Children with HIV: a future compromised

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Children with HIV: a future compromised

Children with HIV: a future compromised

HIV/AIDS is a disease of the young. Last year altogether 400,000 children under the age of 15 years became infected with HIV worldwide, bringing the total number of children living with the virus at the end of 2017 to 830.000. Hundreds of thousands of HIV positive babies are born every year to HIV positive mothers. 

By the end of 2018, UN- AIDS estimates that 1 million children worldwide will be living with HIV.

        In 2017 alone of the 1.5 million people who died of AIDS, 350.000 were children under 15. Analyses indicate that, by the year 2010, if the spread of HIV is not contained, AIDS may increase infant mortality by as much as 75% and under five child morality by more than 100% in regions most affected by the disease. Health services already under strain in many developing countries and in poorer areas of the industrialized world, are likely to have to care for increasing numbers of children with severe HIV associated illnesses.

HIV infection in children typically runs a faster course to AIDS and then death than in adults. And pediatric AIDS kills especially fast in developing countries. Stick children in developing countries are generally at greater risk of death than children in in desterilized countries and this is no less true of children with HIV. In Europe 80% of HIV positive children survive at least until their third birthday, and more than 20% reach the age of 10. In Zambia however, nearly half of HIV positive children in one study had died by the age of two. In another study in Uganda, 66% were dead by the age of three.

In Africa, in general, the situation for sick HIV-positive children in very grave.

Many of the common, inexpensive antibiotics and other medications used to treat sick children without HIV also work for children with HIV but often, even these drugs are unavailable.

Poor families are less able to afford health care and basic drugs to tackle opportunistic infections, a problem which is even more acute in countries with low health budgets and where health services are difficult to access. In addition, drugs for rarer HIV-associated illnesses have not been part of essential drug programmes that supply the world’s poorest hospitals and clinics and clinical practice guidelines for pediatric AIDS are often less clear than those for adult. Increasing the availability of basic antibiotics for acute respiratory infections, anti-fungal drugs for thrush, and of drugs that can cure tuberculosis, is an urgent priority for developing countries with children and adults affected by AIDS UNAIDS has made greater access to these drugs one of its primary concerns.

However, the more rapid course of pediatric AIDS in Africa is explained not only be less developed health care systems, but also by poor nutrition and widespread infectious diseases to which children are particularly vulnerable.

        Poverty is key reason why children die more quickly of AIDS in developing countries. If children are sleeping three or four to a room, for example, which is more common in poorer households, they are far more likely to transmit and contract tuberculosis or other respiratory diseases if one of them has any of these infections. If children are poorly nourished, their immune systems will weaken. If families do not have access to clean water, they are more vulnerable to waterborne diseases including diarrhea.

Children with HIV commonly experience wasting and delayed development and are often killed by typical childhood diseases like diarrhea, measles, tuberculosis and other respiratory infections. Because these diseases are often the same as those that kill other children, it is sometimes difficult for health workers in poor countries, without access to expensive HIV testing equipment, to distinguish HIV positive children from others. This may have at least two important consequences. First, children with HIV may not receive the special care they need. Secondly, a general apathy about child health may arise, with consequences for all children. In communities around the world, increase in infant and child deaths due to AIDS may lead to a mistaken belief that immunization and nutrition and nutrition programmes for children do not work. Disenchantment with these programmers could increase mortality in uninfected children.

The dominant mode of transmission of HIV in newborn babies is so-called vertical transmission from their mothers. While in poorer countries some babies are still being infected through contaminated blood or medical equipment, virtually all HIV positive infants have acquired the virus from their HIV positive mothers during pregnancy or delivery, or through breastfeeding.

And women of child bearing age make up an ever-increasing proportion of people with HIV world. Wide a trend that reflects their own biological and social vulnerability to in faction

Last year, 2.7 million adults became infected with HIV, nearly half of them women, and AIDS now kills more women annually than men in sub-Saharan Africa

Long-standing legal, economic and societal manifestations of gender discrimination and intention to their sexual health influence consider ably women’s vulnerability to HIV/AIDS.

In Kenya, for example an AIDSCAP report found that the vulnerability of women in exacerbated by historical trends which have removed men from their families for lengthy periods of time, increased the acceptability of male sexual activity outside of marital relations, and sanctioned the behavior of older men to use their wealth and prestige to seek sex with girls and young women.

In the longer term, therefore, reducing the vulnerability of infants to vertical transmission calls for the same kind of action as reducing the magnitude of sexual transmission to women. The human rights of women must be fully promoted and protected, an approach that was reinforced by both international conference on population and Development held in Cairo in 1994 and the united nations Fourth world conference on women, held in Beijing in 1995, which called for a strengthening of preventive programmers and for gender sensitive initiatives to address HIV/AIDS and to end the social subordination of women and girls, This encompasses the ability of all women, whether or not infected with HIV. To make and effectuate decisions about their reproductive and sexual health, including the avoidance of unplanned and/or unwanted pregnancies. In the immediate term, it is also vital to increase women’s access to information about the prevention of HIV transmission in general and within this, about existing ways of diminishing the risk of mother to child transmission both before and during pregnancy, and after birth.

