By Priscilla Atwani Idele, PhD, UNICEF Statistic Expert and recipient of the 2010 IAS/CCABA Prize for Excellence in Research Related to the Needs of Children Affected by AIDS
Every two years, over 20,000 delegates attend the International AIDS Conference to deliberate on many issues around HIV and AIDS; to assess progress, present new science; to chart the way forward and turn the tide together! Who turns the tide for the children? Who speaks, acts, talks and fights for children at this mammoth biannual conference?
Children are without a voice or platform and are among the most vulnerable. Children depend on their caretakers for all their health and development needs – including HIV care and treatment for themselves and for their mothers.
We know HIV treatment works. Access to care and effective treatment to mothers, means that the risk of a child being born with HIV is almost non-existent. That child’s mother will live with HIV as she would with any chronic illness.
Turning the tide against HIV means ensuring health and survival of both mothers and their children. If children are to enjoy the future they deserve, it is essential that we not forget their mothers. They are crucial to achieving an AIDS-free generation. Yet, in 2010 less than half (48%) of mothers living with HIV received the most effective antiretrovirals to prevent mother-to-child transmission of HIV.
The coverage of HIV interventions for infants and children is improving but remains low. Less than a quarter (23%) of children aged 0-14 years in need of treatment were getting it, much lower than the 51%coverage of antiretroviral therapy among adults. And without treatment, about half of children will die before their second birthday. Among 65 reporting countries, only 28% of infants born to mothers living with HIV received an HIV test within the first two months of life. Only 23% of HIV-exposed children in 87 reporting countries received co-trimoxazole prophylaxis within two months of birth in 2010.
It is important to improve the outcomes for all children. To do so, means making special efforts to reach those children most in need. By focusing on the most disadvantaged – children marginalized by poverty, geography, stigma and other factors – it is possible to speed up our progress toward global development goals.
Inequities persist in access to quality HIV prevention, treatment, care and support services. Equity means providing services in places where many more children are dying of HIV; narrowing the gaps between developed and developing nations, between the richest and the poorest, between urban and rural populations and between boys and girls.
A child’s vulnerability to HIV infection, in many ways, could be exacerbated by living in a household affected by AIDS, and can indirectly affect children for the worse, making them vulnerable in other ways.
If an adult falls ill or dies, for instance, the child may have to leave school and take work to support the family. Meals may not be regularly available, and the child’s access to healthcare can be limited. That’s why children affected by HIV and AIDS who are orphaned or living with a chronically ill adult are frequently considerably vulnerable.
Care and support for children affected by HIV and AIDS remains abysmally low. In 25 countries where household surveys were conducted between 2005 and 2009, a median of 11% of households caring for orphans and vulnerable children received external support.
In highly impacted HIV countries in sub-Saharan Africa, HIV attributable deaths among children less than five years remain significantly high – ranging from 10 per cent in Zambia to 28% in South Africa
Children are the future of tomorrow. While we can be proud of the progress made so far, these gains are insufficient and far from comprehensive enough to end the epidemic. With equity in mind, the world should focus on the millions of women and children who are still missing out - the children who are unheard; the silent listeners to every deliberation; but the most vulnerable. We must turn the tide on behalf of the children!