Children worldwide are affected by HIV and AIDS, either because they are infected with the virus themselves or because their mother, father or sibling has HIV infection, or because they are vulnerable to infection.
Until recently, the impact of HIV and AIDS on infants and young children has been a neglected issue. This is because children have been the last to be affected by the epidemic, and because children have little voice in society. In addition, children with HIV often have the same infections as children without HIV, so the extent of the problem in children has been unclear. Access is lacking to basic information about how to prevent HIV infection in children, about diagnosis, treatment and care of children with HIV, in settings with limited resources, and about how to provide support and counselling. There has been little research on the effect of HIV infection in young children and on their families, or on young children who are not themselves infected but where other family members may be infected with HIV and AIDS.
This briefing paper has been developed in response to requests to Healthlink Worldwide's Child Health and AIDS and Sexual Health Programmes. It also covers issues and concerns raised by participants at a workshop on AIDS and children held in 1997 in Zambia, who included mothers living with HIV, nurses, paediatricians, midwives, counsellors, and representatives from non-governmental organisations (NGOs). Because children in sub-Saharan Africa have been most affected by HIV/AIDS to date, many of the examples referred to in the briefing paper are from Africa. Other parts of the world, where HIV/AIDS in children is a growing problem, can learn from, use and adapt African experiences.
Greater priority needs to be given to improving the quality of life of children with, and affected by, HIV and AIDS by ensuring that they have access to appropriate treatment, care and support. This means addressing their emotional and psychological needs as well as their physical needs, and ensuring that they are not subject to discrimination, victimisation and exploitation because of their own HIV status or that of members of their family.
The briefing paper focuses on children aged from birth to five years and it is intended primarily for health workers in developing countries who are responsible for the management of young children with HIV and AIDS. It is hoped that the briefing paper will also be of interest to educators, NGOs and those working with community organisations who are involved with HIV prevention and the care of young children with HIV and AIDS.
The paper concentrates on practical information about:
|how HIV is transmitted to infants and young children|
|how transmission can be prevented|
|how to diagnose HIV and AIDS in young children|
|how to care for children with HIV, including treatment of common infections|
|how to provide support to families caring for sick children|
|how children who are not infected may be affected by HIV|
|how HIV and AIDS in children affects health workers and other caregivers.|
Other important issues related to HIV/AIDS and children that health workers need to be aware of - for example, community support, orphans, sexual abuse, HIV testing and counselling - are mentioned briefly but not discussed in detail.
There is still much that we do not know about transmission of HIV to children, in particular when it happens and why. This makes it difficult to know how best to prevent transmission. Clinical diagnosis of HIV in children is also difficult because of the overlap with common childhood illnesses. The briefing paper outlines some of the current debates and unanswered questions, and indicates where more research is needed or is being done. However, health workers should remember two important things, in terms of what they can do. First, the most effective way to prevent HIV in children is to prevent HIV infection in women. Second, care of young children with HIV is based on the same principles as children without HIV-immunisation, good nutrition, preventing infections, and early and effective treatment of common illnesses.