More mothers and children on ARVs

More mothers and children in developing countries are receiving treatment than ever before, according to a new report by the United Nations. But stigma, limited information and fragile health systems still pose hurdles to achieving the Millennium Development Goals (MDGs).

Coverage of mother-to-child transmission prevention (PMTCT) services continues to expand, especially in southern and eastern Africa, according to a report by the UN Children's Fund (UNICEF) entitled, “Children and AIDS: Second stock taking report.”

The proportion of HIV-positive pregnant women receiving antiretroviral therapy (ART) in developing countries increased from 10 percent in 2004 to 23 percent two years later. In eastern and southern Africa, the figure more than doubled in roughly the same period, reaching 31 percent in 2006.

The report is part of the “Unite for Children, Unite against AIDS” initiative started by UNICEF in 2005, and noted that 21 middle and low-income countries are on track to meet the MDG of 80 percent coverage.

More children in low-and middle-income countries were also receiving treatment in 2006 with 127,300 children on ART - a 70 percent increase from 2005 figures. Authors noted that the lower drug prices and wider choice of generic medication for adults had benefited  paediatric treatment as well, most recently with the last year's introduction of a new three-in-one generic drug combo for children.

Room to grow

But less progress has been shown on the initiative’s other goals: preventing infection in adolescents and protecting children affected by HIV. While countries such as Kenya, Zimbabwe and Uganda have shown declines in risky sexual behaviour and multiple partnerships, the report notes the need for more information on the behaviour of young people and their increased participation in national HIV programmes.

Meanwhile, authors found that the disparity in school attendance between children orphaned by AIDS and their peers is narrowing, and programmes such as cash transfers instituted in South Africa, Malawi and Zambia may contribute to increasing school attendance. However, many children and their families continue to face stigma and discrimination when trying to access such services.
 

Stigma is just one of the obstacles standing in the way of the initiative’s goals, the lack of data on children is another.

“It’s much tougher to get data on children versus adults,” said Paul de Lay, director of Evidence, Monitoring and Policy, UNAIDS. “Most studies and surveys don’t include information on children for ethical and consent reasons.”

But fragile health systems, which may face staff, financial and capacity constraints, still remain the biggest obstacle to fighting HIV in children as patients face late diagnosis, missed interventions and poor tracking.

According to the report, just 17 low and middle-income countries have the capacity to diagnose HIV-positive infants and in those that do, there are huge delays in results.

Meanwhile, 50 percent of children born with HIV will die before their second birthday if left untreated, warned Kevin De Cock, HIV/AIDS director of the World Health Organisation. He stressed the importance of expanding CD4 count testing and investing in mothers.

“We also need to prioritise pregnant women who may need HIV treatment for their own health,” he said. “We have seen that the health of the mother determines the health of the family and of the child.”

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