children dying from AIDS-related causes, the majority in sub-Saharan Africa. But it was never data points that moved the world to confront HIV. It was people. Courageous mothers who demanded something be done to protect their children, and brave people living with HIV whose voices forced governments and the UN to listen, fund and provide services. This week, as political leaders gather at the UN Headquarters to assess the global HIV response, we face another defining moment. The question is, will the outcome once again be shaped by the realities of those most affected, or will the final declaration drift into the realm of symbolic commitments?

What's at stake is not abstract. Today, more than 2.4 million children and adolescents live with HIV, yet only 55 per cent are on lifesaving treatment – far behind the 78 per cent of adults. In many parts of Africa, AIDS is still a leading cause of death among adolescents.

We know what works

We have the tools, the science, and the knowledge. Expanding proven interventions could prevent more than half a million deaths.

What works is making sure new medical breakthroughs reach those who need it. Young women and girls are six times more likely to acquire HIV than boys. Lenacapavir, which offers protection with just two injections a year, makes it easier to stay protected from HIV. Two injections a year can also be used safely by pregnant and breastfeeding women, protecting both mothers and their babies. Their access must be non-negotiable. What works is investing in communities, especially young people, who are driving peer-to-peer outreach, using digital tools to spread information, and demanding stigma-free services.

Lethokuhle, a young mother in South Africa, described how mentor mothers transformed her experience at the clinic: "They asked about my life. They listened. They made me feel confident -

as a person and as a mother."

Sometimes, what works is going back to basics. In Tanzania, treatment advocates went door-to-door, checking on families, asking about the health of children, offering nutrition checks, and accompanying caregivers for HIV testing. They found children who were living with HIV but undiagnosed. Every single child who tested positive was linked to treatment. That is what ending

AIDS in children looks like.

Scientific breakthroughs matter. Community action matters. Systems that connect the two, matter even more. Zimbabwe has shown what this looks like at scale, creating a national curriculum for Young Mentor Mothers and formally integrating them into the health system. These are the kinds of choices that save lives. But no country can carry this burden alone.

Declarations must be judged by one measure alone: lives saved.

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The measure of effectiveness for this new Political Declaration is simple: Will children be protected from HIV? Will mothers receive the care they need? Will adolescent girls be allowed to grow up without the shadow of HIV narrowing their futures? If the answer is yes, then the declaration will matter. If not, it will be another missed opportunity.

At no point in history have we come closer to ending AIDS in children. Let's not squander that progress and risk the unravelling of hard-won progress. If we choose action over complacency, investment over indifference, and courage over caution, we can reach the only measure that counts: lives saved.

The High-Level meeting on AIDS – held every five years since 2001 at the UN – is a formal summit convened by the United Nations General Assembly that brings together world leaders, civil society, and health experts to review progress and set global strategies to fight the epidemic. The Political Declaration is the official, negotiated outcome document adopted by UN member states at the end of this meeting. It outlines specific, measurable targets, financial commitments, and human rights goals necessary to end AIDS as a public health threat.