Author : Swapan Deb Barma
Whether the children of AIDS (HIV) victim get same treatment without being discriminated in comparison with normal children. Let’s have a look on this issue
United Nations International Children’s Emergency Fund (UNICEF) is committed to protecting every child from violence, exploitation, abuse and discrimination. But given prevailing social, economic and cultural inequities in India, a large number of children, especially girls are forced to work in inhospitable, unsafe and exploitative conditions. Some of these children are members of families living in remote areas with few, if any, livelihood options. Others are part of units that are on the move – caught up in unrelenting cycles of migration in search of work .
Despite Constitutional guarantee of civil rights, children face discrimination on the basis of caste, religion and ethnicity. Even the basic need for birth registration that will assure them nationality and identity remain unaddressed, affecting children’s right to basic services. Everyday news of children dying of starvation, dipping sex ratio, child marriage, child trafficking, child abuse, etc. is very common. Violations of children’s rights are not limited to poor and downtrodden only .
WHAT IS AIDS?
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS) is a disease of the human immune caused by the human immunodeficiency virus (HIV). This condition progressively reduces the effectiveness of the immune system and leaves individuals susceptible to opportunistic infections and tumors. HIV is transmitted through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk. This transmission can involve anal, vaginal or oral sex, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, breastfeeding or other exposure to one of the above bodily fluids .
HIV lives in white blood cells and is present in the sexual fluids of humans. It’s difficult to catch and is spread mostly through sexual intercourse, by needle or syringe sharing among intravenous drug users, in blood transfusions, and during pregnancy and birth (if the mother is infected). Using another person’s razor blade or having your body pierced or tattooed are also risky, but the HIV virus cannot be transmitted by shaking hands, kissing, cuddling, fondling, sneezing, cooking food, or sharing eating or drinking utensils. One cannot be infected by saliva, sweat, tears, urine, or feces; toilet seats, telephones, swimming pools, or mosquito bites do not cause AIDS. Ostracizing a known AIDS victim is not only immoral but also absurd .
HOW CHILD ARE AFFECTED BY AIDS AND HIV
More than 1,000 children are newly infected with Human Immunodeficiency Virus (HIV) every day, and of these more than two thirds will die as a result of AIDS because of a lack of access to HIV treatment.1 In addition, millions more children every year are indirectly affected by the epidemic as a result of the death and suffering caused in their families and communities.
Preventing HIV infection, providing life prolonging treatment and relieving the impact of HIV and AIDS for children and their families and communities is possible. However, a lack of necessary investment and resources for adequate testing, antiretroviral drugs, and prevention programmes, as well as stigma and discrimination, mean children continue to suffer the consequences of the epidemic.
THE NUMBER OF INFECTED CHILDREN
The figures below show the number of children (defined by UNAIDS as under-15s) directly affected by HIV and AIDS:
•At the end of 2008, there were 2.1 million children living with HIV around the world.
•An estimated 430,000 children became newly infected with HIV in 2008.
•Of the 2 million people who died of AIDS during 2008, more than one in seven were children. Every hour, around 31 children die as a result of AIDS.
•There are more 15 million children under the age of 18 who have lost one or both parents to AIDS.
•Most children living with HIV ¬– almost 9 in 10 – live in sub-Saharan Africa, the region of the world where AIDS has taken its greatest toll.
In countries with an HIV prevalence of above 5%, child mortality rates have not fallen in line with global trends. This is most probably due to the high risk of mortality associated with untreated HIV infection in young children.
•In 2010, the number of children who have lost one or both parents to AIDS is expected to reach 25 million.
•Over 15.7 million AIDS orphans live in Sub-Saharan Africa, alone.
•Experts believe that millions more orphans remain unaccounted for in India, China and Russia.
•In addition to the trauma of losing a parent, orphans are often subject to discrimination and are less likely to receive healthcare, education and other needed services.
•In HIV affected households lacking community support, food consumption can drop by 40% putting children at risk to hunger, malnutrition and stunting.
•Impoverished and often without support to educate and protect them, orphans and vulnerable children face increased risk of HIV infection.
