for anyone with a heartache, just take a glimpse
Well since the new craze seems to be writing about how much life sux, or regrets that u or dont have, or ur heart being broken, i figure i will jump on the band wagon, and explain to u why i get sad all time, the funny thing is it doesnt have much to do with a girl that broke my heart or my parents being assholes, just take a glimpse
The children
In spite of the large numbers of HIV+ children around the world, AIDS is often assumed to be a disease that kills adults. Some people may occasionally think of 'AIDS babies', and children who have lost a parent or parents to AIDS - AIDS orphans - are sometimes in the media. But, because HIV, the virus that causes AIDS, is commonly transmitted sexually or through drug use, people don't really think of it affecting children. It does, though - and millions of children around the world have had their lives damaged by HIV.
The numbers
Across the globe, AIDS is responsible for an increasing number of deaths each year. Of the 3.1 million killed in 2005, over half a million were children aged below 15 years. At the end of 2005, an estimated 2.3 million children globally were living with HIV1. Lack of HIV monitoring facilities in many less-developed countries mean that it is difficult to produce precise estimates, and the actual figures could be higher. What is clear is that very large numbers of children around the world are living with HIV and being killed by AIDS - something that is very hard for an adult to accept, harder still for a child who may still be too young to understand why they are dying.
HIV positive children play in South AfricaInternational law defines2 a child as being a person aged below 18 years. Many AIDS organisations, however, (such as UNAIDS) define children as being people aged below 15 years. This can be confusing and, unless care is taken, it can lead to inaccurate estimates of numbers of children, and can also result in the neglect of those aged between 15 and 18. As this page is based on AIDS data, we use the word 'child' to refer to a person aged below 15 years.
During 2005, an estimated 700,000 children around the world were newly infected with HIV. More than 80% of these infections occurred in sub-Saharan Africa, although Asia and the Caribbean are also seeing increases in the number of children infected with HIV. Most of these children - as many as 90% - acquired the infection from their mothers during pregnancy, birth or breastfeeding.
Child mortality figures have nearly doubled in Botswana and Zimbabwe since 19903, and many other countries that had seen child-survival rates rise, as a result of improved healthcare, are now seeing these rates fall again. Globally, at least a quarter of newborns infected with HIV die before the age of one, up to 60% die before reaching their second birthday, and most die before they are five years old. By contrast, in higher-income countries, the transmission of HIV from mother to child is relatively rare, and in those cases where it does occur, a range of treatment options mean that the child can survive - often into adulthood4. This shows that with funding, trained staff and resources, the infections and deaths of many children in lower-income countries might easily be avoided.
The problems
There are many ways in which children's lives are adversely affected by HIV. Some say that every child in the world is in some way affected, others talk specifically about orphans or about children who are HIV+. Most of the ways in which HIV directly affects a child come in the form of problems for the child, the family or for the community.
The child
Many children are themselves HIV+.
The family
Children live with family members - parents, or older siblings - who are HIV+.
Children act as carers for sick parents who have AIDS.
Children have lost one or both parents to AIDS, and are orphaned.
Children are head of a family - some orphans may have younger siblings, and as AIDS erodes traditional community support mechanisms, an increasing number of households are headed by children.
Many children, as AIDS inhibits the family's wage-earners from working, or creates a need for expensive medication, end up being the family's principal wage-earner.
The 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 in the community.
Problems for the child - Mother-to-child HIV transmission
Mother-to-child transmission (MTCT) of HIV accounts for the vast majority of children who are infected with HIV. They will not necessarily be infected in the womb during pregnancy, but this is one way in which infection does sometimes occur. If they have not been infected during pregnancy, they may come into contact with the mother's infected body fluids during birth, and become infected this way. If the baby is still not infected, they may be fed on the HIV+ mother's breast-milk, and become infected from this.
Problems for the child - medical infection
Children, especially at birth, are sometimes also exposed to HIV infection in medical settings - meaning that they might come into contact with HIV in infected blood products or unsterilised needles or medical equipment - whether their mother is infected or not. This is a problem that has been eliminated in many wealthier countries but which remains an issue in less-developed countries where hospitals are often poorly-resourced. An example of this is the situation in Romania5, which has the largest number of children living with HIV in Europe. It is believed that between 1987 and 1991, more than 10,000 new babies and young children were infected with HIV from contaminated injections and unscreened blood transfusions.
