|Caring with Confidence - Practical information for health workers who prevent and treat HIV infection in children (AHRTAG, 1997, 60 p.)|
|Section 1. How HIV and AIDS affect young children|
· Many children, who are not themselves infected, are affected by HIV and AIDS.
· Loss of a parent or parents affects the emotional, physical and mental health of young children, their security, and educational prospects.
· Children from families affected by HIV/AIDS may be stigmatised and suffer discrimination.
The lives of many children who may not have HIV themselves are affected when family members have HIV and AIDS. Families face increased poverty and stress when adults are too sick to continue with paid employment or to farm their land. Mothers who are ill find it more difficult to care for young children, and young children themselves may end up caring for younger siblings or sick parents.
Impact of HIV/AIDS on infant and child mortality
It is estimated that:
· In Malawi, HIV infection contributes to 17 per cent of the infant mortality rate (number of deaths of infants under one year of age per 1,000 live births) of 147 per 1,000 live births.
· Without AIDS, Kenya would have an infant mortality rate of 47 per 1,000 live births. With AIDS, the rate has increased to 55.
· In Zambia and Zimbabwe, infant mortality rates are 25 per cent higher than they would be without AIDS.
· Projected infant mortality rates for 2010 for Tanzania and Uganda are 40 per cent higher than they would be without AIDS.
· By the year 2010, deaths due to AIDS will more than double infant mortality rates in Zimbabwe and Botswana.
· Child mortality rates in Kenya and Zambia will double by 2010, to be three times higher in Botswana and four times higher in Zimbabwe. Out of every 1,000 children under five, nearly 100 will die because of AIDS in these countries.
· Child death rates will increase by 14 per cent in Brazil, 20 per cent in Guyana and 7 per cent in Haiti because of AIDS.
· In Thailand, the infant mortality rate will rise by 5 per cent due to HIV/AIDS.
Source: US Bureau of Census.
Children orphaned by AIDS may be cared for by grandparents.
In addition to children who are living with HIV-infected parents who are sick or dying, there are many who have been orphaned by AIDS. They may have lost a mother or a father or both. It is estimated that:
· nine million children have already lost a mother because of AIDS
· at least 30 million children in the world are living with HIV-positive parents and are at risk of being orphaned in the future
· by 2010, over 40 million under fives in Asia, Africa and Latin America will have lost one or both parents because of AIDS. By 2020, it is predicted that the largest number of AIDS orphans will be in South and South-East Asia
· by the year 2000 in Zimbabwe, 1 in 10 children will have lost one or both parents, and in South Africa there will be 500,000 AIDS orphans. In Thailand, over 200,000 children - a third of them under five - are expected to lose their mothers because of AIDS by 2005.
Loss of a parent or parents can affect young children in many ways. The effects vary from country to country and depend on culture, social and family structures, and legal systems. For example, in some countries, children may lose their rights to property or land. In others, where many children have lost their parents, family support systems are under great strain. Young children may be cared for by grandparents or older siblings who are unable to cope or to afford extra food and clothing, or they may be cared for reluctantly by relatives who already have too many demands. In these circumstances, young children are less likely to be sent to school and more likely to be expected to work at a very young age to contribute to household finances. They may be seen as a burden, especially young girls because they may need to be provided with a dowry or because they will marry out of the family and therefore not contribute financially.
As well as having to cope with loss, grief and confusion, children from families affected by HIV and AIDS may be stigmatised and rejected and not allowed to play with other children. They may be denied health care, either because it is assumed that they too have HIV infection or because carers cannot afford treatment costs.
Young children who are not infected are also more vulnerable to illness and death if they receive less adequate care either because their parents are sick or because their parents have died.
The health of under fives who do not have a mother is generally worse than that of those who do. The mother is relied on to bring a child for immunisations, to seek treatment for childhood illness and to ensure that a child is well nourished. Health education messages about all these issues are usually targeted at the mother. Grandmothers or siblings may know less about good nutrition, have less time, energy or patience to feed a young child or be less able to travel to clinics or immunisation centres. Future health education strategies will need to target a wider range of carers, or larger numbers of children will be at risk of illness and poor health.