“ The choice between food or shelter and safer sex is not a free one, since almost everyone will choose daily survival over the comparatively abstract risk of HIV” (Pinkham et al., 2008:169)

23Inclusive Socialization : Children inetract and exchange stories with their peers across India

The United Nations General Assembly committed itself to accelerate progress towards elimination of new child infections , reducing the number of new HIV infections among children by 90% reducing mother-to-child transmission of HIV to 5 percent by the year 2015. Since then there has been a significant scale up of HIV testing, Prevention of Parent To Child Transmission (PPTCT) and Anti-Retroviral Treatment (ART) services for adults and children. However there still remains an urgent need for a concerted, sustainable and multi-pronged national and global response to address the multi-factorial issues that revolve around HIV/AIDS in children.

Prevention of transmission of HIV to infants:

Less than a quarter of the 27 million pregnancies in India receive HIV counseling and testing at child birth. In the absence of such interventions, a 20-45 percent. of children born to women living with HIV are at a risk of getting infected from their mother during pregnancy, labour, delivery and through breast feeding.

Clinical diagnosis of HIV: Children differ from adults because they have high rates of viral replication, high viral load and CD4 destruction resulting in faster rate of disease progression. Clinical symptoms also vary between children and adults.

Laboratory diagnosis: The diagnosis of HIV infection in the exposed infants is difficult. Routine screening tests like rapid test and Elisa detect presence of maternal antibodies till 18 months of age. They are useful for children above 18 months old. During these first 18 months DNA-PCR testing is required to confirm or rule out HIV infection. Such testing centers are limited to 1-2 in each state due to competing priorities, limited resources and logistical barriers. In Breast-fed infants, there is a need for repeat PCR testing at least 6 weeks after cessation of breast feeding to confirm a HIV negative diagnosis.

Treatment: With scaling up of ART services by NACO in India HIV infection has become a chronic treatable illness. The following challenges still remain for efficient management of Pediatric HIV/AIDS:

  • Delayed infant diagnosis
  • Lack of appropriate pediatric ARV formulations
  • Lack of skilled health personnel

CARE AND SUPPORT TO ORPHANS AND VULNERABLE CHILDREN (OVC)

  • Psychosocial management of Pediatric HIV: HIV is a social problem and its management require holistic attention and care. Children face social ostracization , dropping out of school and an endless drop through the security of the community network. Worldwide HIV is leaving children orphaned and vulnerable to every conceivable danger and Since most pediatric infections are vertical transmissions, predominantly both the parents are infected. The likelihood of loosing their parents is high. Parental death is recognized as one of the most stressful life events a child can endure leading to major disruption in their lives leading to increased poverty, child`s engagement in risky behavior and more vulnerable to HIV infections, and a higher likelihood of dropping out of school.
  • Counseling and sensitization is necessary for the family as a unit on the importance of status disclosure to children and provide age specific information periodically
  • During adolescent years counseling should focus on life skill management and ART adherence

What is required for Care & Support to Other Vulnerable Children ?

  • Accelerating treatment access for adults with children can reduce the number of Orphans, improve pediatric mortality and general well being.
  • Programs that will promote family centered integrated economic, health, education and social support , counseling and mentoring for orphaned children . Thus ensuring, all round, psycho-social support and well being of the children.
  • ARV treatment with regular medical care can improve health and survival of HIV positive children in resource poor settings.
  • Programs that provide microenterprise opportunities, old age pensions or other targeted financial and livelihood assistance can be effective in supporting orphans.
  • Update policies and legal documents pertaining to confidentiality, consent and status disclosure in children and adolescents.
  • Need for a comprehensive supplementary nutrition program to be urgently implemented (micro & macro nutrients).
  • Inclusion of a pediatrician as integral part of care continuum of children living with HIV/AIDS.
  • Identify areas of need based research in pediatric HIV/AIDS and OVC

Some of the Most Promising Strategies include

  • Programs for OVC should keep siblings together if at all possible.
  • Providing community development projects, rather than a narrowly defined HIV/AIDS program, may reduce the stigma against OVC.
  • Community meetings to reduce stigma against OVC.

Although we have made progress in leaps and bounds since the UN Declaration and the adoption of national legislations, with more than 139,000 affected-infected children living in India, a lot more still needs to be done. Though the data on number of orphaned children is not available, our experience reveals that most households/caregivers are faced with financial difficulties, lack resources to provide basic needs such as food, shelter or transport. FXB programs are developed and implemented all over the world as FXB village programs which provisioning family-centered services that address material needs, cognitive development, medical and psychosocial support. Through our efforts at FXB India we are attempting to ensure recognition of the magnitude of OVC problem due to HIV and the need for an effective and holistic support to OVC affected by HIV/AIDS .

For details on FXB India Suraksha’s project on Care and Support for HIV orphaned children please contact Dr. PSKP Raju at praju@fxbsuraksha.org.

@FXB India Suraksha, May 2016