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Vast numbers of children across the United States become infected with HIV every year. Without treatment, hundreds would die as a result of AIDS.

In addition, thousands more children who are not infected with HIV are indirectly affected by the epidemic, as a result of the death and suffering that AIDS causes in their families and their communities.

Despite the severity of this situation, many people still think of AIDS as something that affects adults. Some people occasionally think of ‘AIDS babies’, and children who have lost one or both of their parents to AIDS – AIDS orphans – are sometimes in the media.

But since HIV, the virus that causes AIDS, is commonly transmitted through sex or drug use, people don’t really think of it affecting children. It does, though – and millions of children around the world continue to have their lives damaged by HIV.

The number of infected children

The most direct way for HIV to affect a child is when they themselves are infected. As the facts below demonstrate, staggering numbers of children are affected in this way:

* At the end of 2006, there were 2.3 million children living with HIV around the world.

* Over half a million children became newly infected with HIV in 2006.

* Of the 2.9 million people who died of AIDS during 2006, over one in ten were children. Every hour, forty children die as a result of AIDS.

International law defines a child as being a person aged below 18 years, but the statistics above (taken from UNAIDS, one of the largest international AIDS organizations) define children as people under the age of 15. The problems

Because every child today is growing up in a world where AIDS is a devastating reality, some people say that every child is affected by the epidemic, whether they are infected or not. Other talk specifically about children who have been orphaned by AIDS, or those who are HIV-positive. Regardless of how people look at the situation, it is clear that there are many ways in which a child can be affected by HIV, and that it is not only those who are infected that are suffering as a result of the epidemic.

HIV can damage a child’s life in three main ways: through its effects directly on the child, on that child’s family, and on the community that the child is growing up in. The direct effects of HIV on children

* Many children are themselves infected with HIV

The effects of HIV on a child’s family

* Children live with family members who are infected with HIV. * Children act as carers for sick parents who have AIDS. * Many children have lost one or both parents to AIDS, and are orphaned. * An increasing number of households are headed by children, as AIDS erodes traditional community support systems. * Children end up being their family’s principal wage earners, as AIDS prevents adults from working, and creates expensive medical bills.

The effects of HIV on a child’s community

* As AIDS ravages a community, schools lose teachers and children are unable to access education. * Doctors and nurses die, and children find it difficult to gain care for childhood diseases. * Children may lose their friends to AIDS. * Children who have HIV in their family may be stigmatized and affected by discrimination.

Becoming infected with HIV The problems for children

Mother-to-child-transmission of HIV accounts for the vast majority of children who are infected with HIV. If a woman already has HIV then her baby may become infected during pregnancy or delivery. HIV can also be transmitted through breast-milk.

For older children, sexual activity and drug use present a risk. It is well known that many young people start to have sex before they have reached the age of consent, and in some cases children make the decision to have sex of their own accord. In other cases, however, children are exposed to HIV through sexual abuse and rape.

Helping children

The main way to stop children becoming infected is to prevent mother-to-child-transmission. Mother to child transmission of HIV is almost entirely avoidable, given appropriate interventions. These measures (which include the giving antiretroviral drugs to a mother during pregnancy, and to her child once it is born) can reduce the risk of mother-to-child transmission from 20-45% to less than 2%. In developed countries, such interventions have minimized the number of children being born with HIV.

In regards to preventing infection through sexual activity and drug use, the most effective thing that can be done is to prevent children from having sex or from using drugs – things that are illegal anyway.

This, however, is not always possible, and legislators and educators need to accept that some children are always going to have sex or use drugs, even if they are told not to. All children and young people should receive effective sexual health and HIV education so that they know how to avoid pregnancy and sexually transmitted infections, including HIV. Educators must also accept that children are likely to be exposed to drugs at some point in their lives - and that they therefore need to be taught how to protect themselves from HIV infection and other dangers associated with drug use.

Children infected with HIV

The problems for children living with HIV

Once a child is infected with HIV, they face a high chance of illness and death, unless they can successfully be provided with treatment. Antiretroviral treatment slows the progress of HIV infection and allows infected children to live much longer, healthier lives. Young children ideally need to be given drugs in the form of syrups or powders, because they cannot swallow tablets. Sadly, most of the drugs that work well in children are only available as tablets. As a result, carers are often forced to break adult tablets into smaller doses for their children, which can lead to children being given too little or too much of a drug.

