Children: the forgotten victims of HIV

Outlook

(27-11-2009)

Children: the forgotten victims of HIV

World AIDS Day next Tuesday will highlight a human rights-based approach to dealing with the scourge.

by Nguyen Kieu Van

Viet Nam continued to set an example for the Asia-Pacific region when Prime Minister Nguyen Tan Dung approved the National Plan of Action for Children Living with and Affected by HIV/AIDS in June.

The plan to 2010 with a vision to 2020 was part of Viet Nam’s response to the appeal for governments to provide such action at the East Asia and Pacific Regional Consultation on HIV-AIDS conference in Ha Noi in 2006.

But while the efforts of Viet Nam’s and other Asia-Pacific-country governments to implement healthcare policies and support for children living with and affected by HIV-AIDS have been acknowledged, the results have not always matched the expectations of those whose lives have been blighted by the virus.

As United Nations Children’s Fund, or UNICEF, representative in Viet Nam Jesper Morch explains: "Viet Nam has excellent policies and legislation in place. But policies and legislation are sometimes difficult to enforce."

Double burden

Many of the affected children carry a double burden: Not only have they lost one or both parents to AIDS or are living with the HIV virus themselves; they are also without caregivers and lack the opportunity to learn.

Vietnamese Labour, Invalids and Social Affairs Minister Nguyen Thi Kim Ngan, who well knows the plight of these children, puts it best: "The pain to their spirit following the death of their parents is made much worse by the discrimination they suffer from those around them."

The epidemic has limited their basic rights.

But progress is being made. A UNAIDS report issued in Shanghai on Tuesday says HIV infections have fallen 17 per cent over the past eight years. The heaviest fall was in East Asia - almost 25 per cent.

"The good news is that we have evidence that the declines we are seeing are due, at least in part, to HIV prevention," says UNAIDS executive director Michel Sidibe.

"If we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved."

The Indonesian National AIDS Commission has provided a particularly impressive initiative with the extension of a life-skills education programme that empowers communities in the management of the virus in the country’s remote Papua Province.

UNICEF East Asia and Pacific Regional Office director Anupama Rao Singh is also quick to acknowledge the progress but advises: "Governments and civil societies should strengthen the evidence about the impact AIDS has on children and put them on a properly costed National Strategic Plan for protection, prevention care and support.

"Given the low-level and concentrated nature of the HIV pandemic in the Asia-Pacific, the best response is to engage in integrated programmes to promote overall child welfare and reduce poverty," she says.

In addition to the early identification of the disease, policies to support AIDS orphans through loans or job training are also necessary.

Such programmes should begin at the grassroots.

Many government and NGO studies reveal why such action is necessary.

These show that children living with and affected by HIV are more vulnerable to ill health, malnutrition, psychosocial suffering, slowed cognitive development, anxiety, depression, abandonment and abuse.

Changing patterns

Anupama Rao Singh warns the number of children living with HIV in Asia-Pacific is increasing. "This is because patterns of HIV infection are changing," she says.

"An increasingly large number of women not traditionally considered to be members of high-risk groups are becoming infected."

More than 43 per cent of new infections in Cambodia were among married women and more than a third of all new infections were from mother to child.

Most HIV infections in children are transmitted from mother to child and this makes early diagnosis through the universal testing of pregnant women and the provision of ART prophylaxis regimens to those infected crucial.

Vietnamese minister Ngan says high-risk children should be a focus of attention.

These include drug users; children who have both parents affected by HIV or those who live at social centres; street children and victims of human trafficking or sexual abuse.

But the Asia-Pacific has more orphans than anywhere else in the world-an estimated 90 million – and so poor children living with HIV in poor countries are all but overlooked.

They receive little support from governments and civil organisations and without money cannot buy the pharmaceutical drugs that would save their lives. Each year an estimated 93 per cent of children living with HIV in poor countries go without access to effective treatment.

The result: 18.4 per cent of the world’s yearly AIDS’s dead are children.

Most died because their parents did not have access to ART prophylaxis Regimens while their health centres lacked testing equipment and the necessary medicine.

The fact that the drugs suitable for children cost four to five times more than those for adults exacerbates the problem.

It means that governments, the World Health Organisation and the global pharmaceutical corporations must give priority to HIV testing, examination and the supply of the necessary drugs to the children in poor countries.

Doctors Without Borders has set the example.

It has supplied free prophylaxis regimens to people living with HIV in 29 poor countries. Surely, most of the beneficiaries were children.

UNAIDS estimates number of people living with HIV globally at 33.4 million.

The agency puts the number of children afflicted at 2.3 million with 95 per cent of them in poor countries mostly sub-Saharan Africa. — VNS