HIV, Aids and Child

Hundreds of thousands of children across the world become infected with HIV every year and, without treatment, die as a result of AIDS. In addition, millions more children who are not infected with HIV are indirectly affected by the epidemic, as a result of the death and suffering that AIDS causes in their families and their communities.

Preventing children from becoming infected and mitigating the impact of HIV and AIDS should be straightforward. However, a lack of necessary investment and resources including adequate testing, antiretroviral drugs and prevention programmes as well as stigma and discrimination mean children will continue to suffer the consequences of the epidemic.

The number of infected children

The figures below show the number of children (defined by UNAIDS as under-15s) directly affected by HIV and AIDS:

• At the end of 2008, there were 2.1 million children living with HIV around the world.¹
  
• An estimated 430,000 children became newly infected with HIV in 2008.²
  
• Of the 2 million people who died of AIDS during 2008, more than one in seven were children. Every hour, around 31 children die as a result of AIDS.³
  

Most children living with HIV – around 9 out of 10 – live in Sub-Saharan Africa, the region of the world where AIDS has taken its greatest toll. Large numbers of children with HIV also live in the Caribbean,Latin America and South/South East Asia.⁴ Around 90% of all children living with HIV acquired the infection from their mothers during pregnancy, birth or breastfeeding.⁵

Many countries that had previously seen child-survival rates rise, as a result of improved healthcare, are now seeing these rates fall again. It has been estimated that without AIDS, Botswana's under-5 mortality rate would have been 31 per 100,000 in 2002 compared to 107 with AIDS. By 2010, the country's under-5 mortality is expected to have increased by 100 deaths per 100,000 as a result of AIDS. Most regions of the world, including African regions, have seen a decline in child mortality but in Southern Africa, the area most affected by HIV, under-5 mortality has increased.⁶

In Africa, studies suggest that one in three newborns infected with HIV die before the age of one, over half die before reaching their second birthday, and most are dead before they are five years old.⁷ Conversely, in developed countries, preventive measures ensure that the transmission of HIV from mother to child is relatively rare, and in those cases where it does occur, a range of treatment options means that the child can survive – often into adulthood. This shows that with funding, trained staff and resources, the infections and deaths of many children in lower-income countries might easily be avoided.

Children affected by AIDS

It can be argued that every child growing up in an area with high HIV prevalence is affected by the epidemic regardless of whether they, or a close family member, are infected.

HIV can damage a child's life in three main ways: through its effects directly on the child, on that child's family, and on the community that the child is growing up in.

The direct effects of HIV on children

• Many children are themselves infected with HIV
  

The effects of HIV on a child's family

• Children live with family members who are infected with HIV.
  
• Children act as carers for sick parents who have AIDS.
  
• Many children have lost one or both parents to AIDS, and are orphaned.
  
• An increasing number of households are headed by children, as AIDS erodes traditional community support systems.
  
• Children end up being their family's principal wage earners, as AIDS prevents adults from working, and creates expensive medical bills.
  

The effects of HIV on a child's community

• As AIDS ravages a community, schools lose teachers and children are unable to access education.
  
• Doctors and nurses die, and children find it difficult to gain care for childhood diseases.
  
• Children may lose their friends to AIDS.
  
• Children who have HIV in their family may be stigmatized and affected by discrimination.
  

Becoming infected with HIV

The problems for children

Mother-to-child-transmission of HIV accounts for the vast majority of children who are infected with HIV. If a woman already has HIV then her baby may become infected during pregnancy or delivery. HIV can also be transmitted through breast-milk.

An HIV positive mother with her HIV positive child in the township of Joza

Aside from mother-to-child transmission, some children are exposed to HIV in medical settings; for instance, through needles that have not been sterilised or blood transfusions where infected blood is used. In wealthier countries this problem has virtually been eliminated, but in resource-poor communities it is still an issue. For older children, sexual activity and drug use present a risk.

