The Joint United Nations Programme on HIV/AIDS (UNAIDS) has said almost half of the world's 1.7 million children living with HIV (46%) did not get treatment in 2020.
It also said 150, 000 children were newly infected with HIV, four times more than the 2020 target of 40, 000.
In the final report from the "Start Free, Stay Free, AIDS Free" initiative, UNAIDS and partners warned that progress towards ending AIDS among children, adolescents and young women has stalled and none of the targets for 2020 were met.
It added that the new report revealed stark inequalities in access to HIV prevention and treatment services for children.
In a joint press statement issued in Geneva, Switzerland on July 21, by UNAIDS and partners, it said the new report showed that "the total number of children on treatment declined for the first time, despite the fact that nearly 800 000 children living with HIV were currently not on treatment.
"It also shows that opportunities to identify infants and young children living with HIV early are being missed - more than one third of children born to mothers living with HIV were not tested. If untreated, around 50% of children living with HIV die before they reach their second birthday," it said.
According to UNAIDS Deputy Executive Director, Shannon Hader, the initiatives for families and children to prevent vertical transmission and to eliminate children dying of AIDS started 20 years ago but despite early and dramatic progress, despite more tools and knowledge than ever before, children are falling way behind adults and way behind.
"The inequalities are striking--children are nearly 40% less likely than adults to be on life-saving treatment (54% of children versus 74% of adults), and account for a disproportionate number of deaths (just 5% of all people living with HIV are children, but children account for 15% of all AIDS-related deaths). This is about children's right to health and healthy lives, their value in our societies.
It's time to reactivate on all fronts--we need the leadership, activism, and investments to do what's right for kids," he said.
The UNAIDS report said, 11 countries account for nearly 70% of the "missing children"--those living with HIV but not on treatment, adding that there was a 24% decline in new HIV infections among children from 2015 to 2020 in focus countries versus a 20% decline globally.
"Focus countries also achieved 89% treatment coverage for pregnant women living with HIV, compared to 85% globally, but still short of the target of 95%, and there were huge differences between countries. For example, Botswana achieved 100% treatment coverage, yet the Democratic Republic of Congo only reached 39%.
"While we are deeply distressed by the global paediatric HIV shortfalls, we are also encouraged by the fact that we largely have the tools we need to change this," said Angeli Achrekar, Acting United States Global AIDS Coordinator, who added: "So, let this report be a call to action to challenge complacency and to work tirelessly to close the gap.
"The report outlines three actions necessary to end new HIV infections among children in the focus countries. First, reach pregnant women with testing and treatment as early as possible--66 000 new HIV infections occurred among children, because their mothers did not receive treatment at all during pregnancy or breastfeeding.
"Second, ensure the continuity of treatment and viral suppression during pregnancy, breastfeeding and for life--38 000 children became newly infected with HIV because their mothers were not continued in care during pregnancy and breastfeeding. Third, prevent new HIV infections among women, who are pregnant and breastfeeding--35 000 new infections among children occurred because a woman became newly infected with HIV during pregnancy or breastfeeding."
Start Free, Stay Free, AIDS Free is a five-year framework that began in 2015, following on from the hugely successful Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive.
It called for a super Fast-Track approach to ensure that every child has an HIV-free beginning, that they stay HIV-free through adolescence and that every child and adolescent living with HIV has access to antiretroviral therapy.
The approach intensified focus on 23 countries, 21 of which were in Africa, that accounted for 83% of the global number of pregnant women living with HIV, 80% of children living with HIV and 78% of young women aged 15-24 years newly infected with HIV.