OVC Support Toolkit  >  Health and nutrition 

Children Living with HIV/AIDS

This section looks at health and nutrition issues which particularly affect children living with HIV/AIDS. More general issues of health and nutrition and how they affect all orphans and other vulnerable children are covered in other sections. Other sections give more details on access to antiretroviral treatment in children, which drugs to use in children and practical tips on how to give such treatment in children.

Key points about the health and nutrition of children living with HIV/AIDS are:

1. UNAIDS estimates that more than 1500 children per day are being infected with HIV globally.

2. Most HIV infection in children occurs through mother to child transmission (MTCT). Other routes of infection include through sexual activity and unsafe health practices.

3. HIV test results in children under the age of 15-18 months do not give a clear result. Children born to HIV positive women have HIV antibodies from their mother in their blood until this age.

4. HIV has serious effects on the health of children. They often grow poorly and are more at risk of infectious diseases. These are often more severe than in other children.

5. Without antiretroviral treatment, 60-75% of children with HIV die before the age of five years. With effective antiretroviral treatment, this figure can be reduced below 20%.

6. Children with HIV have a range of health needs in addition to access to antiretroviral treatment. These include immunization and prevention and early treatment of all infections. These things can help a child with HIV stay healthy even where there is no access to antiretroviral drugs.

In this section, the term children living with HIV/AIDS is used to mean HIV positive children. However, some documents use the term more broadly to describe all children who are affected by HIV/AIDS.

UNAIDS estimates that 1500 children per day are being infected with HIV globally.

Routes of Transmission

Most HIV infection in children occurs through mother to child transmission (MTCT). This can occur during pregnancy, at the time of birth or through breastfeeding. In developing countries, approximately one in every three children born to an HIV positive mother is themselves infected with HIV. In developed countries, less than one child in fifty born to an HIV positive mother is themselves infected. This is because of health practices including delivery by Caesarean Section, treatment with antiretroviral drugs and safe alternatives to breastfeeding. Children may also be infected with HIV through sex and unsafe health practices. Sexual spread of HIV is most common in older children/young people but can occur in younger children through sexual abuse. Unsafe health practices include use of non-sterile needles and unsafe blood products. These practices may also occur in the traditional health sector and include activities such as circumcision and ear piercing.

Most HIV Infection in Children is Unrecognised

Most children in developing countries who have HIV infection do not know that they are infected. There are many reasons for this. Many of these apply to adults also. HIV tests may not be available. People may not see the benefit of having a test, particularly if the child or adult does not feel ill. However, UNAIDS report that 'early awareness that a child has HIV infection, combined with good care and support, can enhance survival and quality of life'.

HIV Testing in Children

A child may be suspected of having HIV infection if the child is born to a woman who is know to be HIV positive herself or if the child becomes ill themselves. However, it is difficult to understand HIV tests in children under the age of 15-18 months. Standard HIV tests detect antibodies to HIV. Children born to HIV positive women have HIV antibodies from their mother in their blood until this age. These are called maternal antibodies. In a very few cases, these maternal antibodies are found in the blood of children aged more than 18 months. It is possible to detect HIV directly. However, these tests are very expensive and not widely available in developing countries. One of the tests used is the HIV DNA polymerase chain reaction (PCR). In the United States, children born to HIV positive mothers receive PCR tests at birth and again at 1-2 months and at 4-6 months. Two positive tests are taken as evidence of HIV infection. Two negative tests are evidence that the child does not have HIV infection. This can be confirmed using standard HIV antibody tests, which become negative after the age of about 18 months.

There are many issues to consider before testing a child for HIV:

• HIV testing should only be carried out if it brings some clear benefit to the child. For example, this might be better care and support.
• Counselling needs to be provided for children and their care givers. The counselling provided should be appropriate for the age of the child.
• Most children who are HIV positive have been infected through mother to child transmission. Therefore, finding out that a child has HIV infection means that the child's mother (and the father) may also be HIV positive.
• HIV testing needs to be carried out in a way which ensures that results are kept confidential.

It is also possible to decide how severe a child's HIV infection is. This is particularly important when deciding whether or not to treat a child with antiretroviral drugs.

Effects of HIV Infection on Children

HIV infection affects children in a number of ways:

• Children with HIV infection often fail to grow properly. This is sometimes referred to as failure to thrive.
• Children with HIV infection are more frequently affected by infectious diseases. These are often more severe than in other children.
• Without antiretroviral treatment, 60-75% of children with HIV die before the age of 5 years. With treatment with antiretroviral drugs, this figure can be reduced to about 20%.
• Children with HIV often face stigma and discrimination as a result of their infection.

Health Needs of Children Living with HIV

Children with HIV have a variety of health needs. These include:

• Early and effective treatment of common infections. Prevention and treatment of common infections are particularly important for children with HIV. Work is currently being undertaken to integrate issues relating to HIV into the approach to childhood illness currently recommended by the World Health Organisation. This is called the integrated management of childhood illnesses (IMCI).
• Prevention and treatment of infections which would not cause illness in a child who does not have HIV. Infections which may be minor in a child without HIV may be very severe in a child with HIV. Infections of this type are called opportunistic infections.
• Medicines which can prevent opportunistic infections occurring. This is called prophylaxis. It is particularly important that children with HIV receive medicines to prevent TB and a particular form of pneumonia (called pneumocystis pneumonia or PCP). PCP and other infections can be prevented by giving Cotrimoxazole to all children born to HIV positive women from the age of 6 weeks to one year, and all HIV positive children. Even in areas of high Cotrimoxazole resistance there is still benefit in prescribing it to HIV positive children. Although it is known that this would help keep children with HIV healthy, most children with HIV in developing countries are not receiving these medicines.
• Immunisation. Children with HIV should receive immunizations in the same way as other children. These help protect the child against infectious diseases. This is particularly important in children with HIV because they are particularly vulnerable to infections. They should receive an additional dose of measles vaccine at six months of age. Children who are ill because of HIV should not receive BCG or yellow fever vaccination. They should receive injectable polio vaccine rather than oral polio vaccine.
• Good nutrition. This has been shown to reduce infections in children with HIV and to slow the onset of HIV-related illness and AIDS. Vitamin A supplementation may be helpful.
• Good hygiene
• A balance between exercise and rest
• Psychosocial Support including care, comfort and counselling

All of the items mentioned above contribute to the health and well-being of children with HIV. This contribution may be as important as providing them with antiretroviral treatment. For example, some people argue that it would be more cost-effective to ensure that all children with HIV receive medicines to prevent TB and pneumocystis pneumonia, rather than focusing exclusively on providing antiretroviral drugs.

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