Problems for the child - infection through sex & drugs
Although sexual activity and drug use are high-risk activities associated with adults, they also represent risks for children - particularly for those closer to 15. It is known that many young people have consensual sex before they reach the age at which national laws deem them legally able to. Some may also slip into drug-taking.
The age at which sex and HIV education are provided to children differs around the world. In both developed and developing countries, children and young people often receive inadequate sex education. This can be for religious, moral or cultural reasons or simply lack of resources. It is quite possible for children to begin having sex or injecting drugs before they have even been taught that these activities expose them to risk. Consequently, they may not only be unaware of how to protect themselves against infection, they may not even know why they should do so. Sex and HIV education may have a lower age-limit - but HIV infection does not.
Some children are exposed to HIV infection through non-consensual sexual activity - sexual abuse, or rape. Not only are such illegal activities terribly emotionally traumatic for a child, they can also result in HIV infection if the abuser is themselves HIV+. Children are more at risk in some places than in others - in South Africa, for example, there is a myth that sex with a virgin can 'cure' a man of HIV - this has lead to a large number of rapes, sometimes of very young children, by HIV+ men.
A child who engages in sexual activity, either voluntarily or involuntarily, is at greater risk of coming into contact with HIV if they live in a high-prevalence area. Sexual exploitation is more of a problem in developing countries, where having sex for money, food or protection can be a means of survival for some children.
Problems for the HIV+ child - childhood illnesses
For a HIV+ child, one area of risk is the childhood illnesses that commonly affect every child - whether or not that child is infected with HIV. All children suffer from the same common childhood illnesses, although those illnesses might vary geographically. Examples of such illnesses include mumps, measles and chickenpox. As a result of his/her weakened immune system, the child who is HIV+ might find that these illnesses are more frequent, last longer, and may respond poorly to the usual treatments5. Immunizations, with some exceptions, and good nutrition can both help to prevent common childhood infections. Live vaccines are not generally recommended for HIV+ children, and the measles vaccine should not be given to HIV+ children who have severe immunosuppression. HIV+ children will not receive the BCG vaccine in the UK, but will be closely followed-up6.
Problems for the HIV+ child - lack of treatment
HIV can progress towards AIDS much more rapidly in babies than it might in adults, meaning that without treatment, many will soon become very ill. They have a high risk of dying in their first few years of life.
The progression of HIV and AIDS is not the same in babies and young children as it is in adults, making it especially important that the child has access to specially-trained medical staff. Many infected children, especially in highly-affected African countries, will be lucky if they have any access to medical care at all. Drug treatment for HIV in children cannot use 'the same drugs, but less' - although this is something that often happens in many resource-poor countries, where paediatric treatments are unavailable. Pills, broken into smaller pieces, are given to children - meaning that there is no way of ensuring that the child gets the correct dose of the drug - or even if the child gets the same dose of the drug from one occasion to another. These practises can lead to resistance or death, and illustrate a need to formulate and provide more medicines for children around the world.
Helping the child - preventing MTCT
Mother to child transmission of HIV is almost entirely avoidable, given appropriate interventions. Unfortunately, it still happens all over the world - although much less frequently in well-resourced countries than it does in poorly-resourced, high-prevalence countries. The possible interventions are :
Helping women to avoid HIV infection.
Helping women who are HIV+ to avoid unwanted pregnancy.
Testing pregnant women to identify those who are HIV+ so that appropriate help can be offered.
A HIV+ woman is more likely to pass the infection to her baby when her viral load count is high. If she is receiving treatment for her own HIV infection - not just treatment but good treatment -her viral load can be lowered, reducing the chance of her baby becoming HIV+ and helping to ensure that her baby has a mother who is alive and healthy.
If it is not possible to provide ongoing treatment for the mother, then both she and her baby can be offered a single dose of nevirapine, either just before birth or just after, which will help to prevent infection occurring in her baby. This is the least-preferable treatment option, but in many areas it is all that is available. Preferably, the mother will receive a dose of three different drugs before the birth of her baby, and her baby will take a triple combination of anti-HIV drugs for a further 4 to 6 weeks.
