Today on World AIDS Day 2008, we of the International Pediatric Association regret to report that HIV is an increasing cause of death for children of the developing world, particularly in Sub-Saharan Africa where over 90 per cent of child AIDS deaths occur.  In 2007 420,000 children worldwide were newly infected with HIV, and 330,000 children died of AIDS.  This is an inexcusable tragedy as both child acquisition of HIV infection and child deaths from AIDS are preventable. Once acquired, HIV infection in children is lethal without treatment. Unfortunately there are large and unacceptable inequities to access for infants and children to both HIV prevention and treatment services.

HIV prevention and treatment have all but eliminated infant and child infections and deaths from HIV AIDS in the industrialized world, but according to the latest statistics from the Countdown to 2015, HIV AIDS is an increasingly prominent factor in preventable child death in the 42 countries with lack of progress towards achieving Millennium Development Goal 4 (reducing child mortality by two thirds by 2015).  In many Sub Saharan countries, AIDS has now become the leading cause of child death. High HIV prevalence in children is associated with high under age five child death rates, and is a factor common to all countries where child mortality rates have increased between 1990 and 2006. Maternal HIV AIDS with its risk of transmitting HIV infection to infants at birth or during breast feeding, and its attendant toll of maternal illness and death, has profound impacts on infant and child health. Millions of children are now orphaned of one or both parents and too often left alone to navigate a difficult world without the help of family.

What can be done to address this unacceptable situation?  Higher priority must be given for access to prevention and treatment services for adolescents and women of childbearing age and their infants.  HIV AIDS services and maternal and newborn and child health services should be integrated, and access for women infants, and children assured. This needed progress in prevention and management of HIV AIDS in mothers and children will necessitate adjustments to national health policies and resource allocations, as well as enhanced training and capacity of health care personnel. The recent global economic downturn should not be accepted as an excuse to do nothing, noting that hard economic times will make the needs of mothers and children even greater than before. 

Without needed attention, the HIV future will remain gloomy for children and mothers in Sub Saharan Africa and throughout the developing world, and the bright promise of the Millennium Development Goals will never be fulfilled.

Link to the IPA Lancet Commentary:

HM Coovadia and JG Schaller. 

Lancet 2008, 372: 271-273.

www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61090-9/fulltext

December 1, 2008