Sexual transmission does not account for a high proportion of child infections but in some countries children are becoming sexually active at an early age. This is potentially conducive to the sexual spread of HIV among children especially in areas where condom use is low. In Sub-Saharan Africa 16% of young females (aged 15-19) and 12% of young males report having sex before they were 15. In Lesotho, these figures are 16% and 30%, respectively; in Kenya, 15% and 31%.⁸

In some cases children have become infected with HIV through sexual abuse and rape. This is a significant problem in many areas. For instance, in parts of Africa, the myth that HIV can be cured through sex with a virgin has led to a large number of rapes – sometimes of very young children – by infected men.⁹ In some cases, young children are coerced into sex work, which can put them at a very high risk of becoming infected with HIV.

Helping children

The main way to stop children becoming infected is to prevent mother-to-child-transmission (MTCT) of HIV. MTCT is almost entirely avoidable, given appropriate interventions. These measures (which include giving antiretroviral drugs to a mother during pregnancy, and to her child once it is born) can reduce the risk of MTCT from 20-45% to less than 2%. In developed countries, such interventions have minimised the number of children being born with HIV.

Unfortunately, prevention of mother-to-child-transmission (PMTCT) services fail to reach most women in resource-poor countries. In 2008, around 45% of HIV-infected pregnant women in low- and middle-income countries received drugs to protect their babies from infection.¹⁰ Reasons for this lack of coverage are discussed in our PMTCT worldwide page, while our Stop AIDS in Children campaign calls for rapid improvement.

The use of sterile medical equipment and screened blood products can help to prevent children becoming infected through medical transmission. In Romania, more than 10,000 new babies and young children were infected with HIV from contaminated injections and unscreened blood transfusions between 1987 and 1991. This illustrates not only how vulnerable children are to infection in a medical setting, but also how a country can respond to these problems. The large number of HIV-positive children in Romania prompted the government to roll out antiretroviral treatment, which today reaches almost all of those in need. Sterile medical equipment is used, and blood-products are now screened for HIV.¹¹

Where children are becoming infected through non-MTCT routes, abstaining from sex or injecting drug use is the most effective means of preventing HIV transmission. However, it is inevitable that there will be some children engaging in risky behaviours, through having unprotected sex or needle sharing. Promoting abstinence could be ineffective if complementary HIV education, including the promotion of safer sex and learning how HIV is transmitted through drug use, is not also provided.

Children infected with HIV

The problems for children living with HIV

Once a child is infected with HIV, they face a high chance of illness and death, unless they can successfully be provided with treatment. HIV treatment for children slows the progress of HIV infection and allows infected children to live much longer, healthier lives. Sadly, many children who could be benefiting from this therapy – an estimated 62% – are not receiving it.¹² A major problem is that few appropriate drugs are available. Young children ideally need to be given drugs in the form of syrups or powders, due to difficulties in swallowing, but most of the drugs that work well in children are only available as tablets. As a result, carers are often forced to break adult tablets into smaller doses for their children, running the risk that children are given too little or too much of a drug.

There are numerous other problems that are stopping children from receiving antiretroviral drugs including high drug prices and the lack of healthcare workers trained to treat children.

Another major problem for children living with HIV is childhood illnesses, such as mumps and chickenpox. These illnesses can affect all children, but since children living with HIV have such weak immune systems they may find that these illnesses are more frequent, last longer, and do not respond as well to treatment.¹³
Opportunistic infections, such as Tuberculosis and PCP (a form of pneumonia), are also a serious risk to the health of children living with HIV.

Helping children living with HIV

The first step to helping a child who is infected with HIV is to diagnose them through HIV testing. It is important that HIV-positive children are diagnosed as quickly as possible, so that – where feasible – they can be provided with appropriate medication and care. However, testing children for HIV can be complicated, especially for those recently born to HIV-positive mothers. Antibody tests, which are used to diagnose HIV in adults, are ineffective in children below the age of 18 months. Instead, children below this age are usually diagnosed through polymerase chain reaction (PCR) testing and other specialist techniques. Since these methods require expensive laboratory equipment and specially trained staff, they are generally unobtainable in the resource-poor areas where they are needed the most.¹⁴

Recently, the use of 'dried blood spot' testing has brought some hope to the situation. This method allows small samples of blood to be collected on paper, and sent away to a laboratory where PCR (or similar testing) is available. Unlike testing methods that use liquid samples, dried blood spots can be stored for a long time and easily transported, so even if the nearest laboratory is some distance away, it may still be possible to use PCR technology on a sample of a child's blood.

