First decade - PMTCT and paediatric AIDS

Second decade - Preventing HIV infection among adolescents

Across both decades - Protection and care for children affected by AIDS

Children and AIDS Regional Initiative (CARI)


Providing paediatric treatment

© UNICEF/NYHQ2009-1910/Pirozzi
A blood sample is taken from a baby's foot at a hospital in Malawi. The infant’s mother is living with HIV, but participated in PMTCT programmes during pregnancy and after giving birth.

HIV infection is a major threat to child survival and development in Eastern and Southern Africa, where 47 percent of the world’s HIV-positive children live. Despite political and financial commitments that have resulted in increased access to HIV services in recent years, the annual number of new infections continues to outpace the annual increase in the number of people receiving treatment, and paediatric treatment is particularly lagging behind.

Without treatment, around half of all children born with HIV will die before reaching their second birthday. In 2010, out of the 1.09 million children who needed antiretroviral therapy in ESA, only 29 percent received it. The lack of treatment has a direct effect on overall child mortality rates. In high-burden countries in Southern Africa, such as Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe, HIV contributes to between 10 and 28 percent of all deaths among children under five years of age.  

Country # of children living with HIV (0-14 years old) # of children needing antiretrovital therapy  Antiretroviral therapy coverage among children (%) 
Angola 22,000 19,000 10
Botswana 16,000 11,000 88
Burundi 28,000 14,000 13
Comoros - - -
Eritrea 3,000 2,600 4
Ethiopia - - -
Kenya 180,000 170,000 21
Lesotho 28,000 21,000 22
Madagascar - - -
Malawi 120,000 - -
Mozambique 130,000 91,000 19
Namibia 16,000 10,000 87
Rwanda 22,000 17,000 45
Somalia - - -
South Africa 330,000 300,000 36
Swaziland 14,000 10,000 55
Uganda 150,000 120,000 16
Tanzania (United republic of) 160,000 110,000 18
Zambia 120,000 98,000 26
Zimbabwe 150,000 100,000 32
Source: State of the World’s Children 2011, UNICEF

Mortality levels can be reduced dramatically when infants are tested and treated within the first 12 weeks of life. Early infant diagnosis is a crucial step in the continuum of care. If properly diagnosed and then provided with treatment early on, children can survive to adolescence and adulthood.

Despite some significant gains, progress in testing newborns and providing prompt treatment is not ensured equitably within or across countries. Access to antiretroviral treatment is lower among children living in rural areas than among children living in cities. Weak infrastructure and transportation systems, and generally higher levels of poverty, have inhibited achieving equity in these situations. Compared to the general adult population, children are also accessing treatment at lower rates.

© UNICEF/NYHQ2006-1364/Pirozzi
A health worker (left) discusses with Chairmaini Samuels, 22, about ARV therapy for her four-year-old sister, who is living with HIV, at the Harriet Shehzi Paediatric AIDS Clinic in Soweto, South Africa.

UNICEF in action

In partnership with the World Health Organization (WHO), the lead UN agency in the area of paediatric HIV care and treatment, UNICEF provides technical and financial assistance to countries in the region to expand and improve HIV services for children. Increased funding from major donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and UNITAID, has facilitated this critical support.

To help implement the new 2010 WHO guidelines, which recommend that all children under the age of two who test HIV-positive, should start ARV treatment immediately, UNICEF’s programmes in the region now focus on and advocate for:

  • The strengthening of health systems and the establishment of better linkages between HIV/AIDS activities with general mother and child health programmes to close the gap between testing and treatment of pregnant women and their babies.

  • The promotion and facilitation of early infant testing to ensure that children living with HIV can start ARV treatment as soon as possible.

To achieve a more effective response, UNICEF also supports the development of guidelines and tools; builds institutional and human resources capacity; and strengthens data collection, analysis and dissemination. The aim is to increase regional coverage of paediatric ART by 2013 to at least 60 percent from a baseline of 32 percent in 2009. 

Results for children

While much more needs to be done across the region, there are clear signs of progress:

  • Opportunities for early infant diagnosis and paediatric treatment are becoming increasingly available across the region. Thirteen countries have scale up plans for paediatric care and treatment.

  • The proportion of children under the age of 15 in need of ART and who received treatment in the region increased from 8 percent in 2005 to 29 percent in 2010. In high burden countries such as Botswana and Namibia, the coverage rate in 2010 was already 88 and 87 percent respectively.

  • The initiation of co-trimoxaxole prophylaxis within two months of birth for HIV-exposed infants, as recommended by the WHO guidelines, tripled in Eastern and Southern Africa, from 9 percent in 2008 to 31 percent in 2010.

  • In almost all countries, prevention of mother-to-child transmission of HIV (PMTCT) and paediatric treatment and care information is now included on mother and child health cards.



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