Globally, children under age 15 account for about 5 per cent of all people living with HIV, 9 per cent of new HIV infections and 14 per cent of all AIDS-related deaths. Children under 1 year of age are among those most vulnerable to HIV. Evidence shows that early initiation of antiretroviral drugs in infants with HIV can save lives; yet, coverage of critical intervention among children remains too low. While there has been slow progress reported in scaling up access to treatment for children living with HIV, the 90-90-90 treatment targets call for 90% of those living with HIV to know their status, 90% of those who know their status to be on treatment, and 90% of those on treatment to be virally suppressed and sustained. Renewed focus has been called to strategically target more decentralized diagnostics and clinical management for children exposed and living with HIV, as well as integration with maternal, child and adolescent services at facilities and within communities.
HIV burden in children
Fast facts:
- Of the estimated 1.8 million [1.3 million-2.2 million] children under 15 years of age living with HIV, 88 per cent live in sub-Saharan Africa.
In 2019, 60 [49-81] per cent of the estimated infants exposed to HIV were tested for HIV within two months of birth. International guidelines advise that immediate antiretroviral therapy is crucial if HIV infection is detected in any child under the age 5 years. In reality, most children entering treatment programmes are older.
An estimated 1.7 million [1.3 million-2.2 million] children under age 15 were living with HIV in 2019. In 2019, 150,000 [94,000-240,000] children were newly infected with HIV, mainly through transmission of the virus from their mothers during pregnancy, delivery or while breastfeeding.
In 2019, an estimated 95,000 [61,000-150,000] children under age 15 died of AIDS-related causes globally. The vast majority of these deaths were preventable, either through antibiotic treatment of opportunistic infections and/or through antiretroviral treatment.
There has been some progress in antiretroviral coverage for children living with HIV
Fast facts:
- In 2019, about 948,000 children under age 15 were receiving antiretroviral therapy (ART) globally, up from about 435,000 in 2010.
- This means that just over half of children under the age of 15 living with HIV are receiving ART (53 [36-64] per cent).
In 2019, coverage of eligible children under age 15 receiving ART varied widely, ranging from under 10 per cent in some countries to over 95 per cent in others. Regionally, coverage of ART for children ranged from 32 [22-45] per cent in West and Central Africa to 82 [49->95] per cent in Middle East and North Africa. Coverage data for Eastern Europe and Central Asia, North America and Western Europe are not available.
Early diagnosis and treatment are particularly critical in the case of infants. The ‘Children with HIV Early Antiretroviral Therapy’ study from South Africa demonstrated a 76 per cent reduction in mortality when treatment is initiated in the first 12 weeks of life among infants who test positive for HIV.
Countries have made some progress in expanding access to early infant HIV-testing services, but testing rates are still low. WHO’s revised treatment guidelines recommend that infants, if HIV-exposed, should be tested by 4 to 6 weeks and 9 months of age using virologic assay, and when the child stops breastfeeding with a rapid antibody test. Those found positive should be started on antiretroviral therapy immediately upon diagnosis.
Protection, care and support for children affected by HIV and AIDS
A growing number of countries are developing national action plans for orphans and other vulnerable children. As of 2019, an estimated 13.8 million [10.2 million-17.9 million] children worldwide had lost one or both parents to due to AIDS-related causes. Three quarters of these children (10.3 million [7.9-13.1 million]) live in sub-Saharan Africa. Children orphaned due to AIDS make up 9 per cent of all orphans worldwide, but 19 per cent of all orphans in sub-Saharan Africa.
Risks faced by orphans and other vulnerable children
Orphans and children considered vulnerable for other reasons, including HIV and AIDS, are at higher risk of missing out on schooling, living in households with less food security, and suffering from anxiety and depression. They are also in greater danger of exposure to HIV. Their experiences differ across families, communities and countries, and are influenced by a complex mix of variables, including children’s relationships to their caregivers, the wealth of their household and community, HIV prevalence in the area and many other factors. To care properly for orphans and vulnerable children, a minimum package of support is needed and includes access to services such as education, health care, social welfare and protection. However, without laws, policies and services that assist families and communities in caring for children at risk, such support tends to remain low.
Developing routine monitoring indicators and tools for collecting data on orphans and vulnerable children is difficult since a standard definition of ‘vulnerability’ has not been established and a minimum package of services has yet to be determined. In addition, poor coordination of services means there is the strong possibility that children will receive multiple services and be counted more than once, skewing the data used to inform programmes. Greater attention needs to be given to defining optimum services and beneficiaries as well as strengthening coordination and reporting on the services provided to orphans and vulnerable children.
Progress: National-level responses
The shift towards inclusive programming to help all vulnerable children, including those directly affected by AIDS, is making an impact. The growing call for a broader, more inclusive definition of vulnerability is reflected in many national action plans. In Zimbabwe, for instance, the National Plan of Action for Orphans and Other Vulnerable Children embraces a broad definition of vulnerability that extends beyond orphanhood and the impact of HIV and AIDS.
National-level responses to orphans and vulnerable children have increasingly become part of broader social welfare and assistance to vulnerable populations, including children, such as social protection programmes that are HIV-sensitive. In sub-Saharan Africa, social protection programmes have been scaled up significantly.
For information on UNICEF’s programme and policy work, visit the Children & AIDS community of practice.
