ABSTRACT Introduction The global community proved remarkably resilient in protecting the progress in and commitment to eliminating HIV in children in the face of the COVID‐19 pandemic. However, sudden disruptions in 2025 in donor support for HIV assistance have posed new and existential threats to the hard‐fought gains in global paediatric HIV control. Discussion Since the early 2000s, the reductions in paediatric HIV acquisitions, in deaths in children with HIV and in the number of children orphaned by HIV/AIDS have been breathtaking, but in recent years, progress has stalled, and gaps remain. The disruptions in political and financial support from the U.S. government obligate us to reframe our plans for ending HIV as a threat to children and also enable us to implement overdue changes in strategy to overcome barriers to success. Pillars for success include: robust integration of HIV into strengthened general healthcare systems; reassertion of national government leadership; prioritizing reduced donor funding for research and innovation; stronger partnership between private sectors and public health programmes; amplified community voices; and bold determination and creative solutions from global paediatric HIV stakeholders. Conclusions The time is right for the global paediatric HIV community to consider the key factors that have enabled the tremendous progress towards ending the threat of HIV in children, the critical barriers to overcoming remaining gaps and a framework no longer so dependent on donor support for getting back on the path to eliminating HIV in children. The diverse and talented global HIV stakeholder coalition will find the opportunities for transformation and innovation in paediatric HIV care and boldly chart a lasting, evidence‐based, person‐centred, community‐informed, national health system‐aligned path to ending HIV as a threat to children.
George K. Siberry (Mon,) studied this question.