In an ideal situation, a HIV+ pregnant woman will be offered a caesarean section birth - a surgical procedure. Expert opinion is, however, divided on when this type of intervention is appropriate and preferable, as any surgical procedure carries some element of risk.
Again, in an ideally-resourced situation, when the baby has been born, a HIV+ mother will be provided with an artificial alternative to breast-milk, so that the baby will not become infected whilst breast-feeding.
Currently a mere 1% of pregnant women in heavily affected countries are offered services aimed at preventing mother-to-child HIV transmission7, and even the minimum drug-treatment option - nevirapine - remains unavailable in many highly-affected areas around the world.
AVERT.org has more information on Mother-to-child transmission of HIV.
Helping the child - avoiding medical transmission
The problems in Romania, for example, where at least 10,000 children were infected with HIV through contaminated medical products, and where 7,500 are now thought to be living with HIV - illustrate not only how vulnerable children are to infection in a hospital setting, but also how a country can respond to these problems. The large number of HIV+ children in Romania prompted the government to 'roll out' antiretroviral (ARV) treatment, so that today, all those determined to be 'in need' according to international guidelines have access to HIV treatment. This covers some 5700 patients, including 4350 children. Sterile medical equipment is used, and blood-products are now screened for HIV. Romania is, however, unusual in this respect - many other countries, particularly in Africa, do not come even close to achieving treatment for all who require it.
Helping the child - avoiding infection through sex & drugs
The key to preventing HIV infection in children via sexual activity or via drug use is to prevent children from being sexually active or from using drugs - something that is illegal anyway in most countries.
This, however, is not always possible, and legislators and educators need to accept the fact that some children are always going to have sex or use drugs, whether or not they are encouraged not to do so. Given that this is the case, all children and young people should receive effective sexual health and HIV education - so that they can make informed choices about whether to start having sex, and so that they know how to protect themselves from pregnancy, STDs and HIV infection. 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, not only from the risk of HIV infection, but also from other dangers associated with drug use.
Helping the child - HIV testing
For those children who are HIV+, there are a number of treatment options available if they are lucky enough to be in an area where they are able to access them. Before a child can be treated, however, their HIV status must be established.
A common way of testing for HIV is to check for antibodies to the virus. Every baby born to a HIV+ mother will have these HIV antibodies from its mother, which means that this test can produce a positive result, even when the baby is not infected. The results of this test have no value for the first 18 months of the baby's life. In areas where complex lab equipment is accessible, a more complex test can be conducted - the viral load test - which can identify HIV in a baby. In resource-poor areas, the antibody test can at least determine which babies are not infected - meaning that those who show a positive result can be monitored for signs of AIDS-related sickness. After 18 months, any baby who still shows a positive result in an antibody test can be said to be infected.
Helping the HIV+ child - treatment
For those HIV+ children who live in countries where medical care is available, the first part of treatment is monitoring the children to keep an eye on their health. In adults, viral load tests and CD4 cell-counts are used to assess the progression of HIV, but because children don't have fully-developed immune systems, the results of these tests will be different. Again, this calls for specially-trained medical staff.
If it is decided that the child should be given treatment, there are fewer drugs available than can be found for adults. Improvements in the prevention of MTCT in much of the developed world mean that drug companies are not keen to produce medicines that will be needed only in less-wealthy countries, who may not be able to afford them. When such drugs are available, they are often more expensive than those for adults - sometimes many times more. The improvements they can make in a child's chances of avoiding illness or death, however, do justify their use.
Children with HIV are vulnerable to opportunistic infections (OIs) - which are the infections that ultimately cause death. PCP (a type of pneumonia) is a common OI, particularly in very young children. The antibiotic co-trimoxazole is effective in preventing PCP and various other opportunistic infections. It has been recommended for use in resource-poor countries with HIV+ children who show any signs of becoming ill. The use of such antibiotics can postpone the time at which ARV treatment should be started. At the end of 2004, WHO recommended that all children born to HIV positive mothers but whose HIV status is unknown be given co-trimoxazole8.