•Orphans are often easy prey to many forms of exploitation: forced labor, prostitution and child soldiering MOTHER-TO-CHILD TRANSMISSION
Nine out of ten children infected with HIV were infected through their mother either during pregnancy, labour and delivery or breastfeeding. Without treatment, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery and a further 5-20% will become infected through breastfeeding. In high-income countries, preventive measures ensure that the transmission of HIV from mother-to-child is relatively rare, and in those cases where it does occur a range of treatment options mean that the child can survive – often into adulthood. This shows that with funding, trained staff and resources, the infections and deaths of many thousands of children could be avoided .
‘MOTHER-BABY PACK’ INTRODUCED
To help these women gain access to preventive care, UNICEF and its partners have developed a product inspired by the very innovation that benefitted Ms. George and Mankhube: the package of pre-measured PMTCT medicines pioneered by Lesotho’s health workers.
UNICEF’s recently introduced ‘Mother-Baby Pack’ is a take-home box containing all the anti-retroviral drugs and antibiotics needed to protect the health of one mother and child. Colour-coding and simple graphics help mothers identify which of the individually packaged medicines to administer during pregnancy, delivery and breastfeeding.
UNICEF is rolling out the Mother-Baby Pack in four sub-Saharan African countries: Cameroon, Kenya, Zambia and Lesotho .
HIV infection can occur in medical settings; for instance, through needles that have not been sterilised or through blood transfusions where infected blood is used. In wealthier countries this problem has virtually been eliminated, but in resource-poor communities it is still an issue. The most large scale case of infections among children resulting from contaminated injections and unscreened blood transfusion occurred in Romania between 1987 to 1991 when more than 10,000 babies and children were infected with HIV as a result of unsafe medical practices.
Unsafe blood transfusions have also led to hundreds of HIV infections in countries in the Central Asia region, namely Kazakhstan, Kyrgyzstan and Uzbekistan from 2006-2008. The widespread reuse of injection equipment as well as encouragement by doctors motivated by financial reasons to carry out ‘unnecessary blood transfusions’, led to the infection of at least 119 children in Kazakhstan and at least 150 in Uzbekistan from 2007-2008.
Although official statistics claim that unsafe injections account for a small percentage (2.5%) of HIV infections in sub-Saharan Africa, this is contested by a number of researchers. HIV prevalence in children can be 1 to 3 times higher than that of pregnant women in antenatal clinics and in one study as many as a fifth of children who were not sexually active had HIV negative mothers: suggesting that the children were infected through contaminated medical procedures.
INJECTING DRUG USE
In central and Eastern Europe, where injecting drug use fuels the spread of HIV, young people living on the street are found to be especially vulnerable to HIV through injecting drug use. In St Petersburg, a study of more than three hundred 15-19 year olds living on the street found that 40 percent of them were HIV positive. In Ukraine, one study found a variety of HIV risk behaviours like sharing needles and unprotected and forced sex were prevalent among 10-19 year old street children, while a multicity study found an HIV prevalence of 18 % among street youth (aged 15-24). Police harassment and the general attitude of society that sees street children as ‘outcasts’ and ‘criminals’ means that that they are difficult to reach with health and social services.
Sexual transmission does not account for a high proportion of child infections but in some countries children are sexually active at an early age. This is potentially conducive to the sexual spread of HIV among children, especially in areas where condom use is low and HIV prevalence is high. In sub-Saharan Africa 16% of young females (aged 15-19) and 12% of young males reported having sex before they were 15 in 2007. In Lesotho, these figures are 16% and 30%, respectively; in Kenya, 15% and 31%. The lower the age of first sex, the higher the lifetime risk of HIV infection. This is because early sexual debut is often associated with older lifetime partners, higher rates of coerced sex and lower rates of condom usage.
Children are also at risk of becoming infected with HIV through sexual abuse and rape. In some parts of Africa, the myth that HIV can be cured through sex with a virgin has led to rapes, sometimes of very young children by infected men – although whether or not this is a significant factor in child sexual abuse in the region is disputed. In some cases, young children are trafficked into sex work, which can put them at a very high risk of becoming infected with HIV.
PREVENTION OF MOTHER-TO-CHILD TRANSMISSION (PMTCT)
To avoid mother-to-child transmission of HIV, antiretroviral drugs are given to the mother before birth and during labour, to the baby following birth and safer infant feeding is also promoted. This approach can almost eliminate the risk of transmission from mother-to-child. Unfortunately, prevention of mother-to -child transmission (PMTCT) services fail to reach most women in resource-poor countries. In 2009 for example, only half of HIV-infected pregnant women in low- and middle-income countries received drugs to protect their babies from infection .
