It’s Time to Step up for Children & Adolescents Affected by HIV and AIDS

Although great progress has been made in the fight against HIV and AIDS globally, advancements for children and adolescents continue to lag behind. While even one child suffering from this scourge is unacceptable, consider that 240,000 children globally became newly infected with HIV in 2013, which is equivalent to one new infection every two minutes.^[1]  In addition, another 190,000 children aged 0 to 14 died of AIDS-related causes due to lack of treatment^.[2]

As children reach adolescence, the epidemic risks remain high. AIDS is the leading cause of death among adolescents in Africa. In fact, the only age group in which HIV infections are increasing is teens between 10 and 19 years old living in southern Africa.^[3]

In order to end this epidemic, we must place an increased focus on this very vulnerable population. We must step up for children and adolescents affected by HIV and AIDS.

HIV and AIDS are particularly insidious as it is not only those who are infected who feel the effects. For example, as of 2013, an estimated 17.7 million children worldwide had lost one or both parents to AIDS.^[4] While grandmothers provide as much 50 percent of the care for these children,^[5] older women are especially challenged to assume the caretaking role as they lack regular income support and are often food insecure.

In addition to the issue of care and support, there are other impacts to consider. Delays in the development of physical and intellectual abilities can occur even in children who are HIV exposed but uninfected. Emerging evidence suggests that HIV-negative children whose mothers are HIV-positive fare worse than other children and perform less well than unaffected children on cognitive measures.

With too many children left behind by large-scale responses, how do we solve this challenge?

A stronger focus on treatment and prevention for children will not be enough to address such complex issues. We must achieve significant, sustained support and protection for children affected by HIV and AIDS. Scaling up treatment and prevention efforts for children will require a systematic approach that prioritizes everyday systems of care — families, schools and communities — and provides for long-term, integrated services to promote psychosocial well being.

In a recent paper, the Coalition for Children Affected by AIDS (the Coalition) and the Regional Inter Agency Task Team on Children & AIDS (RIATT-ESA) outlined key action steps necessary to reach all children and adolescents in the epidemic as well as those who care for them. To defeat the epidemic, we must:

1.       Scale-up access to prevention of mother to child services. The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive sunsets at the end of this year, however its goal of reducing new infections among children by 90 percent will not be met by that deadline. We will need to renew and redouble efforts to achieve this target, particularly in countries making the slowest progress.

2.       Scale-up pediatric testing to ensure timely diagnosis of children in diverse, resource-limited settings.

3.       Increase treatment access and reduce loss to follow-up by scaling up access to the appropriate treatment for children diagnosed with HIV and mitigating loss to follow up.

4.       Provide HIV-sensitive social protection services by integrating HIV-sensitive social protection programs, including cash transfers, as part of countries’ national responses.

5.       Invest in the early years of children living affected by HIV by establishing the supportive environment necessary for optimal cognitive, physical, emotional and social development.

6.       Strengthen linkages between child protection and HIV services by addressing the increased risk of physical and emotional abuse faced by children orphaned by HIV and those living with HIV-positive caregivers.

7.       Intensify HIV prevention and treatment for adolescents by addressing issues of social, emotional and physical transition and stigma impacting adolescents.

8.       Strengthen support for primary caregivers and community level care providers by providing caregivers of children with HIV with the support they need.