Hubert H. Humphrey, American pharmacist and 38th Vice-President of the United States once said, “…the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped.” I would go further to say that this moral test is for any civilized society — not just governments,  especially as it relates to those in the dawn of life who also find themselves living in the shadows, like children impacted by HIV. Unfortunately for them, we are failing the test with great success.

According to the annual update from the Joint United Programme on HIV/AIDS (UNAIDS) aptly titled “In Danger,” we are falling well short of the 2025 goals of the campaign to end HIV as a public health threat by 2030. In 2021, 1.5 million people were newly diagnosed with HIV, 1 million more than the 2025 target, which is still likely an underreporting of actual cases as many people didn’t have access to testing and treatment during the COVID-19 pandemic. Although new diagnoses fell from 2020, the decline of 3.6% was the smallest in 5 years. Of the 38.4 million people living with HIV in 2021, 10 million are still not receiving ART, and last year saw the lowest number of new people starting treatment in a decade. What’s most alarming is that 52% of children living with HIV aren’t on life-saving antiretroviral treatment, resulting in 1 child under the age of 15 dying every six minutes of AIDS-related illness last year.

As a clinician and public health professional, the global situation among children affected by HIV feels like a dereliction of duty, and must be held as a top priority for the HIV response. As a parent, it’s personally unacceptable and a failure on the part of adults to protect children and adolescents from a crisis that they are often born into. As a person of faith, and follower of Christ specifically, the disparity of HIV care between children and adults is downright immoral, considering Jesus’ preferential treatment of children in scripture. In the New Testament’s Gospel of Mark, Chapter 10, verses 13-16, it says that:

[13] People were bringing little children to Jesus for him to place his hands on them, but the disciples rebuked them. [14] When Jesus saw this, he was indignant. He said to them,  “Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these. [15] Truly I tell you, anyone who will not receive the kingdom of God like a little child will never enter it.” [16] And he took the children in his arms, placed his hands on them and blessed them.

God’s favor for children is evident throughout sacred texts across all faiths, not just Christianity. Communities of faith then have a moral responsibility to ‘take the children in our arms, place our hands on them and bless them’ with the HIV care that they deserve.

In a call to action, the faith community, governments, public health officials, and people living with HIV gathered in New York City alongside the United Nations General Assembly for a high-level Interfaith HIV Prayer Breakfast Thursday, September 22, 2022, just days after the announcement of the seventh replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) at a record level of $14.25 billion, the largest replenishment level to date. Hosted by the UNAIDS-PEPFAR Faith Initiative, and emceed by HVTN Faith Initiative Emeritus Rev. Edwin Sanders, the Prayer Breakfast focused on promising faith-based pediatric HIV practices to better address key gaps to end inequalities in HIV services for children.

The Interfaith Prayer Breakfast appropriately began and ended with words of prayer from Christian, Muslim, Jewish, Baháʼí, and Buddhist communities. Rev. Sanders remarked that, "The power of prayer is our greatest capacity in warding off the tyranny of low expectations." It was a meaningful reminder that we are capable beyond the limitations of our collective humanity, because we receive our help from a higher source that has high expectations for us regarding God’s little ones; therefore failure is not an option. Among the notable presenters at the event were PEPFAR Ambassador Dr. John Nkengasong, who deemed faith communities a “game changer” in the prevention of 5.5 million HIV transmissions among children over the last decade, and Winnie Byanyima, executive director of UNAIDS, who offered a keynote speech entitled “Building Partnerships for a One-Community HIV Response.”

There were presentations highlighting successful faith-based projects in sub-Saharan Africa that prioritize children and adolescents in HIV prevention, treatment, and care that I found particularly interesting and relevant to the the work of the HVTN Faith Initiative in innovating the ways we engage diverse faith communities in the U.S. The Baby Shower Initiative in Nigeria was presented by Dr. Timothy Efuntoye of CDC Nigeria as a congregational and community leadership approach to preventing parent-to-child transmission of HIV in a country that boasted the greatest number of infants living with HIV as of 2018. Fr. Richard Bauer of the Eastern Deanery AIDS Relief Program (EDARP) in Kenya celebrated another model named Operation Triple Zero (OTZ), which uses a contextual “asset-based approach” whereby adolescents in Kenya are engaged directly to commit to zero missed appointments, zero missed drugs, and zero viral load. Director Byanyima reflected in her keynote that children can’t advocate for themselves and often aren’t in the room when decisions are made about their futures, so it was refreshing to learn of OTZ that empowers young people to take responsibility for their own health outcomes.

While there were no children present at the Prayer Breakfast, we were blessed to hear the story of Loyce Maturu who was 10 years old when she lost her mother and her brother to AIDS. When she was 12, she herself became ill and was taken to the clinic where she tested positive for HIV, except she wasn’t told that she was living with HIV and was instead just given pills to take. It was only after Loyce’s health improved and she stopped taking her medicine properly that she was finally informed that she was living with HIV and she’d have to take the medicine for the rest of her life to remain well. Now an adult and fierce champion for children affected by HIV, Ms. Maturu challenged the room exclaiming, “We need more than medicines if children are to take their treatment, survive, and thrive. We need better health and psychosocial support to help us understand our condition and treatment, to learn how to grow with HIV to feel confident, valued and loved, and to be able to achieve our hopes and dreams.”

While statistics help inform our progress in the fight against HIV/AIDS, stories like Loyce’s help to transform our hearts to be compelled to do more than just medicine — because medicine isn’t enough. Let us heed Loyce’s challenge for children to never encounter HIV, and the opportunity for those living with HIV to be able to grow and feel confident, valued and loved so that they might achieve their hopes and dreams.

Challenge accepted.