In order to eliminate the risk of a child being infected with HIV in medical settings, either through contaminated needles or blood transfusions, a number of steps can be taken. These include adopting safer injecting practices for injections and screening all donated blood for blood borne viruses.
HIV/AIDS AWARENESS PROGRAM
HIV/AIDS awareness program is an important way of reaching young people with knowledge on sexual health and drug abuse. There are many ways to reach young people: including through school, the media, and peer outreach. Whatever the medium, HIV/AIDS education should not only address the biological facts of HIV and STI transmission and provide information on how to prevent transmission, but it should also take into account the realities of young people’s lives – such as peer pressure or gender inequality .
HIV TESTING FOR CHILDREN
It is important that HIV infected children are diagnosed as quickly as possible, so they can be provided with appropriate medication and care. However, testing children for HIV can be complicated, especially for those recently born to HIV-positive mothers. Antibody tests, which are used to diagnose HIV in adults, are ineffective in children below the age of 18 months. Instead, children below this age are usually diagnosed through polymerase chain reaction (PCR) testing and other specialist techniques. This is referred to as early infant diagnosis and is important because mortality is very high amongst HIV infected infants who go untreated. However, according to recent data, only an estimated 6% of children born to HIV positive mothers received an HIV test within the first two months of life.
A multi country study in Africa showed that without treatment, half of HIV infected children die by 2 years of age. Even when children do survive into adolescence without treatment, they are likely to be stunted, severely underweight or suffering from opportunistic infections. However, the methods for testing children early require expensive laboratory equipment and specially trained staff which are generally unobtainable in the resource-poor areas where they are needed the most.
The use of dried blood spot testing can be more practical in resource poor settings. This method allows small samples of blood to be collected on paper, and sent away to a laboratory where PCR (or similar testing) is available. Unlike testing methods that use liquid samples, dried blood spots can be stored for a long time and easily transported, so even if the nearest laboratory is some distance away, it may still be possible to use PCR technology on a sample of a child’s blood. However, dried blood spot testing can be expensive and it can take a long time for test results to return.
Ideally children need to be diagnosed at a health facility where they can be linked immediately to treatment if needed. This is called ‘point of care’ diagnosis and should include testing that requires minimal infrastructure and medical training and provides quick results. Such tests are referred to as ‘rapid HIV tests’ but as they are not suitable for children under 18 months, the majority of children who need to be tested sooner than this remain undiagnosed and do not access treatment.
Where health facilities can diagnose infants early through PCR testing they should immediately be linked to care and treatment services. However, an increase in access to testing is not always matched with access to treatment. One study in Cameroon found that only a third of infants who had been diagnosed early were alive and receiving treatment after one and a half years and another multi country study found that half of all infants who had tested HIV positive were not receiving treatment.
HIV TREATMENT FOR CHILDREN
HIV treatment for children slows the progress of HIV infection and allows infected children to live much longer, healthier lives. Yet, many of the children who could be benefiting from this therapy in low and middle-income countries (an estimated 72%) are not receiving it.
Children ideally need to be given drugs in the form of syrups or powders, due to difficulties in swallowing. However, drug treatments involving syrups for children are generally more expensive. As a result, carers are often forced to break adult tablets into smaller doses, running the risk that children are given too little or too much of a drug. Studies suggest that breaking down adult tablets into smaller doses can work effectively although this should only really be seen as a last resort.
Although the cost of first line therapy for children has reduced dramatically due to the availability of generic drugs ($50 a year on average in 2009 compared to about $20,000 a few years before), when a child develops drug resistance and needs to begin a second course of drugs, treatment becomes far more expensive. More drugs suitable for children are qualified by the WHO every year, but without access to cheap generic versions of them the majority of HIV infected children will not benefit.
“More drugs suitable for children are qualified by the WHO every year, but without access to cheap generic versions of them the majority of HIV infected children will not benefit.”
Another major problem for children living with HIV is childhood illnesses, such as mumps and chickenpox. These illnesses can affect all children, but since children living with HIV have such weakened immune systems they may find that these illnesses are more frequent, last longer, and do not respond as well to treatment. Opportunistic infections, such as tuberculosis and PCP (a form of pneumonia), are also a serious risk to the health of children living with HIV.
