Children and AIDS
Keeping children and adolescents free from HIV-AIDS
In Guinea Bissau, an estimated 5.3 per cent of the reproductive age population is living with HIV, the second highest rate in west africa. Amongst them, women account for over 70 per cent of all cases. The very high HIV prevalence among young people (3.6 per cent of pregnant women aged 15-19 are testing positive in antenatal care) is evidence that the transmission of HIV is not abating.
Many HIV positive pregnant women do not adhere to their treatment, which results in high rates of mother to child transmission (20 per cent). One in five of the approximately 2 000 children born to HIV positive mothers per year will acquire HIV, thus making HIV a growing public health problem for children and it equals malaria as a cause of under 5 mortality.
During the year 2018, coverage of HIV testing for pregnant women attending antenatal care (ANC) was 81% compared to 86 per cent in 2017. The national programme remains burdened with limited capacity to deliver services, weak management and governance that often hamper utilization of available resources.
According to latest data, only 34.4 per cent of adults enrolled in treatment for one year, well below the national target (90 per cent). The latest UNAIDS estimates suggest that access to ART for children decreased from 15 to 8.3 per cent from 2017 to 2018. Enrolment of children in treatment has decreased due to the stock out of ARV drugs during 2018, in particular in the second semester. Children are still 3.75 times less likely to be enrolled into treatment compared to adults. In this context, access to treatment for adolescents living with HIV remains of serious concern. The program data available in 2018 shows that only 565 adolescents of 10-19 years age have been enrolled into life-saving antiretroviral therapy (ART), representing 21.8 per cent of estimated 2590 adolescents leaving with HIV. Early HIV infant diagnosis of exposed children born to mothers infected with HIV is still a challenge for the national AIDS control programme.
HIV mother to child transmission
Elimination of HIV mother to child transmission is highly prioritized both by UNICEF and NAP, whose interventions are delivered through the existing Antenatal Care (ANC) network. However, according to the ANC, HIV prevalence has slightly risen from 3.6 per cent in 2016 to 4.3 per cent in 2017. Taking data disaggregated by age for adolescent girls attending ANC, HIV prevalence shows 2 per cent for the age group of 15-19 years old, which is nearly 1 per cent higher than reported in 2016 (1.14 per cent). While notable progress has been achieved in pregnant women tested and enrolled in ART, the overall retention in treatment remains challenging.
According to data, the percentage of adults enrolled in ART treatment for one year is well below the national target (90 per cent), while nearly half are lost to follow-up. On the other side, notable progress has been achieved in pregnant women tested and enrolled in ART. In 2017, over 1 200 children were registered to be born to HIV positive mothers, almost the double of 2016 (683), indicating an improvement in registration and eventual retention in services for women living with HIV. With an increased registration of HIV exposed infants, the percentage of these infants tested for HIV before the age of two months increased significantly from 29 per cent in 2016 to 37.6 per cent in November 2017, but decreased to 21.8 per cent in 2018 due to institutional problems and challenges with the sample transportation system from the region to the capital Bissau where early infant diagnosis is available.
Following advocacy to increase access to HIV pediatric testing in clinical settings, an increase was reported in the total number of children. In 2018, 1614 children were tested in general pediatric services, of which 16.2 per cent were found HIV positive. Further on, a total of 686 children were tested at malnutrition treatment sites, of which 23.6 per cent were found positive. This increase in children tested for HIV indicates that the efforts made to improve diagnostic capacity produced positive results in ensuring children optimal access to treatment.