Children and the AIDS response: Five actions for the future

1. Rethink and innovate HIV testing and child-friendly treatment

All pregnant women and all children and young people exposed to HIV should know their HIV status. For pregnant women, knowing their HIV status is critical to be able to access life saving treatment for their own health and the health of their babies. Alternative approaches to HIV testing should be promoted, including home-based testing and periodic testing of women not living with HIV during pregnancy and breastfeeding in order to detect new infections early and link them to care. For children in early diagnosis is essential, in order that care can begin promptly protecting healthy growth and development.

A significantly lower number of children compared with adults living with HIV have access to care and treatment. Children are a third less likely to receive antiretroviral therapy compared with adults. Results from a study of 11 sites in Cameroon showed that only 32% of infants with a positive HIV test result were alive and accessing treatment 18 months later.

HIV prevention and treatment need to be tackled simultaneously and holistically among young people, recognizing and responding not only to their treatment and clinical needs but also to their emotional, physical and sexual needs.

2. Smart integration of HIV with other health services

The decentralization and integration of HIV services for pregnant and breastfeeding women and their infants into broader maternal and child health service platforms is essential to eliminating mother-to-child transmission and scaling up paediatric treatment coverage. To make this happen, however, the weaknesses in health systems — especially those linking mothers and infants — need to be addressed, including expanding and building the capacity of the health workforce.

For young people, youth-friendly services must cater to the specific physical and medical demands of young people living with HIV while providing support for their psychosocial and emerging sexual health needs.

3. Keep mother-baby pairs connected to care

To ensure the long-term health and well-being of mother and child, it is important that mother–baby pairs continue to access care and are not lost to follow-up. Strengthening and expanding community-based approaches to delivering HIV services and peer support is vital to the long-term positive impact on families affected by HIV.

Involving communities more closely could also help to better identify the people in need of services, especially among the most marginalized and hard-to-reach populations. Community-based antiretroviral therapy delivery has also been shown to be more cost-effective, with better uptake, adherence and lower service provision cost.

4. Make breastfeeding safer in the context of HIV

In low- and middle-income countries, many mothers living with HIV still face a decision that no mother should have to make — the choice of whether or not to breastfeed their babies. Breastfeeding gives vital nutrition and immune protection but exposes the baby to HIV. On the other hand, not breastfeeding increases the risk of the baby dying from other infectious diseases and of the baby being malnourished. Combining breastfeeding and antiretroviral medicines confers the greatest chances of the infant surviving while keeping the infant HIV-free. More potent medicines are needed to further reduce the risk of HIV transmission through breastfeeding.

5. Listen and respond to the voices of young people

Groups of young people living with HIV have identified core priorities to move their agenda forward. These include developing a network to advance an agenda for adolescents to access medicines, demanding better treatment services at the country level, with a particular focus on national antiretroviral therapy guidelines, implementing a science agenda to fill the current research gaps regarding young people living with HIV, and developing a mechanism to support the scaling up of targeted programmes for young people living with HIV.

How AIDS changed everything — MDG 6: 15 years, 15 lesson of hope from the AIDS response celebrates the milestone achievement of 15 million people on antiretroviral treatment — an accomplishment deemed impossible when the MDGs were established 15 years ago.

The story continues at www.whitetablegallery.org

Explore the first exhibition at The White Table Gallery which tells the story of how ‘things’ can have special meanings in the AIDS response.