Introduction
The Regional Inter-Agency Task Team on Children and AIDS in Eastern and Southern Africa (RIATT-ESA) participated in the 23rd International Conference on AIDS and STIs in Africa (ICASA 2025), held at the Accra International Conference Centre in Accra, Ghana, from 3 to 8 December 2025. ICASA remains Africa’s premier platform for advancing dialogue, knowledge exchange, and policy influence on HIV, AIDS, tuberculosis, sexually transmitted infections, and broader health and development issues affecting the continent.
RIATT-ESA’s participation aligned with its mandate as a regional knowledge management, advocacy, and partnering network established in 2006 to ensure that the rights, needs, and priorities of children and adolescents affected by HIV are fully integrated into global, regional, and national HIV and social welfare responses in Eastern and Southern Africa (ESA).
About RIATT-ESA
RIATT-ESA is a regional network comprising 44 member organisations, including regional economic communities (SADC, EAC, AUC), United Nations agencies, civil society organisations, academic institutions, and bilateral donors. The network operates through three Technical Working Groups (TWGs): Advocacy; Social Protection; and Care and Support. These TWGs provide strategic leadership in influencing policy, strengthening service delivery, generating evidence, and building regional solidarity around children and AIDS.
The vision of RIATT-ESA is universal access to prevention, treatment, care, and support for all children and adolescents affected by HIV in Eastern and Southern Africa.
Purpose of Participation at ICASA 2025
RIATT-ESA’s participation at ICASA 2025 aimed to:
• Elevate regional concerns regarding the growing crisis of antiretroviral (ARV) shortages and funding disruptions affecting children and adolescents in ESA;
• Contribute evidence-informed perspectives to continental discussions on sustainable HIV and SRH financing;
• Strengthen partnerships with regional and international stakeholders;
• Advocate for child- and adolescent-centred, HIV-sensitive social protection and health systems.
A key highlight of RIATT-ESA’s engagement at ICASA 2025 was the hosting of a satellite session focused on safeguarding children and adolescents amidst ARV shortages and HIV–SRH programme disruptions in the ESA region.
RIATT-ESA Satellite Session at ICASA 2025
4.1 Session Details
• Title: Safeguarding Children and Adolescents amidst ARV Shortages and HIV-SRH Program Disruptions in Eastern and Southern Africa
• Date: Friday, 5 December 2025
• Time: 08:45 – 09:30 am
• Format: Study presentations
4.2 Background and Rationale
Eastern and Southern Africa remains the epicentre of the global HIV epidemic, with children and adolescents bearing a disproportionate burden of new infections, treatment gaps, and HIV-related morbidity and mortality. Over the past two decades, significant progress in HIV treatment, prevention, and care has been made largely due to sustained global financing, particularly funding from the United States Government and other international donors.
However, recent reductions in donor funding have resulted in widespread ARV shortages and serious disruptions to HIV and sexual and reproductive health (SRH) programmes across the region. These challenges pose a significant threat to the sustainability of HIV responses and risk reversing hard-won gains, particularly for children, adolescents, and adolescent girls and young women.
Treatment interruptions increase the likelihood of drug resistance, treatment failure, morbidity, and mortality among children and adolescents living with HIV. At the same time, disruptions in integrated HIV–SRH services further exacerbate vulnerabilities among adolescent girls and young women, who already face structural, social, and economic barriers to accessing comprehensive and youth-friendly health services.
The crisis underscores the risks associated with overreliance on external donor funding and highlights the urgent need for innovative, sustainable, and locally driven solutions to safeguard the health and wellbeing of children and adolescents in ESA.
Objectives of the Satellite Session
The specific objectives of the RIATT-ESA satellite session were to:
• Analyse the impact of ARV shortages and funding disruptions on HIV–SRH services for children and adolescents in Eastern and Southern Africa;
• Identify innovative and sustainable financing mechanisms to reduce dependency on external donor funding;
• Explore alternative service delivery models and community-driven approaches to ensure continuity of HIV and SRH care;
• Strengthen regional advocacy for child- and HIV-sensitive social protection and health systems.
6. Panel Composition and Partnerships
The session was delivered through a collaborative partnership involving RIATT-ESA and key regional and institutional partners, including:
• Eastern Africa National Networks of AIDS and Health Service Organisations (EANNASO);
• Paediatric-Adolescent Treatment Africa (PATA);
• Health Economics and HIV/AIDS Research Division (HEARD);
• Academic experts from the University of the Free State (South Africa);
• Academic and clinical experts from the University of Lubumbashi (Democratic Republic of Congo).
The diverse panel brought together perspectives from regional networks, civil society, academia, and clinical practice, enriching the discussion with evidence, field experience, and policy insights.
Key Discussion Points
7.1 ARV Shortages and Treatment Disruptions
Presenters highlighted the growing incidence of ARV stock-outs in several ESA countries, driven by reduced donor funding, transitions to lower-middle-income status, supply chain inefficiencies, and domestic financing constraints. Particular concern was raised regarding the impact on children and adolescents, who are more vulnerable to treatment interruptions and less able to navigate fragmented health systems.
7.2 Disruptions in HIV–SRH Integration
The session underscored that funding cuts and systemic shocks, including the COVID-19 pandemic, have stalled progress in integrating HIV and SRH services. Despite progressive national policies, implementation gaps persist, leaving adolescent girls and young women at heightened risk of HIV infection, unintended pregnancies, and poor SRH outcomes.
7.3 Innovative and Sustainable Solutions
The discussion explored promising practices and solutions, including:
• Community-based and differentiated service delivery models to decongest health facilities and maintain continuity of care;
• Peer-supported interventions and adolescent-friendly service platforms;
• Technology-driven quality improvement approaches;
• Locally driven financing mechanisms such as pooled procurement, regional health levies, and increased domestic budget allocations for HIV and SRH;
• Strengthened HIV–SRH integration tailored to the needs of adolescents and young women.
Outcomes of the Session
The satellite session achieved the following outcomes:
• Enhanced shared understanding of the scale and implications of ARV shortages and funding disruptions for children and adolescents in ESA;
• Identification of evidence-based and contextually relevant recommendations for sustainable financing and innovative service delivery models;
• Strengthened partnerships among regional networks, academia, and civil society actors;
Overall Reflections and Way Forward
RIATT-ESA’s participation at ICASA 2025 provided a critical platform to amplify the voices of children and adolescents within continental HIV and SRH discourse. The satellite session reinforced the urgency of transitioning from donor-dependent models towards resilient, locally anchored health and social protection systems.
Going forward, RIATT-ESA will leverage the outcomes of ICASA 2025 to strengthen regional advocacy, support evidence-informed policymaking, and promote sustainable solutions that safeguard the rights and wellbeing of children and adolescents affected by HIV in Eastern and Southern Africa.