Helping the HIV+ child - care
A child who is HIV+ is likely to also have another family member who is infected - meaning that the child can also suffer from the stigma and the financial hardships associated with having someone in the family who has HIV. Ultimately, the child may experience the grief and emotional suffering of losing a parent or relative to AIDS. Counselling and support for children and their families can considerably improve their quality of life, relieve suffering and assist in the practical management of illness. Emotional and practical support is crucial for all children who are directly affected by HIV - whether or not that child is themselves HIV+. Such care might include health advice, help with shelter and material needs, and educational support. It involves the community, the school, social workers, counsellors, nurses, doctors and teachers.
Problems for the family
Many children are affected by AIDS in their family - with an estimated 35.7 million adults living with HIV around the world, it is clear that a very large number of children will know a family member who is HIV+ or who has died from AIDS. These children may themselves experience the discrimination that comes from being associated with HIV. They may also be in the position of having to care for a sick parent or relative, and may have had to give up school, if they have access to it, 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.
AIDS has now killed one or both parents of an estimated 12 million children 9 in sub-Saharan Africa. These AIDS orphans are sometimes left in the care of other adults in the family - uncles, aunts, or grandparents. In some situations, however, many family members may have died, or there may not be an extended family - in these cases, orphans may be left without any adult support, and sometimes have younger brothers or sisters who they have to support. AIDS is creating an increasing number of child-headed households. Such children are clearly extremely vulnerable to exploitation, which can also make them even more vulnerable to HIV infection.
Problems for the community
In many countries, children who are left destitute will be cared for by the community. In highly effected areas, neighbours will be aware of the existence of child-headed households, and may help out where they can, providing some assistance with food and clothing. This type of community support is the final safety-net for many children, and it may not hold if many people in the community die.
A large number of deaths in the community affect all children in that community, even those who are not orphans - other affects of many AIDS deaths are that schools and medical services will become unavailable as nurses and teachers die. This might seem like an unrealistic scenario - but it is one that is happening in many high-prevalence African countries, where many villages have houses left empty by the effects of AIDS.
Helping the family
There is no easy solution to the problem of HIV infection in the family - other than to try to ensure that family members do not become infected in the first place, and if they are, to provide ARV treatment. Many organisations focus on providing care and support for AIDS orphans, who have lost one or both parents to AIDS, may have younger siblings to support, and who may themselves be HIV+. Such orphans may need help with looking after siblings or sick family members and help to ensure that they are able to attend school.
It is preferable, however, to try to prevent such children from becoming orphaned at all - by keeping their parents alive. This entails providing care and ARV treatment to their parents. Appropriate medical attention can prolong the lives of parents and enable them to continue work, earning a wage and providing support, both financial and emotional, for their children.
AVERT.org has more information on AIDS orphans.
Helping the community
Much HIV education and prevention work is carried out at community levels - teaching people about the dangers of HIV infection and about how to avoid it, and attempting to reduce the discrimination often felt by those who are infected.
In many areas, the local community - friends and neighbours of the family - will provide help and support to children who are adversely affected or orphaned by AIDS. In areas where a large number of deaths have occurred, however, communities have been overwhelmed, and are simply unable to provide sufficient money or food for all their orphaned children. In such cases, aid organisations may step in to provide assistance.
A community that has been highly affected by AIDS may no longer be able to provide essential services to its members, as people in important roles die. For children, crucial services are primarily schooling and medical treatment. In some fortunate areas, again, aid organisations may step in to help with these problems. In the community, as in the family, it is always preferable to keep people alive than to provide support for children after people have died.
Helping in the future
It is clear that more needs to be done, especially in resource-poor countries. Many children are dying, whilst many more are experiencing the scars that AIDS can leave in their lives - almost all of which is avoidable. Medical technology is such that, in a developed country, a HIV+ woman 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 world.
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 treatment is not available in many countries. Developing countries need not only drugs to treat children, but specialist training for staff and the funding to enable treatment and ongoing care to take place. The world's political leaders and decision-makers already have these tools to save children from needlessly suffering - perhaps, one day, they will do something concrete to help.
