Health and nutrition

It is critical for children and families affected by HIV/AIDS to have access to essential health services including nutrition, child survival programs, prenatal care, HIV prevention and testing, prevention of mother-to-child transmission, palliative care and anti-retroviral (ARV) treatment.

Supporting integration of PMTCT and pediatric HIV with maternal, neonatal and child health (MNCH) services, early childhood development programs, and feeding and nutrition programs at policy- program- and service delivery levels can significantly improve HIV, MNCH and reproductive health (RH) outcomes and impact.

Health support for children affected by HIV/AIDS include integrated health services help to ensure that children and families receive the support they need to prevent, cope with- and treat illness. Integration aims to enable HIV-affected and infected families “to access different but connected health and psychological care services from one point, rather than through many fragmented services and providers. By doing this, HIV healthcare workers are better able to improve patient outcomes with efficiency for both the client and the healthcare system” (Green & Horne, 2012).

Health interventions within effective orphans and vulnerable children’s programs are child-focused, recognizing children’s needs at different ages and stages of development, and family-centered, providing services to all children and adults in a family. Ideally, services are linked together and co-located to strengthen cross referrals and a continuum of care. Examples may include:

• Nutritional support linked to Early Childhood Development (ECD) programs, immunization campaigns, school-based programs and treatment for childhood illness.
• Integration of services and referrals between antenatal care programs, voluntary counseling and testing, prevention of mother-to-child transmission (PMTCT) and Anti-retroviral treatment (ART).
• Kids clubs, safe spaces for adolescent girls and after-school peer groups that include HIV prevention education and referrals for reproductive health services.
• Parent and caregiver education groups that provide training in basic care, safety, health promotion and include caregiver psychosocial support.
• Community links to health facility-based pediatric HIV programs that integrate palliative care for pain management, coping with medication side effects, opportunistic infections and psychosocial support.

Why is health support important?

Children have the right to access basic health care services, the right to medical confidentiality and the right to informed consent. Yet, in many situations children are unable to realize these rights. Providing health support to children affected by HIV/AIDS can help these children to receive the health services that they require.

HIV and AIDS significantly affect the health of children and their families. Countries with severe epidemics have seen increasing rates of under-five mortality. Without access to drugs, 30% of children die by age one and 50% by age two. (WHO/UNICEF 2010). Children born to HIV-positive women are three times more likely to die before the age of two than other children. When a mother dies, her child is ten times more likely to die before age two. Of the estimated 34 million people living with HIV in 2010, 3.4 million of them were children under age 15. Children surviving the first year of life are more likely to die from common childhood diseases. The most common causes of death are respiratory infections, diarrhea and tuberculosis (TB).

HIV and AIDS affect children’s health in multiple ways:

• Parental illness or death negatively affects children’s health and increases a child’s risk of dying soon after their mother dies, regardless of her cause of death.
• HIV and AIDS negatively affects children’s growth and development.
• Children in AIDS-affected households or living with HIV/AIDS, may have reduced immunity making them more vulnerable to other infections such as TB.
• HIV and AIDS worsens already existing poverty for children, families and communities. Families are less able to afford health care and other measures to prevent disease, such as mosquito nets. They often have poorer nutrition, housing, hygiene and water. Poor nutrition makes children with HIV more vulnerable to infection. (WHO/UNICEF 2008).
• Children whose families are coping with the impacts of HIV and AIDS are more likely to work. Child labor is often unregulated and may expose them to health hazards.
• Children in households affected by HIV and AIDS may be less able to access health care than other children. They may face barriers often due to reduced household income and costs associated with treating other family members.
• HIV and AIDS reduce the ability of health systems to cope with demand and deliver services.

How should health support be delivered?

Children’s health depends on the survival of parents who care for them, caregiver and community support resources and effective health systems that link community- and facility-based essential services. The best results are achieved through integrated family-centered services, bringing together health, education and social welfare services. Increasing evidence of the benefits of early childhood development interventions on children’s health suggests that early childhood interventions should be integrated with health services such as PMTCT (JLICA 2008).

Health programs for children need to provide quality, age-appropriate services through:

• Integrating management of basic illnesses, nutritional support, child survival (e.g. programs for TB, Malaria, immunizations, Diarrhea) early childhood development and school-based programs
• Linking health programs to household economic strengthening opportunities and food security support for families and youth
• Providing children and caregivers with basic health education and HIV prevention messages, including referrals for sexual education and reproductive health services
• Integrating palliative care (e.g., psychosocial support and pain management) into pediatric HIV programs
• Supporting a continuum of care by linking services for HIV prevention, voluntary counseling and testing, PMTCT, treatment, including cotrimoxazole and anti-retroviral drugs, and adherence support

Key Health Support Activities and Messages

1. Scale up services through health system strengthening at all levels, such as increased laboratory capacity, staff training and strengthening of networks and referrals linking prevention, care and treatment.
2. Co-locate orphans and vulnerable children’s programs near clinic-based programs to ensure that children and families can access a comprehensive array of health and socio-economic support and a true continuum of response.
3. Promote child-focused, family-centered health interventions, recognizing children’s needs at different ages and stages of development, and providing services to all children and adults in a family.
4. Support parents and caregivers with guidance on how to provide basic health care to children, including managing childhood illnesses, hygiene and safety practices, and on the importance of early childhood development.
5. Follow revised PMTCT guidelines. 2010 guidelines promote: 1) Lifelong ART for HIV-infected women in need of treatment for their own health, which is also safe and effective in reducing mother to child transmission of HIV (MTCT). 2) Short-term ARV prophylaxis to prevent MTCT during pregnancy, delivery and breastfeeding for HIV-infected women not in need of treatment.
6. Offer early diagnosis and treatment for HIV-positive children to improve children’s health outcomes. Start ART immediately in infants with initial positive results while at the same time testing a second sample to confirm the positive test result. ART should NOT be delayed while waiting for the second test result.
7. Help reduce risk of postnatal transmission of HIV through breastfeeding by supporting ARV interventions for an infected mother or child (WHO, 2010).
8. Support integration of PMTCT and pediatric HIV with maternal, neonatal and child health (MNCH) services, early childhood development programs, OVC programs and feeding and nutrition programs at policy- program- and service delivery levels to significantly improve MNCH, reproductive health (RH) and HIV outcomes and impact.
9. Address Stigma and Discrimination to reduce barriers to uptake of services.