In-depth: AIDS 2008: PlusNews in Mexico

GLOBAL: Children short-changed by AIDS response

Photo: Keishamaza Rukikaire/IRIN

Two million children under the age of 15 are now living with HIV

Mexico City, 7 August 2008 (PlusNews) - Huge strides have been made in the provision of antiretroviral (ARV) treatment, and HIV prevention is receiving more attention than ever before, but the global AIDS response has neglected children, said experts at the International AIDS Conference in Mexico City this week.

"Children have been short-changed in the response to AIDS," Linda Richter, of South Africa's Human Sciences Research Council (HSRC), told delegates on Wednesday. "They are visible in the photo opportunities, but mostly invisible in the response."

According to UNAIDS, despite the existence of ARV treatment that can prevent mother-to-child HIV transmission (PMTCT), an estimated 370,000 children became infected in 2007, of which 270,000 died. Two million children under the age of 15 are now living with HIV, an eight-fold increase since 1990.

While an estimated 30 percent of adults in need of life-prolonging ARV medication now have access to it, only 10 percent of HIV-positive children in need of the drugs are getting them. As a result, out of 1,200 children infected with HIV every day, only half will make it to their second birthday.

"From prevention of mother-to-child transmission to access to treatment, to looking after their emotional wellbeing, children have been left out of the global AIDS response," said Agnes Binagwaho, executive director of Rwanda's National AIDS Control Council and co-chair of the Joint Learning Initiative on Children and HIV/AIDS, which works to alleviate the plight of children affected by the pandemic.

Children have been short-changed in the response to AIDS. They are visible in the photo opportunities, but mostly invisible in the response

Although most HIV-positive children contracted the virus from their mothers, a significant number of young girls were becoming infected through sexual transmission, said Alex de Waal, programme director at the Social Sciences Research Council, an international non-profit organisation. "All the renewed attention to HIV prevention must target young girls," he urged.

Citing a study conducted in two districts of Dar es Salaam, Tanzania's commercial capital, which found that teenage girls were propositioned for sex as many as 20 times a day, de Waal said: "These are girls for whom the traditional ABC [Abstinence, Be faithful and Condom use] prevention model has limited use because of their economic powerlessness and social disadvantage."

A family-focused response needed

Several speakers said viewing children in the context of families and not just as individuals was central to improving both prevention and treatment for them.

"Keeping a mother alive is crucial to families and children," said Linda Sherr, a clinical scientist with the United Kingdom's University College London.

Considering that families bear 90 percent of the financial cost of caring for children with HIV, receiving little support from governments and other stakeholders, Binagwaho called for families to be put "at the centre of the HIV response to children”.

"We need to revisit the financial architecture of the response, so that we are able to reach families in a more flexible way and strengthen the economic base of caregivers," said Michael Sidibe, deputy executive director of UNAIDS.

According to Jim Kim, of Harvard University's Centre for Health and Human Rights, offering free prevention and treatment services was not enough for many poor families who could not afford transport to take their children to health facilities.

HSRC's Richter said support for families needed to take the form of treatment allowances, medical insurance, subsidies or even direct cash.

"Giving women money for their families seems to work better than giving them free food, because they are able to purchase food they need and will eat; food that they know how to store," she said. "Very often when families are given food they trade it with neighbours or give it away either because it is impractical or unpalatable."

Speakers said donors would not necessarily have to dig deeper into their pockets to finance such initiatives, they would simply have to take a fresh look at how they spent existing funds.

"Even if no additional money is spent, we can work with what we have," Binagwaho said. "It is all about how and where the funds are directed."

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AIDS 2008: PlusNews in Mexico
AIDS 2008 - Mexico City 3-8 August 2008 - XVII International AIDS Conference