According to the UNAIDS 2006 Report, 2.3 million children under the age of 15 live with HIV/AIDS around the world. Of those children, 2.1 million live in Sub-Saharan Africa. In 2005 alone, an estimated 700,000 children were newly infected, mainly through mother-to- child transmission (MTCT). In the time it takes you to read this article a child somewhere will have contracted HIV. Today 1,400 children will die of AIDS, just like yesterday, and it will happen again tomorrow unless something is done to save these children.
Earlier this year, UNICEF announced that the global child mortality rate has dropped 23 percent since 1990. Although the international community worked hard to achieve this child survival gain, HIV is ravaging it. In some of the highly affected countries up to 58 percent of under-5 mortality is caused by HIV. Current evidence suggests that unlike adults, HIV infected children follow a more aggressive course of illness, with 30 percent dying at age one and 50 percent at age two.  The majority of these deaths could be prevented through early diagnosis and timely provision of effective care, support and treatment. However, this is all easier said than done.
One of the critical challenges in providing care to children infected with HIV is that many are infected in the womb and for children under 18 months old there is a deficiency of specific and affordable diagnostics. The commonly used HIV antibody tests are cheap and easy to use; however, they are unreliable when used among children younger than 18 months. Viral load tests could be used to detect HIV among these children, but they are expensive (between $25 and $1,255) and difficult to use. Therefore, the tests are not available in most health facilities in countries where resources are constrained. But the first step towards providing care, support and treatment is an HIV diagnosis for children. It is essential that prices for diagnostic tests, specifically viral load tests, be significantly reduced and that new more easy-to-use diagnostic tests for children less than 18 months old be developed.
A second challenge in helping these HIV infected children is getting them the proper anti-retroviral treatment (ARTs) to curtail the disease. As previously mentioned, about one-third of HIV-infected infants will die within their first year of life, and half will die before their second birthday, but these numbers can be reduced if the children receive ARTs. Currently only one in ten children needing ART receive it. The remaining 90 percent face a bleak and short-lived future. There are syrup forms of ARTs on the market but they are four to eight times more expensive than their comparative adult forms. Not to mention that pediatric ARTs are difficult to handle and caregivers of young children often opt to break or crush adult medicines in order that the child may receive any form of treatment. Despite the fact that this risks under- or over- dosing the child, many feel that it is a necessity in order to give the child a chance to live.
ARTs are not the only pharmaceutical drugs that these children need. Due to the severe depletion or lack of growth in their immune systems caused by HIV, infected children are at high risk for opportunistic infections, which are infections caused by organisms that usually do not cause disease in a person with a healthy immune system. Some opportunistic infections include Pneumocytis pneumonia, Candidiasis (an infection in the intestinal tract), and severe staph infections, among others. Administration of Cotrimoxazole prophylaxis, which cost as little as three cents per child per day, helps to prevent these commonly acquired opportunistic infections in HIV-infected children. They can reduce hospital visits and mortality by as much as 43 percent in populations where antiretroviral therapy is not available. However, so far only 1 percent of the children who need cotrimoxazole prophylaxis have access to it.
The majority of countries that have HIV/AIDS plans in effect include no provisions specifically for the 2.3 million children around the world who are infected with HIV/AIDS.  Pediatric HIV/AIDS is a growing concern for AFJN. Every child is a gift from God and every child deserves a chance to live. Currently, AFJN is part of a working group that is drafting specific proposals to present to Congress regarding the reauthorization of the President’s Emergency Plan For AIDS Relief. Continue to check our website for ways you can aid in this endeavor. Join us as we advocate for providing better pediatric diagnostic tools and more treatment for children with HIV/AIDS, thus providing hope for the futures of millions of children worldwide.
By Barbie Fischer
This article was featured in the November/December 2007 issue of Around Africa