Break the Silence…… A Focus on HIV Positive Children

“The future of any nation is directly linked to the future of its children – and by investing in children and in the families that sustain them, a nation is ultimately investing in its own development.”

– Carol Bellamy, Executive Director, UNICEF

  1. What is HIV?
  2. What is the global prevalence of HIV infection among children?
  3. What is the prevalence rate of HIV among children in India?
  4. How is HIV transmitted to children?
  5. How to treat HIV positive children?
  6. How to reduce the impact of HIV on children?
  7. What are the precautions to be taken to prevent HIV in children?
  8. What are government initiatives to develop the well being of HIV positive children in India?
  9. Real Time Experiences
  10. What is World AIDS Day?
  11. Myths And Facts about HIV/AIDS

1. What is HIV?
Human Immunodeficiency Virus (HIV) is a virus which attacks human immune system badly. If it is left untreated, it takes around ten years to develop AIDS disease. HIV is found in the blood and the sexual fluids of an infected person and in the breast milk of an infected woman. HIV can be affected to women, men and children.

The effects of the HIV/AIDS epidemic on children are manifold: hundreds of thousands of children every year are infected with HIV, most are left undiagnosed, do not access treatment and die very young. Only few factors like greater access to the drugs that can prevent mother to child transmission, appropriate testing, efficient linkages to care and treatment and support for the families and communities provide the material, social, and emotional foundation for a child’s development.

2. What is the global prevalence of HIV infection among children?

A recent report on HIV in children by WHO reveals below interesting facts:

  1. At the end of 2009, there were 2.5 million children living with HIV around the world.
  2. An estimated 400,000 children became newly infected with HIV in 2009.
  3. Of the 1.8 million people who died of AIDS during 2009, one in seven was children. Every hour, around 30 children die as a result of AIDS.
  4. There are more than 16 million children under the age of 18 who have lost one or both parents to AIDS.
  5. Most children living with HIV/AIDS– almost 9 in 10 – live in sub-Saharan Africa, the region of the world where AIDS has taken its greatest toll.

3. What is the prevalence rate of HIV among children in India?

A recent report by National AIDS Control Organization (NACO) depicts that, 70,000 children are infected with HIV in India due to the mode of parent-to-child-transmission (PTCT). HIV prevalence occurs more in countries, where poverty, illiteracy and poor health are more and the spread of HIV presents an overwhelming challenge. HIV in India spreads from diverse cultures and backgrounds. The vast majority of infections occur through heterosexual sex (80%), and the prevalence is more among high risk groups including sex workers, men who have sex with men, and injecting drug users as well as truck drivers and migrant workers. HIV statistical information about children shows below information:

  1. It is estimated that 70,000 children below the age of 15 are living with HIV in India and 21,000 children are infected every year through parent-to-child transmission. A small percentage of people are also infected by unsafe injections and infected by blood transfusions.
  2. Most of the children are infected with the virus while still in the womb, during birth or while breastfeeding.
  3. A total of 375 antiretroviral therapy (ART) centers shall be equipped to offer pediatric ART in the country.
  4. Follow up of HIV exposed infants, according to the Indian Guidelines, begins at six weeks.

To reach more mother-infant pairs, the Reproductive and Child Health (RCH) programme is linked to the prevention of parent-to-child-transmission (PPTCT) and Pediatric HIV programme in order to provide for and incorporate HIV care into the package of services for mothers and children.

4. How is HIV transmitted to children?

Most of the HIV positive children get infected through below methods:

Mother-To-Child Transmission (MTCT)

Major portion of HIV infected children (more than 90%) acquire the infection through transmission from their mother. South Africa occupied first place in the HIV transmission, with 90% of HIV positive children in Africa. At the same time, the number of cases in Central Asia, Eastern Europe, India and South-East Asia is also rising in a remarkable level. Children may acquire HIV infection from their mother during pregnancy, labour, delivery or after birth during breastfeeding. Fortunately, most children born to HIV-infected mothers are not infected. Among infected infants who are not breastfed, about two-thirds of cases of mother-to-child-transmission (MTCT) occur around the time of delivery and the rest during pregnancy (mostly during the last two months). In countries like India, where breastfeeding is the norm, it accounts for about one-third of all transmissions. As a result, the proportion of infants infected through MTCT is higher in these societies than in those where mothers with HIV infection can safely avoid breastfeeding.

Other routes of transmission

HIV infection can also be transmitted through blood transfusion and the use of contaminated needles and synergies. A recent report says that, more than half the children in Europe were infected in the late 80s through contaminated blood products and syringes. Preventive strategies such as screening of all donated blood and inappropriate use of blood products have been put in place and are succeeding in reducing transmission by this route. Child sexual abuse is another significant cause of childhood HIV infection in few cases.

