| HIV/AIDS and Children | ||||||||||||||||||||||||||
Introduction The number of children under 15 who have lived or are living with HIV since the start of the epidemic in the late 1970's has reached about 4.8 million - 3.6 million of them have already died. Nearly 600 000 children were infected with HIV in 1999, mostly through their mothers before or during birth or through breast feeding (vertical transmission).
The lives of children who do not have HIV themselves are affected when family members have AIDS. Families face increased poverty and stress because adults have to leave their paid employment, or are too sick to farm their land. Women may be ill themselves, as well as caring for other sick family members and looking after young children. Girls in particular often become the care providers for sick relatives and their brothers and sisters. Sometimes children have to leave school to look for work or care for other family members. In addition, denial or neglect of girls' human rights results in gender discrimination, giving young women little access to socioeconomic opportunities. These girls (and boys to a lesser extent) often become vulnerable to commercial sex and to the drug trades. Common symptoms of HIV infection in children HIV-infected children have an increased frequency of common childhood infections such as ear infections and pneumonia. In developing countries, diseases such as chronic gastroenteritis and tuberculosis are also frequent. In HIV-infected infants, the symptoms common to many treatable conditions, such as recurrent fever, diarrhea and generalized dermatitis, tend to be more persistent and severe. Moreover, HIV-infected infants do not respond as well to treatment and are likely to suffer life-threatening complications. Enlarged lymph nodes and an enlarged liver are common in children infected with HIV. Opportunistic infections occur as the immune system becomes more affected, and most of these children have some type of neurological involvement, such as developmental delay or infection in the brain. The course of HIV in infants/children The majority of infected infants develop disease during the first year of life and have a high mortality rate. With recent research and new antiretroviral therapies (ARVs), there has been significant improvement to child mortality in countries where this treatment is available and accessible. The diagnosis of pediatric AIDS is difficult. In addition, in developing countries, diagnostic procedures might not be available or routinely used. Different countries might show slightly different patterns of the opportunistic infections that are common in HIV-infected children.
Making a diagnosis of AIDS in children when HIV testing is not available In infected women, the maternal HIV antibody is passively transmitted across the placenta to the fetus during pregnancy. This antibody can persist in the infant for as long as 18 months. Consequently, during this period, the detection of HIV antibody in infants does not necessarily mean that an infant is infected. Therefore, a case definition for AIDS is made in the presence of at least 2 major, and 2 minor signs.
Please note: Confirmed HIV infection in the mother counts as a minor criterion. Care for infants and children with HIV-related illness Most HIV-related illness is caused by common infections which can be prevented or treated at home or in a health centre. However, the illnesses often last longer in HIV infected children, and are slower to respond to standard treatments. The standard treatments are nevertheless the most appropriate treatments. The following general recommendations should be used in the management of HIV infected infants/children and in teaching/counselling mothers and other care-givers. Maintain good nutritional status in weight loss and failure to thrive Provide early and vigorous therapy for common pediatric infections as early as possible
Emphasize early diagnosis and treatment of suspected TB for all family Immunize according to standard schedules Ensure the child has good quality of life Children orphaned by AIDS Approximately 8.2 million children around the world have been orphaned by the HIV/AIDS epidemic. AIDS orphans, defined as children who have lost their mother or both parents to AIDS before reaching the age of 15, are predicted to number 41 million worldwide by 2010. Nine out of ten (90%) maternal orphans are presently living in sub Saharan Africa. The extended family system, which would traditionally provide support for orphans, is greatly strained in communities most affected by AIDS. This is especially true in populations which migrate. When children are cared for by other family members, this places an added financial burden on these care givers. After their parent's death, children can lose their rights to the family land or house. Without education, work skills or family support, children may end up living on the streets. These children are especially vulnerable, often becoming sexually active at an early age and at risk from HIV themselves. Poverty is an overwhelming problem. These orphans not only lack money, but basics such as clean water, drugs, food, shelter and medical supplies. They do not have information about how to protect themselves, and have poor access to doctors, nurses, and other health care workers and facilities. Finally, these orphans often lack human rights and dignity. The magnitude of this problem will have to be addressed at international, national, local, and community levels. Government, non-governmental organizations (NGO) and other institutions and organizations will have to combine their efforts to provide effective programs and strategies to care for orphaned children.
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