HIV and children

How do children get HIV?

Most children in South Africa have the virus passed on to them in the womb, during birth or breastfeeding as babies. If a mother is HIV positive and receives no medical interventions to prevent transmission, there is a 25-30% chance that she will pass HIV on to her baby. However, this risk can be greatly reduced by giving the mother antiretroviral treatment during pregnancy and breastfeeding and giving the baby drugs to prevent transmission. This treatment is available in South Africa and is due to improve in April 2010. However, not all pregnant women go to clinics to get tested and get the treatment, so far more babies are still becoming HIV positive than should be.

Both boys and girls may get HIV through sexual abuse. Children are more likely to get HIV than adults if they are sexually abused. Children may also become infected if they are willingly sexually active.

A child may become infected through a blood transfusion of infected blood. However this risk is only about 1 in 400,000.

Children who care for sick adults or siblings with HIV may be exposed to infected bodily fluids. The risk of this happening is low, but the risk is increased in traditional healing practices where family members are all cut as part of the healing ritual.

How long to HIV infected children live?

Without treatment, more than 40% of children who are infected in infancy will die before their first birthday. Those who survive past their first year frequently develop moderate to severe physical and mental disabilities. However children respond very well to ART and the risk of dying is reduced to under 10% if they start treatment immediately after diagnosis.

Now that children are on ART, they are surviving into adolescence. It is unclear how long they will live for at this stage. However it is becoming clear that there is a need to set up adolescent friendly services to cater for these young people.

An example of such services can be seen at: SAFAIDSe

Are children getting the treatment they need?

No! Out of almost 300,000 children under 14 years who have HIV infection in South Africa, about 25,300 are on ART. That is less than 10%. The government is now recommending that all children below the age of 1 yr start on ART, which they then take for the rest of their life. If this is implemented, we should see almost all HIV-infected children taking ART.

Myths vs. Realities – The Road to Universal Access

The myth is that member states are strongly committed to increasing prevention, treatment and care interventions
for children, as evidenced by the targets in the 2001 and 2006 declarations. The reality is that not enough resources are reaching the local level to strengthen families and community-based approaches, which ensure vulnerable children (including children living with HIV, children who have an HIV positive parent/parents and orphaned children) have access to essential HIV services, including prevention, treatment, care and protection.

• Few countries systematically collect information on care and treatment of vulnerable children, including CD4 testing, cotrimoxazole prophylaxis or early infant diagnosis, resulting in good global data not being available. Improved monitoring and evaluation will identify good practice to guide future programming and enable closer monitoring of the implementation of policy commitments.
• Children too rarely feature in HIV programming analysis, planning, implementation and assessment.
• Although progress has been made in scaling up PMTCT, there is still an inexcusable shortfall in treatment (66 %) that is far below the agreed target; there remains a huge difference in availability of paediatric treatment
  between developed and developing countries.
• Governments, UN agencies and private sector foundations must press companies to develop and reasonably priced paediatric formulations and diagnostics, and governments must hold companies accountable and utilize compulsory licensing as necessary.
• The needs of vulnerable children, the increasing number of orphans, and the new generation of young people who were born HIV positive must be addressed in policies and programmes aimed at providing services for children.
• Child protection and children’s rights must both be fulfilled to effectively respond to the AIDS epidemic.

UNAIDS estimates that prevention, treatment and care programmes for children will require 12 percent of total AIDS expenditure between 2008 and 2010.

What is needed:

With 2.1 million children worldwide living with HIV and 15 million children under 18 having lost one or both parents to
AIDS, urgent action is needed to protect the rights and needs of all children affected by HIV and AIDS.
The “Four Ps” are critical for achieving universal access targets for children:

1. Prevent mother-to-child transmission of HIV – By 2010, offer appropriate services to 80 percent of women in need. By providing a mother with a full range of prevention of mother to child transmission (PMTCT) services, including antiretroviral (ARVs), the risk of transmission can be reduced to less than 2%.

2. Provide paediatric treatment – Provide antiretroviral treatment, cotrimoxazole or both to 80 percent of children in need. Infant-testing and treatment options must be improved, as early treatment within the first few months of life can dramatically improve the survival rates of children living with HIV.

3. Prevent infection among adolescents and young people – Reduce the percentage of young people living with HIV by 25 percent globally. Rapidly scaling-up effective and well-targeted education programmes directed towards children and young people, is critical to reducing HIV incidence and prevalence.

4. Protect and support children affected by HIV and AIDS – Provide services that reach 80 percent of children most in need. In 2008, high prevalence countries reported that only 15 percent of orphans lived in households receiving some form of external assistance, including school assistance, health care, financial support or psychosocial services.