analysisBy Nicholas Muraguri
"Much has happened since the movement to eliminate new HIV infections among children was launched by UNAIDS in 2009."
I'll start with the good news: less children are contracting HIV now than they were two years ago. This is due to country commitment, ownership and mobilization, political leaders breaking the conspiracy of silence and advocating for what's best, the strategic engagement of women living with HIV and the best science. All of these efforts have gone a long way to help realize rapid results: Among the 22 high-burden countries that are the focus of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive, there has been a 24% reduction in new HIV infections. 24 months, 24% reduction.
Much has happened since the movement to eliminate new HIV infections among children was launched by UNAIDS in 2009. Between 2009 and 2011, anti-retroviral (ARV) prophylaxis prevented 409,000 children from acquiring HIV infection in low and middle-income countries. Countries like Burundi, Kenya, Namibia, South Africa, Togo and Zambia achieved from 40-59% reduction in the number of children acquiring HIV infections.
However, the news is not so good for those children who do in fact contract HIV. Worldwide, 330,000 children were newly infected with HIV in 2011, of which 300,000 were in sub-Saharan Africa. That's compared to less than 200 in western and central Europe. In the same period, 230,000 children died of AIDS-related causes in the world, of which 200,000 were in sub-Saharan Africa and less than 100 in Europe. Worldwide, there are 3.3 million children under the age of 15 years of age living with HIV, of which 3.1 million are in sub-Saharan Africa. Despite our progress, these are startling statistics.
The World Health Organization (WHO) recommends that children under two years of age begin HIV treatment right away, but in 2011, only 28% of children who were eligible for HIV treatment received it, compared to 56% of adults. HIV in children is more aggressive than among adults. Half the infected children die before the age of two if they do not receive the relevant drugs. Of the 330,000 children who acquired HIV in 2011, it could mean death within two years for half of them. In every society, children are one of the best indicators of inequity. In HIV, these inequities portray a grave picture for the children. They are a poignant reminder that children, who are the most vulnerable in society, need the most attention.
There are many reasons why children have less access to treatment than adults. One is that their mother is living with HIV and may be unable to care for the child. This is one of the reasons why early treatment for women is important, as it benefits not only mothers, but their children. Studies show that children whose mothers die are at increased risk of death--regardless of their HIV status. If a mother dies, the child is likely to shuffle from one caregiver to another, diminishing the chances for care.
Another reason is the complexity of pediatric HIV diagnosis and treatment. Because the infant's immune system is still developing, a special type of test is needed to confirm that he or she has acquired HIV. These tests are only available in a few facilities in each country, and often take 2 to 3 months to receive results. This is prohibitive where women have to travel long distances to reach clinics. In comparison, HIV tests for adults return results in only 20 minutes. There is an urgent need to develop better diagnostics for children so results are available faster and through a less cumbersome process.
Yet another reason is health care providers' lack of training in pediatric HIV management. There is an urgent need to strengthen their capacities to diagnose the child, initiate treatment and manage the child's progress.
While the efforts to prevent children's HIV transmission are progressing, efforts to provide treatment to those children who need it lag far behind. Therefore we need to ensure the large inequity between adults and children is vastly reduced, and children have access to as much care as adults, if not more. Only then can we reach the Global Plan's targets for 2015.
Nicholas Muraguri is Director, Global Secretariat to Eliminate HIV Among Children.