AVERT.org has more information on the issues involved in providing AIDS treatment to millions. We also have advice and information for anyone who is concerned about pregnancy and HIV .
The children
In spite of the large numbers of HIV+ children around the world, AIDS is often assumed to be a disease that kills adults. Some people may occasionally think of 'AIDS babies', and children who have lost a parent or parents to AIDS - AIDS orphans - are sometimes in the media. But, because HIV, the virus that causes AIDS, is commonly transmitted sexually or through drug use, people don't really think of it affecting children. It does, though - and millions of children around the world have had their lives damaged by HIV.
The numbers
Across the globe, AIDS is responsible for an increasing number of deaths each year. Of the 3.1 million killed in 2005, over half a million were children aged below 15 years. At the end of 2005, an estimated 2.3 million children globally were living with HIV1. Lack of HIV monitoring facilities in many less-developed countries mean that it is difficult to produce precise estimates, and the actual figures could be higher. What is clear is that very large numbers of children around the world are living with HIV and being killed by AIDS - something that is very hard for an adult to accept, harder still for a child who may still be too young to understand why they are dying.
HIV positive children play in South AfricaInternational law defines2 a child as being a person aged below 18 years. Many AIDS organisations, however, (such as UNAIDS) define children as being people aged below 15 years. This can be confusing and, unless care is taken, it can lead to inaccurate estimates of numbers of children, and can also result in the neglect of those aged between 15 and 18. As this page is based on AIDS data, we use the word 'child' to refer to a person aged below 15 years.
During 2005, an estimated 700,000 children around the world were newly infected with HIV. More than 80% of these infections occurred in sub-Saharan Africa, although Asia and the Caribbean are also seeing increases in the number of children infected with HIV. Most of these children - as many as 90% - acquired the infection from their mothers during pregnancy, birth or breastfeeding.
Child mortality figures have nearly doubled in Botswana and Zimbabwe since 19903, and many other countries that had seen child-survival rates rise, as a result of improved healthcare, are now seeing these rates fall again. Globally, at least a quarter of newborns infected with HIV die before the age of one, up to 60% die before reaching their second birthday, and most die before they are five years old. By contrast, in higher-income countries, the transmission of HIV from mother to child is relatively rare, and in those cases where it does occur, a range of treatment options mean that the child can survive - often into adulthood4. This shows that with funding, trained staff and resources, the infections and deaths of many children in lower-income countries might easily be avoided.
The problems
There are many ways in which children's lives are adversely affected by HIV. Some say that every child in the world is in some way affected, others talk specifically about orphans or about children who are HIV+. Most of the ways in which HIV directly affects a child come in the form of problems for the child, the family or for the community.
The child
Many children are themselves HIV+.
The family
Children live with family members - parents, or older siblings - who are HIV+.
Children act as carers for sick parents who have AIDS.
Children have lost one or both parents to AIDS, and are orphaned.
Children are head of a family - some orphans may have younger siblings, and as AIDS erodes traditional community support mechanisms, an increasing number of households are headed by children.
Many children, as AIDS inhibits the family's wage-earners from working, or creates a need for expensive medication, end up being the family's principal wage-earner.
The 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 in the community.
Problems for the child - Mother-to-child HIV transmission
Mother-to-child transmission (MTCT) of HIV accounts for the vast majority of children who are infected with HIV. They will not necessarily be infected in the womb during pregnancy, but this is one way in which infection does sometimes occur. If they have not been infected during pregnancy, they may come into contact with the mother's infected body fluids during birth, and become infected this way. If the baby is still not infected, they may be fed on the HIV+ mother's breast-milk, and become infected from this.
Problems for the child - medical infection
Children, especially at birth, are sometimes also exposed to HIV infection in medical settings - meaning that they might come into contact with HIV in infected blood products or unsterilised needles or medical equipment - whether their mother is infected or not. This is a problem that has been eliminated in many wealthier countries but which remains an issue in less-developed countries where hospitals are often poorly-resourced. An example of this is the situation in Romania5, which has the largest number of children living with HIV in Europe. It is believed that between 1987 and 1991, more than 10,000 new babies and young children were infected with HIV from contaminated injections and unscreened blood transfusions.
