HIV/AIDS in children: a disaster in the making

Abstract

The Countdown to 2015 meeting earlier this year identified HIV/AIDS as a factor or a leading cause of preventable death in children in the 42 countries with lack of progress towards the target of Millennium Development Goal 4. The identification of HIV/AIDS as a leading cause of death is a particular tragedy because HIV/AIDS in children is almost entirely preventable. 90% of childhood HIV infections now occur in sub-Saharan Africa. Without treatment HIV in children is lethal. There are large and unacceptable inequities in access to HIV prevention and treatment for children. 420000 children worldwide were newly infected with HIV in 2007; 330000 children died of AIDS mostly in sub-Saharan Africa. In the 2008 Countdown statistics high HIV prevalence was associated with the highest rates of child mortality in those aged under 5 years and with increases in mortality between 1990 and 2006. Maternal HIV infection also has a vast impact on child health. Loss of mothers affects the overall welfare of children and families; loss of one or both parents to AIDS leaves millions of orphans. How can these issues be addressed? High priority should be given to preventing HIV infection in young women and offering termination of unwanted pregnancies. These cost-effective measures approximate outcomes achieved through direct interventions in mother-to-child transmission of HIV. The high levels of antenatal coverage reported in Countdown 2008 offer an opportunity to integrate HIV-prevention services with routine prenatal and adolescent care. Interventions aimed at mother-to-child transmission vary widely between countries. Only 9% of HIV-infected African women receive antiretroviral drugs (country range 1-59%); not a single country has attained the target of 80% coverage set by the 2001 Declaration of Commitment on HIV/AIDS Global Targets for low-income and middle-income countries. (excerpt)