Children and HIV and AIDS

Providing Paediatric Treatment

© UNICEF/ HQ06-1323/Versiani

Children dance in the playroom at GAPA (AIDS Prevention and Support Group) in Brazil, where many are being treated with anti-retroviral therapy.

The facts

Every day about 1,200 children under the age of 15 become infected with HIV, and in 2007, UNAIDS estimated there were 2.1 million children living with HIV, approximately 90 per cent of whom live in Africa. The majority of these children either acquire HIV before they are born, during pregnancy or during delivery or when they are being breastfed (if their mother is HIV-positive).

The course of HIV and AIDS is particularly aggressive in children. Without HIV treatment and care, HIV multiplies and destroys the child’s defense to infection, leaving the child less able to resist pneumonia and other common childhood infections. About 50 per cent of children who acquire HIV from their mothers die before their second birthday.

In 2007, UNAIDS estimated that 290,000 children under 15 years died of HIV related illness. Falling drug prices, increased advocacy, introduction of fixed dose antiretroviral (ARV) combinations, and better forecasting of paediatric ARV drug needs has made it possible for many more countries to access and provide ARVs for children, as well as the following:

• Women in the reproductive age group need to have access to HIV preventive interventions including HIV testing. Those who are already infected should be provided PMTCT interventions to reduce the possibility of HIV transmission to their baby. In high income countries HIV infection has virtually been eliminated because women have access to comprehensive PMTCT interventions.
• The first step for any treatment program is identifying infected children. Linking PMTCT and HIV treatment programs using family centred and team approaches is necessary in order to optimize identification of more children in need of HIV care. Similarly, in high prevalence populations, HIV testing should be extended to all sick children in health facilities and for all populations to children of adults known to be HIV infected attending voluntary conselling and testing (VCT) or antiretroviral treatment (ART) centres.
• Its possible to increase access to virological testing using dry filter paper blood spots (DBS) for transporting samples from remote points of care with no access to laboratory capacity.
• Children with HIV need to have access to ART. Antiretroviral therapy is extremely effective in children even in low and middle income countries. Survival rates of over 80 per cent have been reported from scientific studies as well as programmes.
• Cotrimoxazole, a low cost antibiotic given to children exposed to HIV can reduce mortality from opportunistic and other common childhood infections, including malaria. The World Health Organization (WHO) guidelines currently recommend cotrimoxazole prophylaxis for all infants born to HIV infected mothers from 6 weeks of age until infection is ascertained.
• Because treatment for children is often provided in a different clinic than where the mother received antenatal care or delivered, children exposed to HIV often go unrecognized when they present for early care such as for their first set of immunizations. Several countries are starting to document the mother’s HIV status on the child health card so that health workers can identify which children need additional HIV care and support.

The issues

Here are a few challenges around scaling-up paediatric treatment:

• Service coverage remains limited. Although the number of children accessing ART increased by about 80 per cent between 2005 and 2006, access to cotrimoxazole and early infant diagnosis is still remarkably low.
• Most countries have no scale-up plans and therefore determining the number of children either living with HIV or in need of treatment is challenging at country level. Without these numbers, it is difficult to both set treatment targets that are grounded in reality or to measure progress in increasing treatment coverage.
• A great deal of work remains to adequately address the disparity faced by children in access to care and treatment. In many situations, the next steps are to scale up and better harmonize efforts and support national governments with the tools and capacity to make a significant difference in children’s lives.
• Scale up of HIV and treatment efforts also requires ensuring that children have access to other child survival interventions such as immunization, good and optimal nutrition, safe water and basic sanitation.
• Many children whose mothers have been provided with PMTCT services.

UNICEF’s role

UNICEF's role includes provision of technical and financial assistance to countries in strategic planning; guidelines and tools development; development of human resources capacity and programme implementation.

In line with the division of labour amongst UN agencies, UNICEF is a main partner of the lead agency - WHO - in HIV paediatric care, support and treatment and is supporting WHO in their normative work including development of treatment and cotrimoxazole guidelines. WHO and UNICEF co-convene the Inter-Agency Task Team (IATT) on the prevention of HIV infection in pregnant women, mothers and their children and the mandate has been expanded to include paediatric HIV care, treatment and support.

UNICEF with key implementing partners have been conducting joint technical missions to countries to review the status of programmes and make recommendations for increasing access of children and adolescents to treatment.