Undernutrition is common among people living with HIV/AIDS. UNICEF's nutritional priorities for people infected or affected by HIV/AIDS are threefold: encouraging correct infant feeding practices and supporting HIV-infected mothers to appropriately feed their children, supporting the nutritional needs of mother and children living with HIV, and assisting the millions of children orphaned or made vulnerable by the virus.
The UN estimates that:
• Globally, children under 15 accounted for an estimated 3.4 million of the estimated 34 million people living with HIV in 2010.
• An estimated 2.7 million people were newly infected with HIV in 2010. Of these, 390 000 were children under 15.
• An estimated 1.5 million pregnant women were living with HIV in low and middle income countries in 2010
• Sub-Saharan Africa bears the biggest burden of HIV, with 68 per cent of the 34 million people living with HIV worldwide residing in this region. Sub-Saharan Africa is also home to 91 per cent of all children living with HIV, and women represent nearly 60 of HIV infections.
• In 2010, an estimated 1.8 million people died of AIDS-related causes. Approximately 250 000 of these were children under 15 years of age.
• Fifteen million children under the age of 18 have lost one or both parents due to AIDS, including nearly 12 million in sub-Saharan Africa.
Every day about 1,000 children under the age of 15 years are infected with HIV. More than 90 per cent of these new infections occur through mother-to-child transmission of the virus. In the absence of any preventative interventions, infants born to and breastfed by HIV-infected women have roughly a one-in-three chance of acquiring infection themselves. This can happen during pregnancy, during labour and delivery or after delivery through breastfeeding. The risk of mother-to-child-transmission of HIV is about 15%–30% if the mother does not breastfeed the child. With prolonged breastfeeding, the likelihood of infection can be as high as 45%. Timely administration of antiretroviral drugs significantly reduces the risk of HIV transmission. In 2010, an estimated 48% of pregnant women living with HIV in low and middle income countries received antiretroviral regimens to prevent transmission of the virus to their infants.
Breast milk contains all the necessary nutrients for newborns and young infants and provides protection from childhood diseases such as diarrhea and pneumonia. However, breast milk also contains the virus and potentially infects the breastfed infant. HIV-infected mothers used to face an agonizing choice when deciding how to feed their infants. If a mother does not breastfeed, her infant will face a six times greater chance of dying in his or her first two months of life from childhood disease, but if she chooses to breastfeed, her infant may acquire the virus. But, the most recent scientific evidence has shown that antiretroviral drugs reduce the risk of transmission and that mothers living with HIV can now safely breastfeed their infants.
The HIV/AIDS pandemic combined with drought, floods, soaring food prices, decades of conflict, economic decline and cuts in social services, have overwhelmed families in many parts of sub-Saharan Africa, leaving them with few coping mechanisms. Weight loss and low micronutrient levels are associated with increased progression to AIDS in adults living with HIV. This crisis in Africa has underscored the dire nutritional needs of all children who are HIV positive or affected by HIV/AIDS, such as orphans and those living in households with infected family members. Many are left to fend for themselves, while others live with HIV-infected parents who can no longer provide food for their families. Undernutrition rates are increasing and orphans are hardest hit. Without treatment almost 50 per cent of infected infants will die before age two. As of December 2010, about 456,000 children globally were receiving antiretroviral therapy, up from 354,600 children in 2009 and 75,000 in 2005. Many HIV-infected children also suffer from undernutrition.
Fighting HIV/AIDS is one of UNICEF's five organizational priorities. Nutrition programming in the context of HIV is focused on the prevention of mother-to-child transmission in breastfeeding and on care and support for infected mothers and HIV-exposed and infected children. Strategies include: providing voluntary, confidential testing and infant feeding counseling for pregnant women, helping governments develop infant and young child feeding policies that encourage early and exclusive breastfeeding and include HIV guidelines, protecting breastfeeding, and promoting optimal infant feeding in hospitals. UNICEF also addresses the nutritional needs of the growing number of HIV-positive pregnant and lactating women and children who are infected with the virus, orphaned, or living with an HIV-infected parent. Read more in the page “HIV’s high nutritional toll”.