Problems for the child - infection through sex & drugs
Although sexual activity and drug use are high-risk activities associated with adults, they also represent risks for children - particularly for those closer to 15. It is known that many young people have consensual sex before they reach the age at which national laws deem them legally able to. Some may also slip into drug-taking.
The age at which sex and HIV education are provided to children differs around the world. In both developed and developing countries, children and young people often receive inadequate sex education. This can be for religious, moral or cultural reasons or simply lack of resources. It is quite possible for children to begin having sex or injecting drugs before they have even been taught that these activities expose them to risk. Consequently, they may not only be unaware of how to protect themselves against infection, they may not even know why they should do so. Sex and HIV education may have a lower age-limit - but HIV infection does not.
Some children are exposed to HIV infection through non-consensual sexual activity - sexual abuse, or rape. Not only are such illegal activities terribly emotionally traumatic for a child, they can also result in HIV infection if the abuser is themselves HIV+. Children are more at risk in some places than in others - in South Africa, for example, there is a myth that sex with a virgin can 'cure' a man of HIV - this has lead to a large number of rapes, sometimes of very young children, by HIV+ men.
A child who engages in sexual activity, either voluntarily or involuntarily, is at greater risk of coming into contact with HIV if they live in a high-prevalence area. Sexual exploitation is more of a problem in developing countries, where having sex for money, food or protection can be a means of survival for some children.
Problems for the HIV+ child - childhood illnesses
For a HIV+ child, one area of risk is the childhood illnesses that commonly affect every child - whether or not that child is infected with HIV. All children suffer from the same common childhood illnesses, although those illnesses might vary geographically. Examples of such illnesses include mumps, measles and chickenpox. As a result of his/her weakened immune system, the child who is HIV+ might find that these illnesses are more frequent, last longer, and may respond poorly to the usual treatments5. Immunizations, with some exceptions, and good nutrition can both help to prevent common childhood infections. Live vaccines are not generally recommended for HIV+ children, and the measles vaccine should not be given to HIV+ children who have severe immunosuppression. HIV+ children will not receive the BCG vaccine in the UK, but will be closely followed-up6.
Problems for the HIV+ child - lack of treatment
HIV can progress towards AIDS much more rapidly in babies than it might in adults, meaning that without treatment, many will soon become very ill. They have a high risk of dying in their first few years of life.
The progression of HIV and AIDS is not the same in babies and young children as it is in adults, making it especially important that the child has access to specially-trained medical staff. Many infected children, especially in highly-affected African countries, will be lucky if they have any access to medical care at all. Drug treatment for HIV in children cannot use 'the same drugs, but less' - although this is something that often happens in many resource-poor countries, where paediatric treatments are unavailable. Pills, broken into smaller pieces, are given to children - meaning that there is no way of ensuring that the child gets the correct dose of the drug - or even if the child gets the same dose of the drug from one occasion to another. These practises can lead to resistance or death, and illustrate a need to formulate and provide more medicines for children around the world.
Helping the child - preventing MTCT
Mother to child transmission of HIV is almost entirely avoidable, given appropriate interventions. Unfortunately, it still happens all over the world - although much less frequently in well-resourced countries than it does in poorly-resourced, high-prevalence countries. The possible interventions are :
Helping women to avoid HIV infection.
Helping women who are HIV+ to avoid unwanted pregnancy.
Testing pregnant women to identify those who are HIV+ so that appropriate help can be offered.
A HIV+ woman is more likely to pass the infection to her baby when her viral load count is high. If she is receiving treatment for her own HIV infection - not just treatment but good treatment -her viral load can be lowered, reducing the chance of her baby becoming HIV+ and helping to ensure that her baby has a mother who is alive and healthy.
If it is not possible to provide ongoing treatment for the mother, then both she and her baby can be offered a single dose of nevirapine, either just before birth or just after, which will help to prevent infection occurring in her baby. This is the least-preferable treatment option, but in many areas it is all that is available. Preferably, the mother will receive a dose of three different drugs before the birth of her baby, and her baby will take a triple combination of anti-HIV drugs for a further 4 to 6 weeks.
