Blog: Is UHC a fake promise for children living with HIV?

Blog: Is UHC a fake promise for children living with HIV?

By Marielle Hart, Head of Policy U.S. at Aidsfonds

Three months after the first-ever UN High-Level Meeting on Universal Health Coverage (UHC) and the adoption by world leaders of the Political Declaration on UHC(1), the theme of today’s International UHC Day is: “keep the promise”. I believe the choice for this theme is absolutely spot-on as there is a great deal left to be desired in realising good health and wellbeing for all.


The Political Declaration, which includes a long list of commitments that will guide country-level implementation of UHC, emphasises the need to leave no one behind and reach the furthest behind first. We have heard such pledges being made over and over at the different High-Level UN meetings in the past years. For example, at the 2016 High-Level Meeting on AIDS, world leaders agreed that children with HIV would be made a priority and that by 2020, there would be fewer than 20,000 new HIV infections among children.

Sadly, we are very far from reaching that target. In 2018, 160,000 children got infected with HIV. More than 90% of these infections are the result of mother-to-child transmission. In addition, nearly half of the total number of 1.7 million children living with HIV are not receiving HIV treatment. An estimated 120.000 children and adolescents died from AIDS-related illnesses in 2018.

Children Children

“Every 5 minutes, a child dies of AIDS. Children living with HIV are simply forgotten about. Treatment for a whole new generation has been neglected. We must now give top priority to effectively tracing and treating children. We must not wait any longer with the production of child-friendly medication that is affordable too.” Mark Vermeulen, Executive Director, Aidsfonds

How can we talk with a straight face about UHC and keeping the promise when we are failing so many children?  

Doesn’t that make UHC a ‘false’ promise? How can we accept the fact that UHC might face a financing gap of $176 billion in the 54 poorest countries in the world? According to the World Bank, this threatens decades-long progress on health, endangers countries’ long-term economic prospects and makes them more vulnerable to pandemic risks (2). What does this mean for the sustainability of the HIV response in this UHC era? Especially when donors withdraw from countries that have relied heavily on external funding from sources such as PEPFAR and the Global Fund? What does this mean when countries, except for the very poorest ones, are pushed to significantly reduce reliance on donors and other external resources?

Marielle Hart at the United Nations Marielle Hart at the United Nations

How will HIV services be funded in UHC?

Ensuring sufficient domestic financing for UHC is a huge challenge, given many competing health priorities for limited funds.  For HIV alone, every year, costs increase in countries heavily affected by HIV regarding prevention, case identification, linkage to care, and providing ever-larger numbers of people with life-long quality HIV treatment (3). The big question is how these services will be funded in the transition towards UHC. Covering HIV treatment for adults through a national health insurance scheme or other domestic initiatives is already hugely expensive and complicated.  Interventions that could prevent children from dying of AIDS, such as access to point of care, early infant diagnosis and pediatric treatment, are even more expensive and complex. It is very likely they will be left out from UHC basic service packages or national health insurance schemes in high-burden countries, and as a result, children will needlessly continue to die. This is unacceptable.

“Stalling HIV progress is a wake-up call to the world. Progress in stopping new HIV infections among children has stagnated, missing global targets by a wide margin. Countries have to look at why this is happening if 2020 targets are to be met.” Shannon Hader, Deputy Executive Director, UNAIDS

Stop making false promises

Today, when we are celebrating the historic commitment to achieve UHC, we should stop making false promises. Keeping the promise means political commitment from donors and domestic governments alike to make children living with and vulnerable to HIV a top priority. It means global solidarity and continued donor funding, while gaps in HIV treatment for children and access to point-of-care early infant diagnosis continue to exist. It means the recognition by all governments that UHC targets cannot be achieved without covering the full set of HIV services, including those targeting children, and accessible to everyone who needs them. Insurance schemes and other UHC funding mechanisms must be inclusive of all health interventions that prevent children from dying or getting infected by HIV in the first place.

Reaching children living with and vulnerable to HIV with these vital services should be at the core of any UHC plan. These plans should be fully costed, both through domestic and donor funding.  It is time to stop the false promises and stop failing the children. Let’s act now.


By Marielle Hart, Head of Policy U.S. at Aidsfonds

Children being forgotten in the AIDS response

Aidsfonds World AIDS Day report on 'Children being forgotten in the AIDS response' dives into the results of a research Aidsfonds conducted in six African countries (Kenya, Mozambique, Nigeria, Uganda, Zimbabwe and South Africa). The findings show a lack of adequate medical care for babies and children, so they are not being tested for HIV or this is happening too late. uses cookies to offer the best website experience possible and to anonymously analyze website behaviour. More information.