There are numerous other problems that are stopping children from accessing antiretroviral drugs – for instance, high drug prices and the lack of healthcare workers trained to treat children.

Another major problem for children living with HIV is childhood illnesses, such as mumps and chickenpox. These illnesses can affect all children, but since children living with HIV have such weak immune systems they may find that these illnesses are more frequent, last longer, and do not respond as well to treatment. 11 Opportunistic infections, such as Tuberculosis and PCP (a form of pneumonia), are also a serious risk to the health of children living with HIV.

Helping children living with HIV

The first step to helping a child who is infected with HIV is to diagnose them, through HIV testing. It is important that HIV-positive children are diagnosed as quickly as possible, so that – where feasible – they can be provided with appropriate medication and care. However, testing children for HIV can be complicated, especially for those recently born to HIV-positive mothers. Antibody tests, which are used to diagnose HIV in adults, are ineffective in children below the age of 18 months.

Instead, children below this age are usually diagnosed through polymerase chain reaction (PCR) testing and other specialist techniques. Since these methods require expensive laboratory equipment and specially trained staff, they are generally unobtainable in the resource-poor areas where they are needed the most.

Recently, the use of ‘dried blood spot’ testing has brought some hope to the situation. This method allows small samples of blood to be collected on paper, and sent away to a laboratory where PCR (or similar testing) is available. Unlike testing methods that use liquid samples, dried blood spots can be stored for a long time and easily transported, so even if the nearest laboratory is some distance away, it may still be possible to use PCR technology on a sample of a child’s blood.

Once a child has been diagnosed, they ideally need to be carefully monitored and provided with antiretroviral drugs. Even in resource-poor areas where antiretroviral syrups and powders are unavailable, studies suggest that breaking down adult tablets into smaller doses can work effectively – although this should only really be seen as a last resort. 13 Children who are treated successfully may be able to live relatively health lives. To learn about how antiretroviral treatment can be successfully administered to children, visit our page on treating HIV-positive children.

Childhood illnesses can be avoided through vaccines, immunisations and good nutrition. Most routine-vaccines are safe in children living with HIV and are strongly recommended, although ‘live vaccines’ (where a weakened or killed version of a virus is injected, so that the body builds up an immunity to it) are not generally considered safe.

Opportunistic infections can be prevented using drugs such as cotrimoxazole: a cheap antibiotic that has been proven to significantly reduce the rate of illness and death among HIV-positive children. 16 Countless lives could be saved if cotrimoxazole were made more widely available, but at the moment it is estimated that around four million children who could be benefiting from the drug are not receiving it.

Children living with HIV have many practical and material needs, but they also have social, emotional and psychological needs. It is therefore important that emotional care is provided to all children affected by HIV, including those who have lost parents or relatives to AIDS. There are particular stages of a HIV-positive child’s life when meeting these needs can be particularly important: the times when they are first diagnosed, start to receive treatment, have to deal with discrimination, experience problems adhering to drugs, or have to deal with end-of-life issues. They may also face trauma as a result of one or both of their parents dying from AIDS, since there is a highly likelihood that their mother, at least, is infected.

It is ultimately up to the families, friends, caregivers and healthcare workers involved to provide emotional support, but governments and organisations also have a responsibility to address the wider problems that may prevent communities from meeting children’s needs. Through services, programmes and protective legislation, governments can ensure that families and carers have the security that they need to care for children.

The effects of HIV on children’s families

The problems

With an estimated 37.2 million adults living with HIV around the world, large numbers of children have family members that are living with HIV, or who have died of AIDS. These children may themselves experience the discrimination that is often associated with HIV. They may also have to care for a sick parent or relative, and may have to give up school to become the principle wage-earner for the family. When adults fall sick, food still needs to be provided ­– and the burden of earning money usually falls on the oldest child.

One of the harshest effects of the global AIDS epidemic is the number of orphans it has created, and continues to create. By the end of 2005, it is estimated that more than 15 million children had lost one or more of their parents as a result of AIDS. Some AIDS orphans are adopted by grandparents or other extended family-members, but many are left without any support. Child-headed households as a result of AIDS are common in some areas, with older children fending for their siblings and themselves.