Once a child has been diagnosed, they ideally need to be carefully monitored and provided with antiretroviral drugs. Even in resource-poor areas where antiretroviral syrups and powders are unavailable, studies suggest that breaking down adult tablets into smaller doses can work effectively – although this should only really be seen as a last resort.¹⁵ Children who are treated successfully may be able to live relatively health lives. To learn about how antiretroviral treatment can be successfully administered to children, visit our page on HIV treatment for children.

Childhood illnesses can be avoided through vaccines, immunisations and good nutrition. Most routine-vaccines are safe in children living with HIV and are strongly recommended, although 'live vaccines' (where a weakened or killed version of a virus is injected, so that the body builds up an immunity to it) are

not generally considered safe.^16
17

^{Opportunistic infections can be prevented using drugs such as cotrimoxazole: a cheap antibiotic that has been proven to significantly reduce the rate of illness and death among HIV-positive children.18 Countless lives could be saved if cotrimoxazole were made more widely available, but at the moment it is estimated that around four million children who could be benefiting from the drug are not receiving it.19}

Children living with HIV have many practical and material needs, but they also have social, psychological and emotional needs. It is therefore important that emotional care is provided to all children affected by HIV, including those who have lost parents or relatives to AIDS. There are particular stages of an HIV-positive child's life when meeting these needs can be particularly important: the times when they are first diagnosed, start to receive treatment, have to deal with discrimination, experience problems adhering to drugs, or have to deal with end-of-life issues. They may also face trauma as a result of one or both of their parents dying from AIDS, since there is a highly likelihood that their mother, at least, is infected.

Families, friends, caregivers and healthcare workers provide children with the first line of social and emotional support, but governments and other agencies also have a responsibility to ensure that children and families are linked with available services and initiatives that facilitate this.²⁰ A report published at the beginning of 2009 discusses the shortcomings of efforts by governments and agencies to tackle the effects of HIV and AIDS on children. It highlights the insufficient level of formal assistance being provided for families and communities on a national level, and the lack of political commitment and resources being made available internationally. The report emphasises a need for significant changes to the global response to HIV and AIDS that would address the needs of children more effectively, advocating a refocus of HIV and AIDS initiatives to support children in and through their families and communities. In all societies the family is the primary source of protection and support available to children and it is therefore the most effective structure for responding to children's needs. Communities are also vital as they can provide support for families by acting as an informal 'social safety net'.²¹

The effects of HIV on children's families

The problems

An HIV+ boy and his family members

With an estimated 33 million adults living with HIV around the world, large numbers of children have family members that are living with HIV, or who have died from AIDS. These children may themselves experience the discrimination that is often associated with HIV. They may also have to care for a sick parent or relative, and may have to give up school to become the principle wage-earner for the family. When adults fall sick, food still needs to be provided – and the burden of earning money usually falls on the oldest child.

One of the harshest effects of the global AIDS epidemic is the number of orphans it has created, and continues to create. By the end of 2007, it is estimated that more than 15 million children had lost one or both of their parents as a result of AIDS, a significant increase on the estimated 8 million in 2001.²² Some AIDS orphans are adopted by grandparents or other extended family-members, but many are left without any support. Child-headed households as a result of AIDS are common in some areas, with older children fending for their siblings and themselves. See our AIDS orphans page to learn more.

Often, children in HIV-affected households will be cared for by the extended family. It is estimated that grandparents are the sole carers for half of all AIDS orphans, and that the number assuming this role will double by 2015 if present trends continue. Caring for grandchildren can put added strains on time and money in order to provide food and medical care, and older people may have to carry out physically demanding jobs and domestic tasks.²³ Orphaned siblings may also be split up so as not to overburden one family member. This could be another upsetting experience for children especially if they have to live far from where they grew up, and away from their familiar support networks.

