This was the impassioned call made on Wednesday by Professor Linda Richter, one of only two South Africans invited to address a plenary session of the International AIDS Conference in Mexico City.
‘Children and families have been severely neglected in our response to HIV and AIDS,’ said Richter.
Describing poverty as ‘arguably the single biggest barrier to the scale-up of HIV treatment and prevention’, Richter said that HIV programmes may not be able to expand unless households were given support so that they could access services.
‘Because of potential stigmatization and perverse incentives, targeting should be to the poorest families in high prevalence areas rather than specifically to HIV-affected families or children,’ said Richter, who heads the Human Sciences Research Council’s child, youth and family programme.
Sketching a grim picture of how ‘children have simply been too small to count’, Richter said HIV in children had grown eight-fold in sub-Saharan Africa where 90% of the world’s infected children live.
The major cause of the increase in infection was babies being infected by their HIV positive mothers. This was despite the fact that for 10 years, the effectiveness of prevention of mother-to-child transmission (PMTCT) programmes had been known.
‘PMTCT is not reaching enough of those who need it,’ said Richter, adding the many pregnant women did not know they were living with HIV so did not access PMTCT services.
In addition, ‘children living with HIV have far less access to treatment than adults in the same areas’. Less than one in 10 babies in low and middle income countries were tested for HIV within two months of their birth ‘ despite new evidence that early treatment of babies significantly increased their chances of survival.
Half of all babies infected with HIV will die before their second birthday, and the World Health Organisation has called for all babies at risk to be tested at six weeks and started on ARVs as soon as possible after testing HIV positive.
Richter also criticised the UNAIDS characterisation of children as ‘orphans’ even if one of their parents was still alive, and then singling them out for special treatment.
‘It is the needs of all children, especially vulnerable children ‘ not whether they meet the definition of ‘orphan’ ‘ that must be our primary focus when designing and implementing policies,’ stressed Richter.
‘The focus on orphans has individualised the challenge of care and support. It has framed the epidemic’s impact on children as individuals rather than a national social problem and has separated assistance to children from efforts to support families and communities,’ said Richter.