In an ideal situation, a HIV+ pregnant woman will be offered a caesarean section birth - a surgical procedure. Expert opinion is, however, divided on when this type of intervention is appropriate and preferable, as any surgical procedure carries some element of risk.
Again, in an ideally-resourced situation, when the baby has been born, a HIV+ mother will be provided with an artificial alternative to breast-milk, so that the baby will not become infected whilst breast-feeding.
Currently a mere 1% of pregnant women in heavily affected countries are offered services aimed at preventing mother-to-child HIV transmission7, and even the minimum drug-treatment option - nevirapine - remains unavailable in many highly-affected areas around the world.
AVERT.org has more information on Mother-to-child transmission of HIV.
Helping the child - avoiding medical transmission
The problems in Romania, for example, where at least 10,000 children were infected with HIV through contaminated medical products, and where 7,500 are now thought to be living with HIV - illustrate not only how vulnerable children are to infection in a hospital setting, but also how a country can respond to these problems. The large number of HIV+ children in Romania prompted the government to 'roll out' antiretroviral (ARV) treatment, so that today, all those determined to be 'in need' according to international guidelines have access to HIV treatment. This covers some 5700 patients, including 4350 children. Sterile medical equipment is used, and blood-products are now screened for HIV. Romania is, however, unusual in this respect - many other countries, particularly in Africa, do not come even close to achieving treatment for all who require it.
Helping the child - avoiding infection through sex & drugs
The key to preventing HIV infection in children via sexual activity or via drug use is to prevent children from being sexually active or from using drugs - something that is illegal anyway in most countries.
This, however, is not always possible, and legislators and educators need to accept the fact that some children are always going to have sex or use drugs, whether or not they are encouraged not to do so. Given that this is the case, all children and young people should receive effective sexual health and HIV education - so that they can make informed choices about whether to start having sex, and so that they know how to protect themselves from pregnancy, STDs and HIV infection. 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, not only from the risk of HIV infection, but also from other dangers associated with drug use.
Helping the child - HIV testing
For those children who are HIV+, there are a number of treatment options available if they are lucky enough to be in an area where they are able to access them. Before a child can be treated, however, their HIV status must be established.
A common way of testing for HIV is to check for antibodies to the virus. Every baby born to a HIV+ mother will have these HIV antibodies from its mother, which means that this test can produce a positive result, even when the baby is not infected. The results of this test have no value for the first 18 months of the baby's life. In areas where complex lab equipment is accessible, a more complex test can be conducted - the viral load test - which can identify HIV in a baby. In resource-poor areas, the antibody test can at least determine which babies are not infected - meaning that those who show a positive result can be monitored for signs of AIDS-related sickness. After 18 months, any baby who still shows a positive result in an antibody test can be said to be infected.
Helping the HIV+ child - treatment
For those HIV+ children who live in countries where medical care is available, the first part of treatment is monitoring the children to keep an eye on their health. In adults, viral load tests and CD4 cell-counts are used to assess the progression of HIV, but because children don't have fully-developed immune systems, the results of these tests will be different. Again, this calls for specially-trained medical staff.
If it is decided that the child should be given treatment, there are fewer drugs available than can be found for adults. Improvements in the prevention of MTCT in much of the developed world mean that drug companies are not keen to produce medicines that will be needed only in less-wealthy countries, who may not be able to afford them. When such drugs are available, they are often more expensive than those for adults - sometimes many times more. The improvements they can make in a child's chances of avoiding illness or death, however, do justify their use.
Children with HIV are vulnerable to opportunistic infections (OIs) - which are the infections that ultimately cause death. PCP (a type of pneumonia) is a common OI, particularly in very young children. The antibiotic co-trimoxazole is effective in preventing PCP and various other opportunistic infections. It has been recommended for use in resource-poor countries with HIV+ children who show any signs of becoming ill. The use of such antibiotics can postpone the time at which ARV treatment should be started. At the end of 2004, WHO recommended that all children born to HIV positive mothers but whose HIV status is unknown be given co-trimoxazole8.
