Dear Ambassador Birx,
Congratulations on your recent confirmation as U.S. Global AIDS Coordinator. I look forward to continuing our work with you to ensure that children and their families have access to critical HIV prevention, care and treatment services through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
One of the most powerful testaments to the United States' commitment to ending the AIDS pandemic has been its efforts around children. It is in that vein that I write to you today asking that you set aggressive targets to reach HIV-positive children with lifesaving treatments as part of the global treatment target-setting exercise President Obama cited in his World AIDS Day 2013 remarks and bilateral targets required under PEPFAR legislation enacted last year.
Children continue to be left behind when it comes to HIV treatment access. Globally, 3.2 million children are living with HIV, yet only 647,000 have access to antiretroviral therapy (ART). As you know, this is a matter of life and death for these children - without ART, half of children born with HIV die by the age of two, and 80 percent die by the age of five. The World Health Organization (WHO)'s 2013 guidelines for treating HIV-infected children reinforce the need to reach children as early as possible, recommending immediate initiation of ART for all HIV-positive children younger than five.
Since inception of the PEPFAR program, HIV treatment targets have challenged the U.S. global HIV/AIDS response to continuously expand and improve how it delivers services to the people who need them. Congress reaffirmed the power of targets in the PEPFAR Stewardship and Oversight Act of 2013, instructing your office to establish and report on separate annual targets for children and adults under PEPFAR.
PEPFAR's strong and steady leadership is largely responsible for the historical gains made in eliminating new pediatric HIV infections, and that bold leadership can also ensure that the millions of children living with HIV and AIDS get the medicines they need to survive and thrive.
We urge you to push for meaningful, data-driven pediatric treatment targets as part of congressionally mandated PEPFAR bilateral targets and as a part of the global HIV/AIDS target setting process currently underway. We ask that as part of these efforts you consider pediatric treatment targets that address patient outcomes - such as adherence and retention - not just initiation of ART. In addition, analyzing the needs of different age and gender groups within the pediatric population is critical to understanding and addressing barriers to beneficiary access and uptake. For example, an infant in need of HIV testing and treatment services faces significantly different barriers and challenges than an older child or an adolescent. Therefore, we ask that you also prioritize collection and disaggregation of pediatric HIV treatment data by gender and age to monitor how programs are being implemented and ensure effective and equitable treatment access.
Simply put, we can lay the foundation of an AIDS-free generation by ending AIDS in children. I thank you for your ongoing commitment to children living with and affected by HIV and AIDS, and urge you to put the full weight of your office behind strong bilateral and global pediatric HIV treatment targets.
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