Overview of Children Living with HIVAIDS

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Overview of Children Living with HIV/AIDS

• Ms. Sara Bowsky RN, MPH

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Global HIV/AIDS EstimatesChildren under 15
years of age

• By The End of 2002
• 3.2 Million children were living with HIV/AIDS
• 87 in sub-Saharan Africa
• 610,000 children died from AIDS
• 90 of deaths in sub-Saharan Africa
• 800,000 new HIV infections in children
• 90 in sub-Saharan Africa

Source UNAIDS/WHO
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Estimated impact of AIDS on under 5 child
mortality rates Selected African Countries 2010

Deaths per 1000 live births
with AIDS
250
without AIDS
200
150
100
50
0
Botswana
Kenya
Malawi
Tanzania
Zambia
Zimbabwe
Source U.S. Bureau of the Census
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How do children become infected with HIV?

• 90 of HIV infection in children occurs through
  mother to child transmission (pregnancy, labour
  or breast feeding)
• Other routes of transmission
• Blood transfusion
• Contaminated needles and syringes.
• Child sexual abuse

Source UNAIDS
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The Impact of HIV/AIDS on Infant and Child
Survival

• Between 62-75 of children with HIV in developing
  countries will not survive to their 5th birthday
  (E. Pisani, 2001).
• Rwanda, risk of death for a child with HIV is
  45 and 62 by 2nd and 5th year of life.
• 20 of children with HIV develop serious
  illnesses within the 1st year of life (NAID,
  1977).
• Approximately half of the children showing signs
  and symptoms in the first year of life die before
  the age of three.

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Why Are Children With HIV Dying So Young?

• Short survival time is a result of
• Late diagnosis or suspicion of HIV
• Lack of access to
• adequate health care
• case management of childhood illnesses
• prophylaxis treatment of opportunistic
  infections
• ART
• And prevalence of other endemic, acute or chronic
  diseases

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Response to Date

• Community Response
• Home Based Care
• Palliative Care
• Psychosocial Support
• Family Support
• Orphans and other Vulnerable Children
• IMCI/HIV

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Response To Date Cont

• PMTCT Coverage 1 (0-37 range)
• 70 receive less than essential care package
• Without prevention, up to 10 of all newborns in
  most affected countries could become infected
  vertically.
• 6 adults and only 1 of children receive PCP
  Prophylaxis
• 1 ART coverage for adults (range 1-18)
• ART coverage for children unknown

Source WHO 2000
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Challenges

• Discrepancy between where child health and HIV
  services are sought and where they are available.
• The majority of children present to primary level
  care
• Overwhelming majority of children with HIV never
  see an HIV trained practitioner.
• Of those who do present to tertiary level care in
  some southern and eastern Africa countries
• Children with symptomatic HIV infection occupy
  approximately 30 of hospital beds
• Nearly 80 of these children are below 2 years
  of age

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Challenges cont

• Consumer choice
• Use of different service providers for different
  child health/survival services increased
  difficulty to provide integrated and
  comprehensive services.

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Source WHO
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Comprehensive HIV/AIDS Care and Support
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Needs of Children with HIV/AIDS Medical
Nursing

• Confidential Counseling and testing
• Initial diagnosis and treatment
• Routine care (esp. immunizations), health and
  development
• Nutrition
• Treatment of common childhood illnesses
• Access to prophylaxis and treatment of OIs and
  other related illnesses
• Access to ART
• Complementary home based care
• Palliative care (including pain management)

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Needs of Children with HIV/AIDS Medical and
Nursing Sero-status Unknown

• Somewhat similar to that of children with known
  HIV sero-status but
• Option of VCT
• Counseling the parents
• Training of and identification by primary health
  care workers in symptomatic diagnosis (IMCI/HIV)
  and OI treatment

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Needs of Children with HIV/AIDS Psychosocial

• Development of trust, self -worth and autonomy
• Ability to express fears and concerns
• Social integration with age groups and community
• Consistent, secure, and loving support from adult
  care provider
• Ability to carry out activities of daily living
  with minimal discomfort

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Needs of Children with HIV/AIDS continued

• Early Childhood Development (ECD)
• To continue school
• Caring and loving adult
• Stigma reduction
• Community care
• Family support interventions
• KEEP THEIR PARENTS ALIVE

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The Bottom Line

• Some challenges are similar to those faced by
  child health/survival programs
• BUT in addition to strengthening integrated child
  health services, including HIV/AIDS care and
  support and ART, also need to
• Mobilize/support communities
• Extend and strengthen social safety nets
• Strive towards family centered care