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An HIV-free generation is closer than you think

The effort to protect babies from HIV is working. It’s also in danger.

Ismail Harerimana grew up in Uganda not knowing why he was always sick.

His childhood in the 1990s was a string of recurrent infections: malaria, diarrhea, headaches, and skin rashes. By 14, he was scarily thin, at which point doctors put him on a new medication that seemed to help. It was for kidney disease, his father falsely told him. But a classmate with the same prescription knew better. “Are you also suffering from kidney disease?” Harerimana remembers asking him. “And the boy said, ‘No — I’m suffering from AIDS.’”

In theory, no baby should be born with HIV in 2026. But almost 120,000 children are still infected with HIV each year, normally during pregnancy, childbirth, or breastfeeding.

The world has made tremendous strides in reducing children’s HIV infections in recent decades, but many parents still lack access to the HIV testing and prenatal care they need to keep their babies safe.

USAID made much of this progress possible. With US funding for HIV prevention in flux, the world’s hard-earned wins against childhood HIV could be in jeopardy.

New advancements in prevention and care mean an HIV-free generation is genuinely within reach — but only if families can access them.

In the 1990s, at the height of the AIDS crisis in Uganda, hundreds of thousands of babies like Harerimana were born with HIV each year, contracting the virus from their HIV-positive parents in utero, during childbirth, or while breastfeeding. About half did not live to see their second birthday.

But those outcomes have changed in radical, often remarkable ways over the past three decades. In some parts of Uganda, as many as one in four infants were once infected with HIV at birth, leading to 32,000 new childhood HIV infections annually in the mid-1990s. Today, that infection rate has plummeted to fewer than 5,000.

This changed because Uganda — along with much of the world — has diligently perfected the simple interventions needed to keep babies safe from the virus: repeated HIV testing for all expectant parents, and widely available anti-retroviral therapies for those who test positive, which makes the virus virtually untransmittable. In some countries, Botswana among them, new childhood infections are now so exceedingly rare that every new baby born with HIV prompts a comprehensive federal audit.

“I’m filled with hope because now, as Africans, we’re not asking whether elimination is possible,” said Doris Macharia, president of the Elizabeth Glaser Pediatric AIDS Foundation. “We are actually confronting what it will take to finish this job. That is profound. That is progress. And that’s where we should be.”

But finishing the job would mean building a world where no babies are born with HIV at all, and many African countries with the highest HIV burdens remain far from that goal. About 120,000 children are still newly infected with HIV each year, most of them before or shortly after birth, accounting for nearly 10 percent of all new infections. That’s one child every four and a half minutes.

Thanks to advancements in treatments, even babies born with HIV today can go on to live long, healthy, happy lives. But it is more difficult, because the same barriers that prevent their parents from getting on treatment while pregnant mean that many of their children struggle to access care. As a result, roughly 75,000 kids die from AIDS-related causes each year, typically before their fourth birthday. That is almost definitely an undercount, as it likely excludes many of the roughly 34 percent of children living with HIV who are never accurately diagnosed.

Reaching these kids is what Macharia calls the last mile in preventing childhood HIV. It is also the hardest to cross — and particularly so now. Cuts to foreign assistance from the US and other countries have hampered progress, and in some harrowing cases, even reversed it. A projection by UNAIDS found that sustained aid cuts could lead to 1.1 million additional HIV infections in children between 2024 and 2040, and 820,000 more deaths.

Harerimana, who has found his calling as a community health worker, is already seeing some of those dire scenarios play out. For the first time in years, he’s seen an uptick in babies being born with HIV in his town.

“It takes me back to those days,” he said, “when there was no access to medication, where there was no access to research,” there was only “a disease everyone fears, a disease that has no concrete cure.”

Regression is not inevitable. Even the Trump administration — which deeply destabilized global HIV services last year — has supported the rollout of Lenacapavir, a potentially game-changing HIV prevention drug, for expectant parents at risk of HIV. Stopping babies from being born with HIV is, after all, about as sympathetic........

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