II. The Challenge of HIV/AIDS and Children

The pandemic�s effect on children

Addressing HIV/AIDS in children is a significant global challenge. It is estimated that 2.2 million children, defined as those under the age of 15, are living with HIV/AIDS, constituting 13% of new HIV/AIDS infections and accounting for 17% of HIV/AIDS deaths annually.2 Over 1.2 million HIV-positive children live in 15 Emergency Plan focus countries, as reflected in Table 3.3 In some southern African countries, as many as 40-60% of deaths of children less than 5 years old have been attributed to AIDS.3 Where care and treatment are not available, studies suggest that 35% of infected children die in the first year of life, 50% by their second birthday, and 60% by their third birthday.4

In addition to the pain and suffering caused by HIV/AIDS, these children are more vulnerable to common causes of death that affect all children in developing countries, such as malaria, malnutrition, pneumonia, tuberculosis (TB), diarrhea, and vaccine-preventable diseases such as measles.

Services to prevent mother-to-child transmission of HIV (PMTCT) can help to prevent infection of children, and long-term combination antiretroviral treatment (ART) that includes antiretroviral drugs (ARVs), are crucial interventions for children who are infected. Because parents and caregivers are often suffering with or have died from HIV/AIDS, it is important to remember that both their infected and uninfected children need other types of care as well. Activities aimed at improving the lives of children and families directly affected by AIDS-related morbidity and/or mortality are considered orphans and vulnerable children (OVC) programs. These may include training caregivers; increasing access to education; economic support; targeted food and nutrition support; legal aid; medical, psychological, and emotional care; and other social and material support. While these interventions supported by the Emergency Plan are beyond the scope of this report, data on them are nonetheless included in select tables in order to give a fuller picture of activities directed at the care of children.

[Editor's note: The following table also is available as text-only.]

Table 3: Children (0-14) living with HIV/AIDS
in Emergency Plan focus countries
Country Estimated number
of children living
at the end of 2003
Botswana 25,000
Cote d'Ivoire 40,000
Ethiopia 120,000
Guyana 600
Haiti 19,000
Kenya 100,000
Mozambique 99,000
Namibia 15,000
Nigeria 290,000
Rwanda 22,000
South Africa 230,000
Tanzania 140,000
Uganda 84,000
Vietnam N/A
Zambia 85,000
All Countries 1,269,600

Source: Report on the Global AIDS Epidemic, UNAIDS, July 2004.

Obstacles to meeting the needs of children

While effective interventions are available to prevent the transmission of HIV from mother to children and to diagnose and treat those children who become infected, the barriers to rapidly expanding these programs are significant.

Challenges to effective PMTCT programs in the developing world include: stigma, which poses a barrier to service and increasing access; the failure of women to return for HIV test results where rapid testing is not available; low acceptance of short-course preventive ARVs offered to HIV-positive women at antenatal clinics; difficulty in tracking and follow-up for mothers who deliver their infants at home; and the complexities of infant feeding for HIV-positive mothers in very low-resource settings. Referral for ART, when needed by mothers and children, depends on the availability of ART service sites in the area.

Obstacles to successful long-term ART programs in resource-poor settings begin with the challenge of diagnosis. From a clinical standpoint, accurately diagnosing HIV in the youngest children, when treatment may be most effective, is especially difficult and costly.

Both HIV diagnosis and treatment are affected by shortages of trained health care providers and of needed commodities. ARVs in formulations appropriate for children may not be available, and when they are available, they may cost up to four times the cost of adult treatment. In addition, the regimens are complex and difficult to follow. Even where diagnostics and drugs are available, once a child is diagnosed, health providers may not be familiar with pediatric treatment and care protocols.

Additional challenges are posed by limited health systems, which often face difficulties with management, commodity supply chains, and monitoring and evaluation. Monitoring and evaluation systems often do not report by age, making it difficult to assess the services that are being provided.

Mobilizing communities to meet the additional needs of children with HIV/AIDS and their caregivers can be difficult. Stigma can undermine essential efforts. Older children, who may have survived early childhood, often live in communities without access to services.

U.S. leadership in meeting the challenge

The Emergency Plan has brought unprecedented focus to the many faces of the HIV/AIDS crisis, including the impact on children. In keeping with the vision articulated in the U.S. Five-Year Global HIV/AIDS Strategy, the Emergency Plan is working with multi-sectoral host country partners, including governments, nongovernmental organizations, faith-based and community-based groups, and international partners to scale up prevention, treatment and care for children infected with and affected by HIV/AIDS.

2 WHO World Health Report 2005.
3 The fifteen focus countries are: Botswana, Cote d�Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia.
3 WHO World Health Report 2005.
4 WHO World Health Report 2005.

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