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PEDIATRICS AND HIV/AIDS
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To
order free copies of the 2008 Ryan White
Grantee folder and fact sheets, call 1.888.ASK.HRSA
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online.
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On
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| SURVEILLANCE |
- In
2006, an estimated 38 AIDS cases were
diagnosed among children under age 13
in the 50 States and the District of Columbia
(DC), a decrease of 70 percent since 2000.1
In the 25 States with confidential name-based
HIV reporting, the reported number of
perinatally infected infants dropped by
65.5 percent between 1996 and 2006.2
- In
2006, an estimated 3,775 children were
living with AIDS, of whom 14.5 percent
were White, 66.3 percent were Black, 17.5
percent were Hispanic, and less than 1
percent were Asian/Pacific Islander or
American Indian/Alaska Native.3
- From
the beginning of the epidemic through
the end of 2006, 9,144 children are estimated
to have been diagnosed with AIDS. Of those
cases, 93 percent resulted from perinatal
transmission.4
- Perinatal
HIV transmission has declined significantly
in the United States with the aid of antiretroviral
(ARV) treatment. Nevertheless, perinatal
infections continue to occur, with the
majority occurring among African-Americans.5,6
- In
2006, the rate for children living with
AIDS ranged from an estimated 0 per 100,000
in Idaho, Montana, Utah, American Samoa,
Guam, and the Northern Mariana Islands
to an estimated 36.5 per 100,000 in DC.7
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| CRITICAL
ISSUES |
| Today,
most children with HIV are born to women who
receive inadequate prenatal care. Interventions,
such as routine HIV screening of pregnant
women, use of ARV drugs for treatment and
prophylaxis, avoidance of breastfeeding, and
use of elective cesarean delivery when appropriate,
have lowered the number of cases of HIV/AIDS
in infants born to HIV-positive mothers from
a peak of 1,650 in 1991 to 65 in 2006 in the
25 States with confidential HIV reporting.2
When
AZT is administered appropriately, the risk
of passing HIV from mother to child is less
than 2 percent, compared with transmission
rates of 24 to 30 percent with no intervention.6
Access to care for pregnant women is therefore
critical for reducing HIV infection in infants.
Children
with HIV/AIDS face an array of difficult
issues, including stigma. Unlike adults,
school-age children often have no choice
about disclosing their HIV status to others.
As a result, children often must grapple
with adult issues associated with living
with a chronic illness, especially an illness
that is stigmatized by society. Children
lack the maturity to effectively manage
these issues on their own.8
Caregivers
of young children may attempt to protect
them from anticipated stigma by postponing
telling them about the diagnosis. This decision
may be motivated by the caregiver’s
fear that the child, unaware of the social
repercussions of disclosure, will inappropriately
reveal the diagnosis.9
People
infected with HIV during childhood are living
longer than ever. Many have grown into adolescence
and face the normal challenges of teenagers.
Children and adolescents, however, are at
greater risk for the number and severity
of psychosocial complications related to
HIV infection, such as mental illness, and
are likely to experience body image concerns
resulting from delayed development, chronic
dermatologic conditions, or lipodystrophy.10
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| HRSA'S
RESPONSE |
| Care
for HIV-positive infants and children is most
successful when provided in the context of
care for the entire family. Most caregivers
are also HIV positive and must take care of
their own health needs to meet the needs of
their children. Services that respond to the
myriad problems commonly seen in families
with an HIV-positive family member—including
comorbidities, poverty, lack of transportation,
and poor housing—are essential.
All
Ryan White HIV/AIDS programs serve children
and their families, and Part D programs
specifically focus on this population.
Services include perinatal and pediatric
specialty care, support services, and linkages
to research and clinical trials.
The
HRSA publication From Isolation to Transformation:
A CARE Act Guide to Supporting Men Caring
for Children Living with HIV/AIDS is
a tool for fathers and other men caring
for children and youth living with HIV/AIDS.
The guide includes tips and tools for effective
programs; it also addresses the benefits
of male involvement, the effects of stereotypes
on health care provision, isolating factors,
and barriers to involvement. (This tool
is available at:
www.aids-alliance.org/resources/publications/isolationtransformation.pdf
(PDF – 585KB).  )
For more information on children and HIV/AIDS,
see the June 2007 issue of HRSA CAREAction,
available at: http://hab.hrsa.gov/publications/june2007/default.htm.
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| END
NOTES: |
| 1 |
Centers
for Disease Control and Prevention (CDC).
HIV/AIDS Surveillance Report.
2006;18:14. Figure 1. |
| 2 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:27. Table 23. |
| 3 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:23. Table 11. |
| 4 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:13. Table 3. |
| 5 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:14. Table 4. |
| 6 |
CDC.
Achievements in public health: reduction
in perinatal transmission of HIV infection—United
States, 1985–2005. MMWR.
2006;55:592–7. Available at: www.cdc.gov/MMWR/preview/mmwrhtml/mm5521a3.htm.
Accessed April 23, 2008. |
| 7 |
CDC.
HIV/AIDS Surveillance Report.
2006;18:21. Map 2. |
| 8 |
Brown
LK, Lourie KJ. Children and adolescents
living with HIV and AIDS: a review.
J Child Psychol Psychiatry. 2000;
41: 81–96. |
| 9 |
Baylor
International Pediatric AIDS Initiative.
HIV curriculum for the health professional.
In: Close KL, Rigamonti AK, eds. Psychological
Aspects of HIV/AIDS: Children &
Adolescents. 3rd ed. 295–309.
Available at: www.bayloraids.org/curriculum/files/24.pdf
(PDF – 691KB). Accessed April
23, 2008. |
| 10 |
Gaughan
DM, Hughes MD, Oleske JM, Malee K, Gore
CA, Nachman S. Psychiatric hospitalization
among children and youths with human
immunodeficiency virus infection. Pediatrics.
2004;113:e544–51. |
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