But for prevention strategies to be equitable and effective, AIDS programmers must avoid failing into the ancient trap of seeing women only as mothers. And it would be tragic if, ones again, as for contraction, women alone were left with the responsibility, for HIV prevention within sexual relationship, and men were absolved of this responsibility. HIV prevention must also move beyond measures that primarily focus on reducing the transmission of HIV between sexual partners. As stressed by UNFPA and other leading agencies the respective status and roles of men and women in society must be considered in order to understand and act on the constraints imposed by the gender gap on behaviors relevant to HIV.

While not all children born to HIV-positive mothers become infected, this risk is, again, significantly greater in poorer countries.

Most studies suggest that the probability that an HIV-Positive woman’s baby will have the virus is between 25% and 44% in a developing country and in an industrialized country. There are a number of factors that increase a woman’s risk of having an infected baby. They include a depressed immune status, poor nutrition, complications in pregnancy, and protracted labor after the waters break.

A further risk factor for the baby is breastfeeding a practice that by and large is the norm in developing countries. It is estimated that, on average, approximately 1 in 7 during the breast-feeding period. A recent study of transmission through breast feeding to infants over six months of age in cote d’lyoire found a rate of 12%. Another south African study found that the mother to child transmission of HIV infection was 17% for bottle-fed infants and 38% for breastfed babies. Variations in rates are thought to be dependent on such factors as the level of viral load in the mother and in the breast-milk, the nutrition status of mother and infant, infected and bleeding nipples, and teething problems of the baby.

But while breastfeeding can kill by transmitting HIV, bottle-feeding can also be dangerous and increases risks to child health.

In recent years, breastfeeding has been heavily promoted and encouraged for good reason. If affords vital protection against deadly childhood diseases, particularly diarrhea and respiratory infection. And breastfeeding is a natural, cost-free method, whereas the cost of infant formula and even the clean water and fuel needed to prepare it. Are often beyond the means of poor families in developing countries.

The HIV- positive mothers of newborns thus face a difficult dilemma in choosing between breastfeeding and bottle-feeding. The context will differ depending on the country and the woman’s own socioeconomic status. For example, in Thailand where there is relatively wide access to safe water, HIV – positive mothers are given free infant formula by the government, provided with information on the risk factors, and the mother is encouraged to decide not to breastfeed. In countries in sub-Saharan Africa, however, providing infant formula would not be appropriate in may settings because clean water for making up the formula is not available.

The policy of UNAIDS and its cosponsors is to encourage HIV positive mothers to be given a much information as possible on the relative risk of bread feeding and bottle-feeding so that they can decide whether to breastfeed or not. Women must decide for themselves how to handle the delicate balance between the risks and advantages of two approaches there can be no universally valid recommendation. But only women in possession of all the information are in a position to make fully informed choices.

To increase women’s control over the situation, it is also important for countries to make voluntary HIV testing and counseling more widely available. This is important now for example, women who know they are HIV positive may choose to shorten the breastfeeding period or use artificial feeding and will become increasingly important as new drug regimens are developed to reduce the risk of vertical transmission.

In 1994, French and American researchers found that the antiviral drug AZT (zidovudine) administered to HIV-positive women in pregnancy and to their newborns reduced the rate of vertical transmission by 68%. Without AZT there was a mother to child transmission rate of 25.5% with AZT, it was only 8.3%.

While clearly an important breakthrough, it soon became clear that this discovery would create an enormous ethical dilemma because a preventive regimen like this is difficult if not impossible to apply in many developing country settings. To begin with AZT is a very expensive drug. A full course of preventive treatment and her newborn costs about us $ 1000 – 1500

In the United States.

An equally important problem is that the AZT regimen as initially developed, calls for the drug to be given for months before delivery, and to be administered as an intravenous infusion during delivery-neither of these being suited to prenatal and delivery care in many developing countries.

As a result, in many industrialized countries including the United Kingdom and the United States, and in countries such as Brazil, the initial AZT regimen is now routinely offered to HIV positive pregnant women and their newborns.

In other countries, such as Thailand, promotion of its use in this context in under consideration by the government. But in many developing countries, where the annual per capita health expenditure may be as little as US $10, and where women often attend clinics for prenatal care only late in pregnancy if at all, AZT is only available to the very wealthy or to women participating in clinical trials sponsored by agencies from industrialized countries.

UNAIDS has made improved access to all drugs needed for the treatment of HIV disease in the developing world one of its highest priorities. For this purpose, it is conducting a trial in five sites in South Africa, Tanzania and Uganda to evaluate the efficacy and tolerance of three simpler, shorter regimens for the prevention of mother-to – child transmission of HIV in a population where breastfeeding in the norm.

The UNAIDS trial has been designed to ensure that it is comparable to the real situation in which the local standard of care applies.

The 1.900 HIV – positive participating pregnant women are fully informed about the way the trial is being conducted.

Every year 350.000 children get infected with HIV in developing countries from mother – to – child transmission. Finding shorter and more effective regimens which are adapted to the standards of care of most developing countries increases the chances that women will have access to drugs to protect their new born.

At the same time, every effort must be made to ensure that women are counseled and supported in refusing unsafe sex during pregnancy for their own sake, to maximize their chances of staying uninfected, and for the sake of protecting their infants. Equally important is to recognize and promote male responsibility in this respect.

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