Helping families

There are two main things that can be done to help families cope with the burden of HIV. The first is to provide treatment to family-members who are infected. Although antiretroviral drugs are still not widely available in many resource-poor areas, a child’s family-members may be able to reach a clinic or hospital that can provide these drugs. Treatment access is slowly improving in resource-poor countries, but much more money and effort will be needed if the situation is to improve. In Sub-Saharan Africa, for instance, only around 23% of people in need of treatment are receiving it.

The second thing that can be done is to provide family members who are not infected with HIV with knowledge and resources – such as condoms – that can help them to stay uninfected. HIV prevention campaigns, whether run by the government, local groups, or international organisations, can help to bring these things to families and their communities.

Children who have lost their parents as a result of AIDS may be in particular need of support and care. Many organizations focus on providing care and support to AIDS orphans and other children made vulnerable by HIV and AIDS. This may involve providing food, clothing, help with looking after siblings or sick family members, and help to ensure that children are able to attend school.

Ideally, campaigns need to prevent such children becoming orphaned in the first place, by keeping their parents alive through treatment. Parents who are receiving antiretroviral drugs can work, earn a wage and provide financial support and emotional care to their children.

The effects of HIV on children’s communities

The problems

HIV and AIDS have held back development and economic growth in many of the world’s poorest communities, and have caused practical problems and emotional distress to large networks of families, friends and neighbours. For the children growing up in these communities – even those who are uninfected, and who have no family members that are infected ­– HIV and AIDS are negatively affecting their lives.

In areas where there is a high rate of sickness and mortality due to HIV and AIDS, it is often difficult to provide essential services to children. One of the most important services that children need is healthcare. In areas heavily affected by AIDS, hospitals are often overwhelmed by the large number of patients that they have to look after. In many cases these hospitals have lost staff to AIDS, making it even more difficult for them to cope. In this situation, it is hard to provide children with adequate medical care, whatever they need treatment for.

Another essential service for children is schooling. As with healthcare services, many schools have deteriorated as a result of AIDS, as teachers and pupils become sick and die. This results in a poorer education for all children in affected areas. In turn, those children may face a higher risk of becoming infected with HIV in the future, because effective schooling can help children to become more aware of HIV and give them the confidence to take responsibility for their sexual choices.

There are numerous other ways in which a child’s life can be changed by the affects that AIDS is having on their community. For people living in countries where HIV is not widespread, it can be hard to appreciate how severely some communities have been damaged by the epidemic ­– but the reality is that many children are now living in towns and villages where a lot of houses are left empty as a result of AIDS.

Helping communities

As with families, helping communities to overcome HIV and AIDS is essentially a twofold process – HIV prevention needs to be carried out to stop new infections occurring, and antiretroviral treatment needs to be provided to those that need it, so that they can stay healthy and fulfill their role in the community.

Many groups and organizations carry out HIV prevention programs on a community level, educating people about how to avoid infection and supplying condoms. Usually, these campaigns also attempt to address the stigma and discrimination surrounding HIV, which can stop communities discussing AIDS openly and frankly. There are all sorts of ways that prevention messages can be brought to communities: billboards, theatrical productions, HIV education in schools, and radio programs are some examples. Children who live in areas where prevention campaigns are being carried out are more likely to be aware of HIV as they grow up.

Increasing the provision of antiretroviral treatment in a community can help HIV-positive adults to work and live relatively normal lives. This can allow HIV-positive adults who are in a position where children are depending on them – whether parents, doctors, nurses, or teachers – to live up to this responsibility. In communities, as in the family, it is always better to keep children’s family members alive than to provide them with support after that relative has died. To read more about international efforts to improve access to antiretroviral drugs in resource-poor countries, see our providing treatment for millions page. What needs to be done?

It is clear that much more needs to be done, especially in resource-poor countries. Many children are dying, whilst millions more are experiencing the scars that AIDS can leave on their lives ­– almost all of which are avoidable. Medical treatment is such that, in a developed country, a woman living with HIV can now be almost certain that her child will not be infected - and yet there are still delays in making the appropriate tests and drugs available around the country due to ADAP Waiting Lists.

If infected with HIV, children can be effectively treated, and, given this treatment, can have longer, healthier lives ­– yet they continue to die, because the antiretroviral drugs are still not widely available in many countries. Programs need not only the drugs to treat children, but also specialist training for staff, and funding to enable treatment and ongoing care.

America's political leaders and decision-makers already have these tools to save children from needless suffering, but they are still not reaching most of those who need them.