HIV affects children’s health both directly and indirectly. This is through directly living with HIV or indirectly through being orphaned or their family being driven into poverty due to HIV.
Whether affected directly or indirectly, these children are more likely to suffer from common infections, but be less able to access health care. In addition, many of these children, like adults living with HIV, may face stigma and discrimination at health facilities and as a result will not receive the same care at health facilities as people without HIV, for example not be immunized.
HIV impacts the immune system and so increases vulnerability to many opportunistic infections. Without care and treatment, about one third of children living with HIV will die in their first year of life and almost 50 per cent by the second year of life.
World vision’s global campaign Child Health Now is taking action to stop children dying from preventable causes. There are 5 health related areas of HIV which can prevent child deaths:
Governments have committed, through the UN, to provide universal access to HIV prevention, treatment, care and support by 2010, however this target will not be met. World Vision is working with partners and the communities we work in to call for these services to be provided.
1. Prevention of Mother to child transmission of HIV (PMTCT)
Transmission of HIV can occur during pregnancy, labour, delivery or breast-feeding. This is the route by which more than 90 per cent of all children living with HIV are infected. Without proper care and treatment, more than half of these children will die before their second birthday. A full PMTCT package can reduce mother to child transmission to less than 2 percent, however, in 2008 only 45 per cent of mothers in need of these services received them.
2. Early Infant Diagnosis
Almost 50 per cent of children living with HIV die undiagnosed before their second birthday. When test results are promptly provided and acted upon, infected infants experience significantly reduced morbidity and mortality.
Testing infants for HIV is more complicated than testing adults because the standard antibody tests used for adult diagnosis of HIV cannot be used with infants since they retain their mothers’ antibodies for 18 months after birth. For this reason, Polymerase Chain Reaction (PCR) test for HIV DNA are recommended for infants, which is more expensive and complicated.
3. Cotrimoxazole Preventative Therapy
Cotrimoxazole is an antibiotic which has been shown to prevent life-threatening opportunistic infections in HIV infected children, especially pneumonia. These benefits are particularly important for resource-limited settings where access to effective PMTCT and antiretroviral treatment (ART) remains limited. A study found up to 43 per cent drop in mortality when HIV infected children had access to cotrimoxazole alone. Despite ministries of health having policies in place and the fact that cotrimoxazole is an inexpensive, lifesaving, safe drug which is theoretically simple to deliver, in 2008, only 8 per cent of children exposed to HIV were initiated on cotrimoxazole by two months of age.
4. Paediatric Antiretroviral Treatment
HIV infection progresses aggressively in children who don’t have optimal HIV treatment and care, yet children are about one third as likely to receive antiretroviral therapy compared to adults. The World Health Organisation advises that children under one year living with HIV should go on treatment even if they are not yet displaying symptoms but only 38 per cent of children in poor countries who need it get treatment. Without treatment almost 60 per cent of infants with HIV will die before the age of 2 years and about 80 per cent will not live to see their fifth birthday.
5. Co-infection with malaria
Where malaria and HIV & AIDS are both present, the vicious cycle of poverty is often exacerbated as children, families and communities are overwhelmed by decreased health and economic productivity. People living with HIV and AIDS are at increased risk of clinical malaria and severe illness, and HIV infection can decrease the protection offered by anti-malarial treatment. Compared to women with either malaria or HIV infection, co-infected pregnant women are at increased risk of anaemia, preterm birth and intra-uterine growth retardation. As a result, many children born to women with dual malaria and HIV infection have low birth weight and are at higher risk of death during infancy.
Reagan’s mother, Alice, was determined to protect him from HIV. By closely following advice from a prevention of mother-to-child transmission programme, she succeeded. Alice now works hard to encourage other HIV positive mothers in her Ugandan community to do the same.
Photo: Simon Peter Esaku/World Vision
Stuart Kean is our Senior HIV and AIDS Policy Adviser
Stuart Kean is our Senior HIV and AIDS Policy Adviser
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