Helping families

There are two main things that can be done to help families cope with the burden of HIV. The first is to provide treatment to family-members who are infected. Although antiretroviral drugs are still not widely available in many resource-poor areas, a child's family-members may be able to reach a clinic or hospital that can provide these drugs. Treatment access is slowly improving in resource-poor countries, but much more money and effort will be needed if the situation is to improve. In sub-Saharan Africa, for instance, only around 44% of people in need of treatment are receiving it.²⁴

The second thing that can be done is to provide family members who are not infected with HIV with knowledge and resources – such as condoms – that can help them to stay uninfected. HIV prevention campaigns, whether run by the government, local groups, or international organisations, can help to bring these things to families and their communities.

Pictures drawn by children who are caring for parents living with HIV/AIDS in South Africa.

Children who have lost their parents as a result of AIDS may be in particular need of support and care. Many organisations focus on providing care and support to AIDS orphans and other children made vulnerable by HIV and AIDS. This may involve providing food, clothing, help with looking after siblings or sick family members, and help to ensure that children are able to attend school. Ideally, campaigns need to prevent such children becoming orphaned in the first place, by keeping their parents alive through treatment. Parents who are receiving antiretroviral drugs can work, earn a wage and provide financial support and emotional care for their children.

The effects of HIV on children's communities

The problems

HIV and AIDS have held back development and economic growth in many of the world's poorest communities, and have caused practical problems and emotional distress to large networks of families, friends and neighbours. For the children growing up in these communities – even those who are uninfected, and who have no family members that are infected – HIV and AIDS are negatively affecting their lives.

Children are adversely affected by the impact that HIV and AIDS has on a country's essential services. One of the most important services that children need is healthcare. In areas heavily affected by AIDS, hospitals are often overwhelmed by the large number of patients that they have to look after. In many cases these hospitals have lost staff to AIDS, making it even more difficult for them to cope. Providing adequate care for sick children is made all the more difficult with a health system heavily burdened by the HIV epidemic.

AIDS results in a poorer schooling system for the children that rely on them. In some high prevalence countries teacher mortality and absenteeism has grown tenfold as a result of HIV and AIDS. Permanent or temporary absence of just one teacher can affect the education of as many as 100 children. In Swaziland it is estimated that 7,000 new teachers will have to be trained by 2020 to compensate for AIDS deaths.²⁵ As well as their general education being badly affected, children may face a higher risk of becoming infected with HIV in the future, because effective schooling can help children to become more aware of HIV and give them the confidence to take responsibility for their sexual choices.

There are numerous other ways in which a child's life can be changed by the affects that AIDS is having on their community. For people living in countries where HIV is not widespread, it can be hard to appreciate how severely some communities have been damaged by the epidemic – but the reality is that many children are now living in towns and villages where a lot of houses are left empty as a result of AIDS.

Helping communities

As with families, helping communities to overcome HIV and AIDS is essentially a twofold process – HIV prevention needs to be carried out to stop new infections occurring, and antiretroviral treatment needs to be provided to those that need it, so that they can stay healthy and fulfil their role in the community.

Crowd watching an AIDS education event near Lundazi

Many groups and organisations carry out HIV prevention programmes on a community level, educating people about how to avoid infection and supplying condoms. Usually, these campaigns also attempt to address thestigma and discriminationsurrounding HIV, which can stop communities discussing AIDS openly and frankly. Prevention messages can be brought to communities in a variety of ways including billboards, theatrical productions, HIV education in schools, and radio programmes. Children who live in areas where prevention campaigns are being carried out are more likely to be aware of HIV as they grow up.

Increasing the provision of antiretroviral treatment in a community can help HIV-positive adults to work and live relatively normal lives. This can allow HIV-positive adults who are in a position where children are depending on them – whether parents, doctors, nurses, or teachers – to fulfil their responsibilities. In communities, as in the family, it is always better to keep children's family members alive than to provide them with support after that relative has died.

