‘Getting to Zero’: The policy role of social determinants of health as they relate to children and youth living with HIV in sub-Saharan Africa Sara Belton a, ⁎, Morten Skovdal b,c a Institute of Social Psychology, London School of Economics and Political Science, United Kingdom b Department of Public Health, University of Copenhagen, Copenhagen, Denmark c Save the Children, London, United Kingdom abstract article info Available online 4 April 2014 Keywords: Policy UNAIDS Health services HIV AIDS Children Youth Families Major changes in UNAIDS international policy and treatment guidelines from 2010 to 11 still need to be corre- spondingly translated into policy and practice at national and local in-country levels. This special issue has drawn on social determinants of health (SDH) perspective to investigate how better to provide HIV and health services to affected children and youth. The articles featured here give examples of how a SDH perspective not only supports flexible and coordinated in-country service provision, but also fits well with UNAIDS' broader policy goals for the eradication of HIV and AIDS through the “Getting to Zero” policy campaign. We call for the widespread adoption of a SDH-based framework for policy, programming, and funding at all levels, to advance the UNAIDS policy goals of increased HIV service usage and decreased HIV rates in children and youth, as well as in all populations globally. © 2014 Elsevier Ltd. All rights reserved. 1. Introduction 1.1. Rationale for special issue This special issue was developed from the conference “Growing up with HIV in Africa,” held at the London School of Economics and Political Science, London, UK, in March, 2013, which brought together over 40 researchers and academics from 11 different countries who work in pe- diatric HIV/AIDS. The rationale for hosting this conference came out of research that suggests that children are a vastly underserved population affected by HIV/AIDS, despite pediatric medication being on the global market for over 20 years and increasingly available in most low- income countries (UNICEF, 2013). Whilst acknowledging that structural and materiel barriers are often the cause of such access problems (Barnett & Whiteside, 2006; Seeley et al., 2012), research also suggests that non-logistical barriers linked to the social landscape are also signif- icant factors (Campbell, 2003; Campbell & Cornish, 2010), as access rates for children's HIV services are roughly half that of adults, not only in African countries, but globally (UNICEF, 2013). The conference and special issue therefore sought to examine the lived experiences of children and youth against current research and practices in the field, to take stock of where current practice is, and where it should be head- ing, to better serve children and their families and increase the uptake of HIV services overall. As the aim of current UNAIDS (2010) global policy is “Getting to Zero” in terms of new HIV infections, discrimination, and barriers to treatment, there are not only practice concerns to be consid- ered, but policy implications as well. 1.2. Current state of global HIV/AIDS policy In 2010, UNAIDS (2010) and WHO (2011a) announced new HIV/ AIDS treatment guideline revisions, which called for the early introduc- tion of anti-retroviral drugs (ART) in the treatment regime of people liv- ing with HIV, as recent research demonstrated improved day-to-day health and long-term survival rates with earlier initiation of drug treat- ment. Since then, HIV treatment guidelines and protocols continue to be further revised for adults and children, with a corresponding need to in- crease access and adherence to ART medication as outlined in the cur- rent “Treatment 2.0” initiative (WHO, 2013, 2011b). UNAIDS global policy was also changed (2010), with current policy for 2011–2015 ad- vocating a massive scale-up of HIV testing and drug treatment, known as the “Getting to Zero” campaign. It can be considered the most ambi- tious policy response to the HIV/AIDS pandemic to date, as it calls for zero new HIV infections, zero AIDS-related deaths, achieved partly through an 80% ART coverage rate, and a commitment to work towards achieving zero rates of HIV-related discrimination (WHO, 2013, 2011b). Given these lofty goals, it has become clear that practice and policy will have to evolve, to facilitate such a massive response. UNAIDS argues that “Getting to Zero” will require a multifaceted approach, which inherently recognizes HIV as both a biomedical and a social disease, and which re- quires interventions at multiple levels with multiple stakeholders, Children and Youth Services Review 45 (2014) 160–163 ⁎ Corresponding author at: Department of Social Psychology, London School of Economics and Political Science, WC2A 2AE London, United Kingdom. E-mail address: s.k.belton@lse.ac.uk (S. Belton). http://dx.doi.org/10.1016/j.childyouth.2014.03.043 0190-7409/© 2014 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth