Today 2.1 million children under the age of 15 years are living with HIV. Yet children remain forgotten in global and national efforts to address HIV and AIDS.

For children, HIV is particularly aggressive. The virus multiplies rapidly, destroying their defenses against infection and facilitating the development of pneumonia, TB and other opportunistic infections.

Without adequate care and treatment, as many as one third of children born with HIV will die before their first birthday, and half of them will die before they are two years old.

Diagnosing and prevention in infants
The most common test for HIV identifies HIV-antibodies. But infants get antibodies from their mothers to fight off infections, so they may have the antibodies and not the virus. That means testing for antibodies in children is inconclusive.

Another type of test is needed. However such virological tests need sophisticated laboratories and trained staff. Children in richer countries can find out within six weeks of being tested, but in poorer countries HIV is detected in children only after they already have AIDS-related symptoms or once they are two years old.  That is often too late.

Roughly  420,000 children were newly infected with HIV during 2007, mainly through mother-to-child transmission even though pre¬ventative treatment is available. Mother-to-child transmission can be reduced to less than 2% through a combination of anti-retroviral therapy, elective Caesarean section and avoidance of breastfeeding, when appropriate. Improving prevention would cut out the need for expensive diagnosis.

Child friendly medicine
It is estimated that approximately 800,000 children urgently need HIV treatment. Children must take three or more different anti-retroviral drugs. These medicines must be formulated differently than those for adults. 

Pediatricians often have only liquid formulations available. Syrups are difficult to dose properly and to administer, especially for grandparents who may well be the last remaining care-provider alive. They are costly to transport and difficult to store without refrigeration. Since syrups are so difficult to handle, some pediatricians are forced to suspend HIV therapy for some children.

In 2006, some generic manufacturers started producing fixed-dose-combinations for children living with HIV. Since three different drugs are combined into one pill, the treatment regimen is simplified, and it is easier to administer by caregivers and better tolerated by children. Even at the present time, few pediatric fixed-dose-combinations are available and only two of them have been listed by the World Health Organisation in the essential medicines list for children.

The deadly duo
In Africa, a person with HIV and TB dies every three minutes. TB is curable, even in persons with HIV, and yet such deaths continue to occur. Both diagnosis and treatment of TB in people living with HIV are complex tasks. Children with TB and HIV die more quickly. The drugs required to treat both are not available in child-friendly liquid or tablet forms.

The high cost therapy for children
When child-friendly anti-retroviral drugs (ARVs) have been developed, they often are not registered or marketed in the countries where they are most needed, and usually they are very expensive. Economic barriers do not only include the high cost of anti-retroviral drugs (ARVs) that treat HIV, but also other health-related user fees, and the cost of transport and testing.

Weak health systems
Also affecting the access of children to anti-retroviral (ARV) treatment is the unacceptable state of health systems in most of the countries hardest hit by the pandemic and the shortage of skilled healthcare workers, in particular, of pediatricians and nurses familiar with treating children. Unlike adults, children taking anti-retrovirals (ARVs) demand constant check-ups and advice from trained personnel in order to receive maximum benefit from and adhere to their respective treatment programs.