To read more about international efforts to improve access to antiretroviral drugs in resource-poor countries, see our page on universal access to aids treatment: targets and challenges.

What needs to be done?

It is clear that much more needs to be done, especially in resource-poor countries. Many children are dying, whilst millions more are experiencing the scars that AIDS can leave on their lives – almost all of which are avoidable. Medical treatment is such that, in a developed country, a woman living with HIV can now be almost certain that her child will not be infected - and yet there are still delays in making the appropriate tests and drugs available around the world.

If infected with HIV, children can be effectively treated, and, given this treatment, can have longer, healthier lives – yet they continue to die, because the antiretroviral drugs are still not widely available in many countries. Developing countries especially require not only the drugs to treat children, but also specialist training for staff, and funding to enable treatment and ongoing care. The world's political leaders and decision-makers already have these tools to save children from needless suffering, but they are still not reaching most of those who need them.

Written by Steve Berry, edited and updated by Graham Pembrey

References

1. UNAIDS (2009) 'Report on the global AIDS epidemic'.
   
2. UNAIDS (2009) 'Report on the global AIDS epidemic'.
   
3. UNAIDS (2009) 'Report on the global AIDS epidemic'.
   
4. UNAIDS (2008) 'Report on the global AIDS epidemic'.
   
5. UNAIDS (2008) 'Report on the global AIDS epidemic'.
   
6. U.S. Agency for International Development and U.S. Department of Commerce (2004, March),'The AIDS Pandemic in the 21st Century'
   
7. Newell M-L et al (2004, 2nd October), 'Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis', The Lancet 364(9441).
   
8. UNAIDS, UNICEF, WHO (2008), 'Children and AIDS: Third stocktaking report'
   
9. BBC News (24th October 2006), 'Staging sex myths to save Zimbabwe's girls'.
   
10. WHO/UNAIDS/UNICEF (2009) 'Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector'
    
11. Human Rights Watch (2006, August), 'Life Doesn't Wait –Romania's Failure to Protect and Support Children and Youth Living with HIV'.
    
12. WHO/UNAIDS/UNICEF (2009) 'Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector'
    
13. Riordan A (2005, September), 'The Child With HIV And Respiratory Illness', The British HIV Association.
    
14. Medicines Sans Frontiers (2006, July), fact sheet, 'Children and HIV/AIDS'.
    
15. O'Brien D. P. et al. (2006) 'In resource-limited settings good early outcomes can be achieved in children using adult fixed-dose combination antiretroviral therapy', AIDS 20(1955).
    
16. UNAIDS/WHO 2006 Report on the global AIDS epidemic.
    
17. Royal College of Paediatrics and Child Health (2002, February), 'Immunisation of the Immunocompromised Child - Best Practice Statement'.
    
18. Chintu C., Bhat G.J., Walker A.S. et al. (2004), 'Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian children (CHAP): a double-blind randomised placebo-controlled trial', The Lancet, 2004; 364:1865-71.
    
19. UNAIDS/WHO 2006 Report on the global AIDS epidemic.
    
20. Bernard van Leer Foundation (July 2006), 'Where the Heart is: Meeting the Psychosocial Needs of Young Children in the Context of HIV/AIDS'.
    
21. JLICA (2009), 'Home Truths; Facing the facts on children, AIDS and poverty'
    
22. UNAIDS (2008) 'Report on the global AIDS epidemic'.
    
23. Help the Aged (2008, 29th September), 'Number of grandparents caring for orphaned grandchildren worldwide doubles in ten years'
    
24. WHO/UNAIDS/UNICEF (2009) 'Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector'
    
25. UNAIDS Inter-Agency Task Team on Education (2008), 'Teachers Living with HIV'
    

Article credits @ Lee Meau Hui

Article Source : http://www.avert.org/children.htm

PS : There are two videos at the original webpage which i can't link it to youtube and post it here. so if anyone is interested with the video please go to the original webpage to view it..

If any blog representatives found a way to link it up to that two videos please inform me. OR if you manage to download it please do send it to me :D so i can post it up here..

thx :D