5. How to treat HIV positive children?

HIV infected children are not getting (provided) enough opportunities for diagnosis of HIV which arise at facilities providing services for antenatal care, prevention of mother-to-child transmission (PMTCT) of HIV, immunization, nutrition, inpatient admissions and within programmes for other vulnerable children. It is estimated that only 8% of HIV-exposed infants received early virological testing in 2008. Analysis of international cohort data confirms that very few HIV-infected infants are started on antiretroviral therapy, and those who do receive it, are started when they are already very sick, largely due to a delay in HIV testing.

The benefits of expanded access to HIV testing and counseling for infants and children are numerous and include the following:

  1. Early identification of HIV-infected infants and children as a first step to treatment and care;
  2. Identification of HIV-exposed but uninfected infants, which facilitates follow-up care and prevention measures that will help to ensure that they remain uninfected and healthy;
  3. Life-planning for parents and/or children who are HIV infected; and
  4. Increased access to care and antiretroviral therapy for parents.

Children and adolescents who were infected at birth or via blood products as young children follow a unique clinical course that may differ from that of other adolescents and long-term surviving adults. Children ideally need to be given drugs in the form of syrups or powders, due to difficulties in swallowing. Teens with sexually acquired HIV are in a relatively early stage of infection and are ideal candidates for early intervention that may avoid the need to be on lifelong antiretroviral therapy.

6. How to reduce the impact of HIV on children?

HIV impact on children can be reduced by taking below precautions:

Early awareness

Early awareness of HIV infection and better access to health care services are required to improve the treatment and survival of HIV infected children.

Diagnostic facilities  

The presence of maternal antibodies limits the use of HIV antibody testing for diagnosis of HIV infection in infants under the age of 15–18 months.

Immunization

All children born to suspected or known HIV-positive mothers should be fully immunized according to the national expanded programme of immunization childhood vaccination guidelines.

Nutrition

Nutritional support is therefore important in the management of HIV-infected children. Studies have shown that vitamin A is important in reducing morbidity and mortality from infections in HIV-positive children.

Drugs

Basic drugs for treating common childhood infections and infections associated with HIV, such as pneumonia, sepsis and fungal infections, as well as drugs for supportive and palliative care, are essential.

7. What are the precautions to be taken to prevent HIV in children?

Prevention of Mother-to-child transmission (PMTCT)

Mother-to-child transmission (MTCT) is a process, when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding.

Blood safety

Blood safety encompasses actions aimed at ensuring that everyone has access to blood and blood products that are as safe as possible, available at reasonable cost, adequate to meet the needs of patients, transfused only when necessary and provided as part of a sustainable blood programme within the existing health care system.

HIV/AIDS education

HIV/AIDS education plays an important role in reducing the stigma and discrimination of HIV positive.

8. What are government initiatives to develop the well being of HIV positive children in India?

The National AIDS Control Organization (NACO) is a government institution that was established in 1992 for planning and implementing HIV prevention, control, and management. HIV testing is offered by government institutions and by private hospital-based or independent clinical laboratories. There is no national information network that collects HIV testing information from clinical laboratories in the private sector, so prevalence estimates are based solely on the sentinel surveillance mechanism. The basic measures taken by NACO are:

  1. Promoting HIV/AIDS awareness among young people and empower them to fight against HIV/AIDS.
  2. Influencing the resource persons at national, state and district levels to influence the policy, promote multi-sectoral response and increase government resources to fight against HIV/AIDS.

The other important measures taken by the Indian government are as follows:

  1. Ensure safe blood transfusion
  2. Scale up programmes for individuals and communities at high risk
  3. Scale up prevention of parent-to-child transmission (PTCT), care, support and treatment.

UNICEF is assisting the government to further expand and enhance the quality of programmes to reduce the transmission of HIV from infected mothers to their children and to increase the access of these mothers and their children to treatment in various ways: by providing strategic supplies of drugs and commodities, improving the capacity of staff; by developing innovative communication approaches for prevention and care; helping to improve monitoring and reporting systems.

9. World AIDS Day – December 1st

World AIDS day is dedicated to raise awareness about the AIDS disease and spread of the HIV infection. The World Health Organization observed the first World AIDS Day on December 1st, 1988. Month of December is also considered as AIDS awareness month. This day raises awareness about the HIV prevention, treatment and care of HIV/AIDS. Every year world AIDS day come up with a unique theme to raise awareness among the people and the theme will be selected by the World AIDS Campaign’s Global Steering Committee.

10. Real Life Experiences

Ruth: Uganda (October 19, 2011)

Ruth. (Photo: James Pursey)

My name is Ruth Kamiini. I am 39 years old and am the mother of eight children.

I found out I was HIV-positive after my seventh child, Sharon, fell ill when she was six years old. When I took her to the hospital, she was tested for HIV and we were informed that like me, she is HIV-positive too.

Sharon is feeling much better now. She is on medication and I bring her to hospital for regular checkups.

The Foundation’s Family Support Group has taught me the importance of adhering to treatment. I will continue to ensure that she takes her medication correctly. And I believe that she will live a happy, meaningful life.