Opportunistic infections can be prevented using drugs such as cotrimoxazole: a cheap antibiotic that has been proven to significantly reduce the rate of illness and death among HIV-positive children. Countless lives could be saved if cotrimoxazole were made more widely available, but at the moment it is estimated that only 8 percent of the four million children who could be benefiting from the drug are receiving it.
One of the greatest challenges when it comes to treating children with HIV is loss to follow up. This is when a patient tests HIV positive but does not return to a health facility to receive treatment. According to UNAIDS and UNICEF “the number of women and children lost to follow-up is tragically high”. Some of the reasons children are lost to follow up include “clinical organization and data flow of results, lack of caregiver contact information, stigma and counselling challenges, the burden on patients to return for results, and weak follow-up within clinics.”
THE NATIONAL COMMISSION FOR PROTECTION OF CHILD RIGHTS (NCPCR)
The National Commission for Protection of Child Rights (NCPCR) was set up in March 2007 under the Commission for Protection of Child Rights Act, 2005, an Act of Parliament (December 2005). Presently Dr Shantha Sinha, Chairperson of the newly constituted National Commission for Protection of Child Rights (NCPCR). The Commission’s Mandate is to ensure that all Laws, Policies, Programmes, and Administrative Mechanisms are in consonance with the Child Rights perspective as enshrined in the Constitution of India and also the UN Convention on the Rights of the Child. The Child is defined as a person in the 0 to 18 years age group.
The Commission visualises a rights-based perspective flowing into National Policies and Programmes, along with nuanced responses at the State, District and Block levels, taking care of specificities and strengths of each region. In order to touch every child, it seeks a deeper penetration to communities and households and expects that the ground experiences inform the support the field receives from all the authorities at the higher level. Thus the Commission sees an indispensable role for the State, sound institution-building processes, respect for decentralization at the level of the local bodies at the community level and larger societal concern for children and their well-being.
MANDATE OF THE NCPCR
NCPCR is an Act of the Parliament set up to protect, promote and defend child rights in the country. It performs various functions in order to maintain its mandate. However, one the major of function which has to be mention is “Examine all factors that inhibit the enjoyment of rights of children affected by terrorism, communal violence, riots, natural disasters, domestic violence, HIV/ AIDS, trafficking, maltreatment, torture and exploitation, pornography, and prostitution and recommend appropriate remedial measures”
ACCESS TO CARE AND SUPPORT
People living with HIV have a wide range of care and support needs. These include psychosocial support as well as treatment for ‘opportunistic infections’ (the illnesses to which they become vulnerable as the immune system is destroyed by the virus). When their HIV infection reaches the stage that it becomes life-threatening, they require treatment with antiretroviral drugs.
However, the vast majority of people around the world do not yet have access to such services. Reaching out to them is a global priority.
AIDS-related care and support are key elements in the response to the epidemic: not only do they directly benefit people living with HIV, but they help also to reduce the social and economic impact of the epidemic and to boost HIV prevention .
CONCLUSION AND RECOMMENDATION
The global response to AIDS must be significantly reoriented to address the unmet needs of millions of children and their families in the worst affected countries, according to a new report by the independent Joint Learning Initiative on Children and HIV/AIDS (JLICA) .
The effects of the HIV/AIDS epidemic on children are manifold: hundreds of thousands of children every year are infected with HIV, most are left undiagnosed, do not access treatment and die very young. Those who are not infected may live in families and communities where AIDS reduces the productivity of their households and aggravates poverty. Only a combination of factors can improve the situation. These include greater access to the drugs that can prevent mother to child transmission, appropriate testing, efficient linkages to care and treatment, and support for the families and communities that provide the material, social, and emotional foundation for a child’s development.
Therefore, it is highly recommended to focus on children’s needs, not their orphan or HIV status when designing and implementing policies and programmes. Health and social services, such as expanded access to HIV testing and treatment, should reach out to families as a whole. An effective response to AIDS requires the delivery of integrated, family-centred services in health, education and social welfare that are well-resourced and linked to communities.
Economic security can help families invest in children’s health and education, increase their use of available services, and pay for essentials such as food, medicine and transport to health facilities. Income transfer efforts, which place funds directly in the hands of families that need them, have demonstrated impressive results in improving child and family well-being. Urgent action is needed to address the social conditions and norms that render women and adolescent girls highly vulnerable to HIV infection.
From the above finding it can be concluded that State bears the most important responsibility in protecting, promoting in realising the rights of this children so they grow with dignity and full fill their aspiration.