Ending paediatric AIDS
In recent years we have seen significant progress towards ensuring children are born HIV free. Successful programmes that prevent vertical transmission have brought with them the optimism that the end of paediatric AIDS is in sight. All those who are part of the global HIV response have every reason to celebrate but this must not blind us to the challenges that remain.
We must not forget that to reach the targets of zero new infections in children 1 we have to reach the most vulnerable people in society who are often too afraid to access Preventing Mother to Child Transmission (PMTCT) services even when they are available to them. This might be because they sell sex or use drugs or will be beaten or abandoned if they admit to being HIV positive. We still have major obstacles to clear to help people overcome barriers of access and stigma so that they can enrol in PMTCT programmes and only when we achieve this will there be a real hope of an end to paediatric AIDS.
Meanwhile, in the lives of children the end of vertical transmission should signal the beginning of support, not the end.
A child born free from HIV nevertheless begins a lifetime in an HIV-affected family often facing devastating social and psychological impacts, something that can get overlooked when the notion of an HIV free generation is being discussed. This makes the care and support agenda for children more important than ever. To truly enable children to live free from HIV in the wider sense, programmers must address the needs of a child beyond the clinical intervention and look to their long term future.
To effectively care for and support a child we must first understand and strengthen his or her family and the community surrounding them. In the past, child-focused HIV programming engaged with children later in life often only when they had become orphans. Programmes aimed to meet the material needs of children in the absence of their parents by providing things like school books, uniforms and food packages but we know the most useful thing we can do for a child is to keep the people they rely on alive and well. To be effective, HIV programming should take advantage of the fact that PMTCT provides an early entry point into a family. Becoming involved with a family from the word go means programmers can better provide the right social protection, care and support services to strengthen that unit, which in turn provides the best possible chance for a child to be looked after and protected.
At the International HIV/AIDS Alliance we aim to ensure that a family unit, in whatever form it takes, stays as strong as it can be. For instance, our linking organisation in Côte d’Ivoire (ANS-CI) has begun a new family centred PMTCT programme to reach families as early as possible and link them with long term community care and support. 2 The initiative, part of the wider SIDA-funded Africa Regional Programme, engages people from the community, particularly other mothers, to encourage women to get tested for HIV and access antenatal care and PMTCT services. If a woman is living with HIV they are then eligible for home visits where they’ll get practical advice on a range of issues from infant feeding and nutrition through to family planning, and will also be encouraged to have their child tested for HIV. Access to the home means that services also reach the wider family, as referrals can then be made for partners, children and other family members.
SUNRISE, an Alliance Uganda supported programme, seeks to strengthen Uganda’s social welfare system in order to build a workforce dedicated to children most at risk from the impacts of HIV. The USAID funded programme works at many levels, improving the capacity of staff at the Department for Gender, Labour and Social Development in care and protection of children throughout their lives while supporting the community to help identify and support the most vulnerable children.
Vasavya Mahila Mandali (VMM), an NGO working in Andhra Pradesh supported by Alliance India, has done fantastic work strengthening the ability of families to care for children affected by HIV. They have linked relatives and extended families to social security, pension and livelihood schemes and supported the creation of support groups to deal with issues of exclusion .These groups have grown to include families as well as community members and leaders, creating broader acceptance and support for vulnerable families through improved child protection, foster care, legal support and income generation.
The work being carried out by Alliance Cote d’Ivoire, Alliance Uganda and VMM demonstrate what can be done when programmes act early to strengthen those families most affected by HIV. For it is this unit, and the wider community of which it is part, that has the biggest part to play in keeping a child safe, healthy and happy, and who ultimately holds the key to creating a generation free from the impacts of HIV.
Kate Iorpenda is the Senior Advisor on Children at the International HIV/AIDS Alliance and Chair for the Coalition for Children Affected by AIDS.
Image copyright: Marcela Nievas for the International HIV/AIDS Alliance
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All opinions expressed in 'Reflections on the Epidemic' do not necessarily represent those of AVERT.
- 1. UNAIDS (2011) ' GLOBAL PLAN TOWARDS THE ELIMINATION OF NEW HIV INFECTIONS AMONG CHILDREN BY 2015 AND KEEPING THEIR MOTHERS ALIVE'
- 2. International HIV/AIDS Alliance (2012) ' Good Practice Guide: Family-centred HIV programming for children'