Children and HIV/AIDS

DECEMBER 01 : WORLD AIDS DAY

By Dr. B.J.C.Perera

(December 01, Colombo, Sri Lanka Guardian) The disease human immunodeficiency virus infection and acquired immune deficiency Syndrome (HIV/AIDS) generally brings to mind the picture of sexually promiscuous young people with a severe potentially fatal disease. Most people think that it is a disease of irresponsible adults. However, it may come as a surprise to many people that children too can be infected and affected by the disease. In fact, hundreds of thousands of children across the world become infected with HIV every year and without treatment, die as a result of their illness progressing to AIDS. In addition, millions more children who are not infected with HIV are indirectly affected by the epidemic as a result of the death and suffering that AIDS causes in their families and their communities. It is essential to note at the outset that there is no absolutely curative treatment for this unfortunate disease. Drugs against the virus can only control the disease. There is no vaccine against it. Treatment has to be for life, whatever period that might ultimately turn out to be.

At the end of 2008, there were over two million children living with HIV around the world. An estimated 430,000 children became newly infected with HIV in 2008 alone. Of the 2 million people who died of AIDS during 2008, more than one in seven were children. Every hour, around the world, 31 children die as a result of AIDS. More than 1500 children become infected with HIV every day. The vast majority, over 90 per cent, acquire the infection from their mother. Babies could acquire HIV during pregnancy, labour, delivery or after birth through breastfeeding. Among infected infants who are not breastfed, about two-thirds of cases of mother-to-child transmission occur around the time of delivery and the rest during pregnancy. Children may also become infected with HIV through contaminated blood transfusion or blood products, the use of contaminated needles and syringes, and sexual abuse or exploitation. Since the beginning of the pandemic, of the over 5 million infants who have been infected with HIV, 90% were born in Africa. However, the number of cases in Central Asia, Eastern Europe, India and South-East Asia is rising.

HIV infection is a major contributing factor to childhood disease and mortality. In developing countries, it is threatening to completely nullify the gains made in infant and child survival and health over recent decades. Many countries that had previously seen child-survival rates rise, as a result of improved healthcare, are now seeing these rates fall again. It has been estimated that without AIDS, Botswana’s under-5 mortality rate would have been 31 per 100,000 in 2002 compared to 107 with AIDS. By 2010, the country’s under-5 mortality is expected to have increased by 100 deaths per 100,000 as a result of AIDS. Most regions of the world, including African regions, have seen a decline in child mortality but in Southern Africa, the area most affected by HIV, under-5 mortality has increased. In Africa, studies suggest that one in three newborns infected with HIV die before the age of one, over half die before reaching their second birthday, and most are dead before they are five years old. Conversely, in developed countries, preventive measures ensure that the transmission of HIV from mother to child is relatively rare. In those cases where it does occur, a range of treatment options means that the child can survive, often into adulthood. This shows that with funding, trained staff and resources, the infections and deaths of many children in lower-income countries might easily be avoided.

HIV can damage a child’s life in three main ways. It could act through its effects directly on the child, on that of the child’s family and on the community that the child is growing up in. HIV affects the very core of the defense mechanisms of the human body. It principally interferes with the ability to fight off and resist infection by all types of infective agents. The involvement is such that these patients are also vulnerable to organisms that normally do not cause illnesses in humans. In addition, the effects of the virus also involve several other organs and systems directly. The end result of all these involvements lead to a situation whereby the entire body feels the consequences and then leads to a condition of major derangements of function.

Once children are infected with HIV, they face a high chance of illness and death, unless they can successfully be provided with specific anti-retroviral treatment. HIV treatment for children slows the progress of HIV infection and allows infected children to live much longer, healthier lives. Sadly, many children who could be benefiting from this therapy, an estimated 60 per cent, are not receiving it. A major problem is that only few appropriate drugs are available for use in children. Young children ideally need to be given drugs in the form of syrups or powders but most of the drugs that work well in children are only available as tablets. As a result, those who look after these children are often forced to break adult tablets into smaller doses for their children, running the risk that children are given too little or too much of a drug. There are numerous other problems that are stopping children from receiving antiretroviral drugs including high drug prices and the lack of healthcare workers trained to treat children.