Ezra is tested for HIV. (Photo: James Pursey)

When I was pregnant with my eighth baby, Ezra, I was put on medication to prevent the transmission of the virus to the baby. Ezra is now two years old, and being tested for HIV today. Although I am anxious to know his results, I am hopeful because he is strong and looks healthy.

Twenty minutes later… Ruth emerged from the counseling room, with a smile on her face.

“Ezra is Negative! I feel so happy my baby is well! I will have him tested again to confirm these negative results in the next couple of months.”

Jane: Uganda (October 19, 2011)

Jane. (Photo: James Pursey)

My name is Jane. I am a hairdresser who lives in Ibanda district, southwestern Uganda. My husband is a motorcycle taxi driver. We have been together for seven years. We have a five-year-old son named Daniel and a six-week-old daughter we call Princess.

I found out that I was HIV-positive during an antenatal visit in 2006, when I was pregnant with Daniel. I was immediately put on medicine to treat the virus, and prevent the transmission of HIV to my unborn son.

After discovering my status, my husband was tested and found that he too was HIV-positive. He also takes medicine.

We feel well and healthy.

Thanks prevention of mother-to-child transmission of HIV (PMTCT) services, Daniel is HIV-negative. He is a happy, healthy boy.

Jane’s healthy family. (Photo: James Pursey)

I have come to the health center today to test my second baby, Princess. She is just six weeks old and I have hope that she too will be HIV-negative. I will not know her status until I receive the results of her test.

Don’t let us down…

Shashank (name changed) was diagnosed HIV positive in 2004. He has now got used to facing discrimination all the time.

“At the time of Shashank’s birth in 2002, I got blood transfusion at a government hospital in Delhi, and they gave me HIV infected blood. Both me and my son are HIV positive now,” Shashank’s mother said.

“Some school authorities also refused to take him when they saw HIV positive mentioned on his birth certificate,” she added.

His mother is reluctant to reveal the government hospital’s name as she has lost the papers of blood transfusion and is unable to claim justice.

Shashank, who lives with his family in a rented accommodation in west Delhi, now studies in a government school nearby. The Class 2 student falls ill frequently and needs constant medication, but he aspires to join the police when he grows up.

“I want to be like other children. But the moment I say I am affected by HIV, I am made to feel like a victim,” he said.

Lost childhood

“I want to go to school, but they won’t let me in,” said Lakshmi. The five-year-old was accompanied by her grandmother, who shared experiences of stigma and discrimination the child had to go through right from the birth. “She isn’t old enough to make sense of why she has to be away from the school and other children,” the grandmother added.

11. Myths And Facts about HIV/AIDS

1. Myth: I have just been diagnosed with HIV and AIDS…I am going to die.

Fact: This is the biggest myth of all. In fact people are living with HIV and AIDS longer today than ever before. Medications, treatment programs and a better understanding of HIV and AIDS allow those infected to live normal, healthy and productive lives.

2. Myth: HIV can be cured.

Fact: There is no cure for HIV at this time. People are living full lives with HIV and AIDS, but there is no cure yet.

3. Myth: You can get HIV from breathing the air around an HIV-infected person or from hugging or holding hands with an HIV-infected person.

Fact: HIV cannot be transmitted through…

  1. Toilet seats or door-knob handles.
  2. Touching, hugging, holding hands, or cheek kissing with an HIV-infected person.
  3. Sharing eating utensils with an HIV-infected person.
  4. Mosquito bites.

4. Myth: You can get HIV by kissing an HIV-infected person.

Fact: Casual contact through closed-mouth or “social” kissing is not a risk for transmission of HIV.

5. Myth: I would know if a loved one or I had HIV.

Fact: A person with HIV may not show any symptoms for up to 10 years. Since HIV affects each person differently, many people with HIV can look and feel healthy for years. The only sure way to know is to get tested.

6. Myth: Since I am HIV-positive, if I get pregnant, I will spread the disease to my unborn baby.

Fact: A woman who knows about her HIV infection early in pregnancy has 2 percent chance of having a baby with HIV.

7. Myth: Both my partner and I have HIV. We don’t need to use a condom.

Fact: This is not true. You still need to practice safer sex. Even if you have HIV, you can be infected with a different type from what you already have. You could become infected with drug-resistant strains of HIV. This can make it very hard for treatment to work. Make sure to use a condom every time you have any kind of sex.

8. Myth: HIV is the same as AIDS.

Fact: HIV is the virus that leads to AIDS. A person is said to have AIDS when his or her CD4 count drops below 200 or when he or she has certain infections or cancers. A person can have HIV for years without having AIDS. Having HIV does not mean you have AIDS.

9. Myth: A vaccine to prevent HIV has already been invented, but the general public is kept uninformed.

Fact: There is no official statement about such an invention has ever been made by any country of the world. There is no vaccination against HIV infection, so far.

10. Myth: The number of people infected with HIV is going down.

Fact: It is not true. The number of people who are infected with HIV is going up.

 

Post Comment