Only a quarter of HIV-positive pregnant women in poorer countries receive antiretroviral therapy to prevent mother-to-child transmission of HIV, according to a UN report issued on April 3rd. Nevertheless, the report found that increasing numbers of HIV-positive children and expectant mothers are receiving anti-HIV drugs.
Jointly produced by the World Health Organization (WHO), UNAIDS and UNICEF, Children and AIDS: Second stocktaking report, found that, in 2007, an estimated 290,000 children aged under 15 died because of HIV and that 2.1 million children were living with the virus. The HIV epidemic in adults is also having an effect on children, and 12.1 million children in sub-Saharan Africa have had one or both parents die because of HIV.
Focusing on low- and middle-income countries, the report details progress in four key areas: the provision of antiretroviral drugs to prevent mother-to-child transmission of HIV; the provision of paediatric anti-HIV treatment; preventing new HIV infections in children and young people; and, the protection and support of young people affected by HIV.
Prevention of mother-to-child transmission
In 2006, just over a third of a million pregnant women with HIV received antiretroviral therapy to prevent HIV transmission to their baby. Although this represents a 60% increase on 2005, it means that only 23% of expectant mothers with HIV are receiving drugs shown to dramatically reduce the risk of HIV transmission to their infant.
Nevertheless, 21 countries are now on track to meet the target 80% coverage of treatment to prevent mother-to-child transmission. This includes several countries with a high adult HIV prevalence such as Botswana and South Africa.
Other encouraging news is evidence of a decline in HIV prevalence amongst women attending antenatal clinics. Between 2001 and 2006, prevalence declined in eleven Eastern and Southern African countries.
Provision of HIV treatment to children
A 70% increase was observed in the number of HIV-infected children in poorer countries who received antiretroviral therapy between 2005 and 2006 (127, 300 children up from 75,000).
Treatment capacity has expanded in many settings, and advocacy has secured reductions in the price of several drugs. Donors, including PEPFAR, the Global Fund and the Clinton Foundation, have provided funds allowing the purchase of drugs. Another important advance has been the approval of a fixed-dose generic combination antiretroviral pill specifically for paediatric treatment.
Preventing infections in adolescents and young people
An estimated 5,400,000 people aged between 15 and 24 are living with HIV, according to the report, and 40% of new HIV infections in 2007 were in this age group.
UNICEF figures suggest that, between 2000 and 2006, the proportion of young women with a good knowledge of HIV increased 17 middle- and low-income countries with a high prevalence of HIV. But in only three of these countries were over 50% assessed as having a comprehensive knowledge of HIV. There was also evidence of increasing levels of knowledge of HIV amongst young men. But of the five countries surveyed, in only one, Rwanda, did over 50% have a good knowledge of the virus.
Protecting and supporting young people affected by HIV
The number of children orphaned by HIV in poorer countries continues to increase, and in sub-Saharan Africa an estimated 12.1 million children in 2007 had lost one or both parents to HIV.
Stigma in countries with a lower HIV prevalence, such as India and Pakistan, can mean that HIV-affected children are denied basic social services, an education, and are sometimes institutionalised or denied access to their parents.
And there is evidence that HIV-positive mothers are sometimes unable to care for their children. In some countries of the former Soviet Union, an estimated 10% - 20% of HIV-positive babies are abandoned at birth by their mothers at hospitals and other state institutions. These facilities are often unable to provide the support and facilities required by these children.
But 21 countries in sub-Saharan Africa now have action plans to for orphans and other vulnerable children.