Reauthorise PEPFAR to prevent death, orphanhood, and suffering for millions of children.
Reauthorise PEPFAR to prevent death, orphanhood, and suffering for millions of children.
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重新授权总统防治艾滋病紧急救援计划（PEPFAR），以防止数百万儿童死亡、成为孤儿和遭受痛苦。
DOI：
10.1016/s0140-6736(23)01723-3
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Cluver L
中科院分区：
文献类型：
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作者：
Cluver L
作为艾滋病毒、艾滋病和儿科健康的研究人员，没有什么比保护儿童的生命更重要。考虑到目前对美国总统艾滋病紧急救援计划（PEPFAR）5年重新授权的挑战，我们使用了2023年联合国艾滋病规划署对艾滋病孤儿、婴儿和幼儿艾滋病毒感染率以及成人和儿童艾滋病死亡率的估计，以估计PEPFAR对儿童生存和健康的影响。我们把重点放在撒哈拉以南非洲地区：该地区获得了PEPFAR资金的90%以上，并拥有三分之二的艾滋病毒感染者。我们注意到，总统艾滋病紧急救援计划通过全球抗击艾滋病、结核病和疟疾基金（总统艾滋病紧急救援计划是该基金的最大捐助者）、各国政府、联合国艾滋病规划署和其他联合国机构并与之合作提供支持。总统艾滋病紧急救援计划大大扭转了艾滋病毒和艾滋病对新近成为孤儿的儿童的破坏性影响（图A）。失去父母与教育损失、虐待儿童和儿童性剥削有关，从而增加了感染艾滋病毒的风险。2利用艾滋病规划署的数据，我们通过对前一年的艾滋病流行率和成人（15 - 49岁）艾滋病死亡率进行回归，估计了总统艾滋病紧急救援计划前后每年因艾滋病而成为孤儿的儿童人数。撒哈拉以南非洲的孤儿发病率自1990年以来迅速上升，2004年达到高峰，有160万儿童（18岁以下）因艾滋病成为孤儿。今年，PEPFAR开始通过向撒哈拉以南非洲的28个国家大规模推广抗逆转录病毒药物来防止父母死亡。从2005年开始，艾滋病致孤人数逐年减少，到2021年将减少到38.2万人。联合国艾滋病规划署的数据显示，撒哈拉以南非洲地区仍有1 030万艾滋病致孤儿童需要支助（图B）。在全球范围内，有1390万儿童成为孤儿，没有一方或双方死于艾滋病的父母，还有750万儿童因COVID-19相关的超额死亡而成为孤儿。3总统艾滋病紧急救援计划双边资金的10%专门用于照顾孤儿和弱势儿童，
As researchers on HIV, AIDS, and paediatric health, nothing is more central to our work than preserving children’s lives. Considering the current challenge to the 5-year reauthorisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR), 1 we used 2023 UNAIDS estimates on the prevalence of children orphaned by AIDS, infant and young child HIV-infections, and incidence of adult and child AIDS deaths to estimate PEPFAR’s effect on child survival and health. We focused on sub-Saharan Africa: the region receiving more than 90% of PEPFAR funds and containing two-thirds of all people with HIV. We note that PEPFAR provides support through and in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (to which PEPFAR is the largest donor), national governments, UNAIDS, and other UN agencies. PEPFAR has substantially reversed the devastating effects of HIV and AIDS on children who are newly orphaned (figure A). Loss of a parent is associated with education loss, child abuse, and child sexual exploitation, with consequent elevated risks of HIV infection. 2 Using UNAIDS data, we estimated the number of children who were newly orphaned by AIDS annually before and after PEPFAR by regressing orphanhood prevalence on previous-year orphanhood prevalence and adult (aged 15–49 years) AIDS deaths. Incidence of orphanhood in sub-Saharan Africa increased rapidly from 1990, reaching a peak of 1· 6 million children newly orphaned by AIDS (aged< 18 years) during 2004. In this year, PEPFAR began to prevent parental deaths via a massive roll-out of antiretroviral agents to 28 countries in sub-Saharan Africa. From 2005, the incidence of orphanhood due to AIDS has reduced annually to 382 000 in 2021.UNAIDS data show that 10· 3 million children orphaned by AIDS in sub-Saharan Africa remain in need of support (figure B). Globally, 13· 9 million children are orphaned, living without one or both parents who have died of AIDS, alongside 7· 5 million children orphaned due to COVID-19-associated excess deaths. 3 10% of PEPFAR's bilateral funding is dedicated to care of orphaned and vulnerable children,