Another major problem for children living with HIV is childhood illnesses, such as mumps and chickenpox. These illnesses can affect all children, but since children living with HIV have such weak immune systems they may find that these illnesses are more frequent, last longer, and do not respond as well to treatment. Opportunistic infections, such as Tuberculosis and PCP, a form of pneumonia caused by an organism that usually does not cause disease in healthy children, are also a serious risk to the health of children living with HIV.

There are several important consequences of HIV on a child’s family. With an estimated 33 million adults living with HIV around the world, large numbers of children have family members that are living with HIV, or who have died from AIDS. Some children may have to act, through necessity, as people looking after sick parents who have HIV or AIDS. Quite a few children may have lost one or both parents to AIDS, and are consequently orphaned. An increasing number of households are also headed by children as AIDS erodes traditional community support systems. In some instances, children end up being their family’s principal wage earners as AIDS prevents adults from working and creates expensive medical bills.

HIV and AIDS could have devastating effects on the community which indirectly affect children. As AIDS ravages a community, schools lose teachers and children are prevented from having access to a reasonable education. In some of the severely affected countries, even doctors and nurses die of the disease, and children find it difficult to gain care for childhood diseases. Some children may lose their friends to AIDS. In addition, children who have HIV in their family may be stigmatized and affected by discrimination. All these have major social and psychological effects even on normal children.

The main way to stop children becoming infected is to prevent mother-to-child-transmission (MTCT) of HIV. This type of transmission is preventable in the majority of cases. The measures to be undertaken which include giving antiretroviral drugs to a mother during pregnancy, and to her child once it is born can reduce the risk of MTCT from 20 to 45 per cent to less than 2 per cent. In developed countries, such interventions have minimised the number of children being born with HIV. Unfortunately, PMTCT services fail to reach most women in resource-poor countries. In 2008, around 45 per cent of HIV-infected pregnant women in low- and middle-income countries received drugs to protect their babies from infection. The use of sterile medical equipment and screened blood products can also help to prevent children becoming infected through medical transmission. In Romania, more than 10,000 new babies and young children were infected with HIV from contaminated injections and unscreened blood transfusions between 1987 and 1991. This illustrates not only how vulnerable children are to infection in a medical setting, but also how a country can respond to these problems. The large number of HIV-positive children in Romania prompted the government to roll out antiretroviral treatment, which today reaches almost all of those in need. Sterile medical equipment is used, and blood-products are now screened for HIV. Where children are becoming infected through non-MTCT routes, abstaining from sex or injecting drug use is the most effective means of preventing HIV transmission. However, it is inevitable that there will be some children engaging in risky behaviours, through having unprotected sex or needle sharing. Promoting abstinence could be ineffective if complementary HIV education, including the promotion of safer sex and learning how HIV is transmitted through drug use, is not also provided.

Up to the present time, there are just over forty children who had been diagnosed with HIV. This is just the tip of the iceberg. It is estimated that the real number living with the disease so far is at least three times this number. They are so far undetected. Those known cases of children living with HIV are on highly active anti-retroviral treatment. These drugs, which are quite expensive, are provided completely free of charge by the National Health Service of Sri Lanka.

People need to know that children can become infected with HIV and that, in the majority of cases, HIV infection is acquired from an infected mother. Frequently, but not always, the father is also infected. People also need to know that a small number of children used to acquire HIV infection as a result of receiving unscreened infected blood or blood products, and that infected medical or surgical equipment and certain traditional medical practices also put children at risk of becoming infected. An unknown but not inconsiderable number of children may become infected with HIV through sexual exploitation or abuse. It is also important to know that, with good care and support, infected children can live a longer and better life. It is clear that much more needs to be done, especially in resource-poor countries. Many children are dying, whilst millions more are experiencing the scars that AIDS can leave on their lives, many of which are avoidable. Medical treatment is such that, in a developed country, a woman living with HIV can now be almost certain that her child will not be infected and yet there are still delays in making the appropriate tests and drugs available around the world, very specially in the developing countries.

-Sri Lanka Guardian