Helping the HIV+ child - care
A child who is HIV+ is likely to also have another family member who is infected - meaning that the child can also suffer from the stigma and the financial hardships associated with having someone in the family who has HIV. Ultimately, the child may experience the grief and emotional suffering of losing a parent or relative to AIDS. Counselling and support for children and their families can considerably improve their quality of life, relieve suffering and assist in the practical management of illness. Emotional and practical support is crucial for all children who are directly affected by HIV - whether or not that child is themselves HIV+. Such care might include health advice, help with shelter and material needs, and educational support. It involves the community, the school, social workers, counsellors, nurses, doctors and teachers.
Problems for the family
Many children are affected by AIDS in their family - with an estimated 35.7 million adults living with HIV around the world, it is clear that a very large number of children will know a family member who is HIV+ or who has died from AIDS. These children may themselves experience the discrimination that comes from being associated with HIV. They may also be in the position of having to care for a sick parent or relative, and may have had to give up school, if they have access to it, 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.
AIDS has now killed one or both parents of an estimated 12 million children 9 in sub-Saharan Africa. These AIDS orphans are sometimes left in the care of other adults in the family - uncles, aunts, or grandparents. In some situations, however, many family members may have died, or there may not be an extended family - in these cases, orphans may be left without any adult support, and sometimes have younger brothers or sisters who they have to support. AIDS is creating an increasing number of child-headed households. Such children are clearly extremely vulnerable to exploitation, which can also make them even more vulnerable to HIV infection.
Problems for the community
In many countries, children who are left destitute will be cared for by the community. In highly effected areas, neighbours will be aware of the existence of child-headed households, and may help out where they can, providing some assistance with food and clothing. This type of community support is the final safety-net for many children, and it may not hold if many people in the community die.
A large number of deaths in the community affect all children in that community, even those who are not orphans - other affects of many AIDS deaths are that schools and medical services will become unavailable as nurses and teachers die. This might seem like an unrealistic scenario - but it is one that is happening in many high-prevalence African countries, where many villages have houses left empty by the effects of AIDS.
Helping the family
There is no easy solution to the problem of HIV infection in the family - other than to try to ensure that family members do not become infected in the first place, and if they are, to provide ARV treatment. Many organisations focus on providing care and support for AIDS orphans, who have lost one or both parents to AIDS, may have younger siblings to support, and who may themselves be HIV+. Such orphans may need help with looking after siblings or sick family members and help to ensure that they are able to attend school.
It is preferable, however, to try to prevent such children from becoming orphaned at all - by keeping their parents alive. This entails providing care and ARV treatment to their parents. Appropriate medical attention can prolong the lives of parents and enable them to continue work, earning a wage and providing support, both financial and emotional, for their children.
AVERT.org has more information on AIDS orphans.
Helping the community
Much HIV education and prevention work is carried out at community levels - teaching people about the dangers of HIV infection and about how to avoid it, and attempting to reduce the discrimination often felt by those who are infected.
In many areas, the local community - friends and neighbours of the family - will provide help and support to children who are adversely affected or orphaned by AIDS. In areas where a large number of deaths have occurred, however, communities have been overwhelmed, and are simply unable to provide sufficient money or food for all their orphaned children. In such cases, aid organisations may step in to provide assistance.
A community that has been highly affected by AIDS may no longer be able to provide essential services to its members, as people in important roles die. For children, crucial services are primarily schooling and medical treatment. In some fortunate areas, again, aid organisations may step in to help with these problems. In the community, as in the family, it is always preferable to keep people alive than to provide support for children after people have died.
Helping in the future
It is clear that more needs to be done, especially in resource-poor countries. Many children are dying, whilst many more are experiencing the scars that AIDS can leave in their lives - almost all of which is avoidable. Medical technology is such that, in a developed country, a HIV+ woman 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 world.
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 treatment is not available in many countries. Developing countries need not only drugs to treat children, but specialist training for staff and the funding to enable treatment and ongoing care to take place. The world's political leaders and decision-makers already have these tools to save children from needlessly suffering - perhaps, one day, they will do something concrete to help.
AVERT.org has more information on the issues involved in providing AIDS treatment to millions. We also have advice and information for anyone who is concerned about pregnancy and HIV .