TIGblogs - Henry Ekwuruke

The world's response to protect and support HIV-infected and AIDS-affected children remains "tragically insufficient", but that is beginning to change, according to a new report by the U.N. children's agency UNICEF. The "Unite for Children, Unite Against AIDS" initiative was launched in October 2005 by UNICEF with the goal of putting the "missing face" of children at the centre of the global HIV/AIDS agenda.

This week's report, titled "Children and AIDS: A Stocktaking Report", evaluates the world's response to protect and support AIDS-affected children in the year since the initiative began. "One year ago we did not know how many children were on treatment, we did not know how many governments were spending money on children, and we couldn't say with any certainty how many services children orphaned or otherwise were getting," Peter McDermott, who runs UNICEF's AIDS programme, told reporters at the launch of the report. "Most countries did not count children," McDermott explained. He stressed that one year on, UNICEF has established baseline data with cooperation from governments.

And the agency has identified some positive trends. "Over the past year, there has been a broad, growing recognition of the need to intensify and accelerate actions towards universal access to comprehensive prevention, treatment, care and support," according to the report. Commitment to this goal by 2010 was affirmed by heads of state and government and their representatives participating in the 2006 High-Level Meeting on AIDS held at the U.N. last June.

Glimmers of hope have been seen in preventing HIV transmission from mothers to children. In several countries in Eastern and Southern Africa, trends in access to antiretroviral regimens for preventing mother-to-child transmission are starting to show remarkable increases. In Namibia, for example, access rates jumped from 6 to 29 percent from 2004 to 2005. Increasing numbers of children living with HIV are now receiving treatment, although the numbers are far too few. The increases are a result of improved testing, better skills among health workers, lower drug prices and simpler formulations, according to the report. Two years ago, UNICEF was concerned that a number of factors stopped children from getting treatment. One was the ability of health workers to identify infected children. Another was whether the available drugs were safe for children and affordable in poor countries, McDermott said. Prices have now declined and the drugs have been proven safe when administered to children, he continued. There are however, huge gaps in progress.

Globally, as of 2005, an estimated 15.2 million children under 18 have lost one or both parents to AIDS; about 80 percent of these children live in sub-Saharan Africa. By 2010, more than 20 million children will have been orphaned by AIDS. In addition to these orphans, many more children are left vulnerable by AIDS, including those who live with parents who are chronically ill, those who live in households that have taken in AIDS orphans, or those who have lost teachers and other adult members of the community to the disease. Orphans and other children affected by AIDS face grave risks to their education, health and well-being. Children who have lost both parents -- to AIDS or any other cause -- are generally less likely than non-orphans to attend school, according to UNICEF.

To counter this threat, at least 20 countries in sub-Saharan Africa have completed national plans of action (NPA) on orphans and vulnerable children, and several others have nearly completed and launched their NPAs. In South Africa, the country with the largest number of orphans due to AIDS, more than 7.1 million children under 14 living in poverty were benefiting from a government child support grant by April 2006. Botswana and Namibia also provide child grants and other benefits to children affected by AIDS.

Of the 2.3 million children under 15 living with HIV, an estimated 780,000 were in need of antiretroviral treatment (ART) in 2005. Just 10 percent of children in need of ART have access to it, according to the report. Those not receiving ART face a bleak and short-lived future. An estimated one-third of infected infants die in their first year, and half die by their second birthday, according to U.N. statistics. In 2006, an estimated 380,000 children died of AIDS-related causes; the vast majority of these deaths could have been prevented either by treating opportunistic infections or providing ART. Only seven countries identified in the report provided ART at least 20 percent of children needing it. They are Botswana (84 percent), Cape Verde (47 percent), the Dominican Republic (23 percent), Jamaica (47 percent), Namibia (52 percent), Rwanda (20 percent) and Thailand (95 percent). These countries are "on target", according to McDermott.

One out of 10 pregnant women living in the capital cities of sub-Saharan Africa is infected with HIV and about one in three children born to HIV-positive mothers will contract the virus. The highest known infection rates among pregnant women are in Gaborone, Botswana and Mbabane, Swaziland, where one in three is infected, and in Maseru, Lesotho and Pretoria, South Africa, where one in four is infected. "Barriers to care are poor transportation for families and lack of disclosure within families of infection," said Heidi Schwarzwald, vice president of Clinical Affairs for the Baylor International Pediatric AIDS Initiative, who just returned after spending eight months in Botswana.

Another persistent problem identified at the launch was the overwhelming lack of data for some regions. "Even in large countries like Brazil, key data are not available for children," Marie-Pierre Poirier, UNICEF representative in Brazil, told reporters. “Countries must put children at the center of their national responses," Poirier stressed. The report emphasises that the Millennium Development Goals (MDGs) -- especially MDG 6, which is to halt and reverse the spread of HIV/AIDS, malaria and other diseases by 2015 -- will not be reached without integrating approaches to children and AIDS with approaches to child health and survival. The other seven MDGs include a 50 percent reduction in poverty and hunger; universal primary education; reduction of child mortality by two-thirds; cutbacks in maternal mortality by three-quarters; the promotion of gender equality; environmental sustainability; and a global partnership for development between the rich and poor.