The Vulnerability of Children
Joy Hurlow & Elizabeth Styffe

When the first cases of HIV were identified over 25 years ago, the thought that children might be infected was initially far from most people’s minds. While there was an incredible amount of ignorance due to limited experiences with HIV at the time; it was soon tragically apparent that children would be greatly affected and infected and that the virus would change the global landscape for children forever. The effects of HIV on children has been tremendous. Many hoped that children would not be affected. They were wrong. Tragically, children were diagnosed with HIV early in the pandemic. 2.5 million children are currently infected. Millions of lives have been lost and over 15 million children in sub-Saharan Africa alone have been left orphans due to HIV/AIDS.

Children continue to suffer and remain the most vulnerable members in society. Thus, when children are infected, the effects of HIV are often more pronounced and more intrusive than the effects of HIV on adults. In many resource-limited settings, in the absence of early diagnosis and treatment, children with HIV do not survive until their fifth birthday.

Tragically, children were diagnosed with HIV early in the pandemic. The HIV virus was more widespread and complex than what was originally thought. Early research focused on deterring the mode of transmission for children. It is clear now that most common way children become infected is through Mother-to-Child transmission. HIV can be transmitted during the course of pregnancy, during childbirth, and through breastfeeding. Rarely, children are also infected from the physical or sexual abuse of HIV positive adult. In resource-limited settings with an unsafe blood supply, children continue to be infected through blood and unsafe medical practices. It is important to note that even if the mother is HIV positive, even in the worst-case scenarios where treatment is unavailable, the child has only a 30% chance of becoming infected. Surely, this number is absolutely unacceptable, but this statistics confounds the fear that every pregnancy results in an HIV positive child. 

When the children are positive as well, they are at risk of being rejected by family members and friends who otherwise might take care of them. Some children will test falsely positive for the first 18 months of life. However, with the correct test, children can be definitively identified as positive or negative as early as 4 months of age. If tested shortly following birth, with more elementary testing procedures, infants may test falsely positive as they are carrying the antibodies of the mother. 

The crisis of children orphaned due to AIDS is ever growing and requires special attention. The number of HIV positive orphans is also continuing to grow in much of the developing world. Measures to help the local church in resource-poor settings care for children in their own community should be the first priority in care. Interventions supporting in-country adoption, removing children from orphanages in the care of a family, promoting the full range of wholistic family-centered child services should be emphasized. Churches all over the world can consider international adoption of HIV positive children when the local church exceeds the capacity.

In the United States, infection during pregnancy and childbirth has been almost eliminated due to the availability of pre-natal treatment. Early and effective treatment of an HIV positive mother is the best prevention strategy for children. Recent research has demonstrated that HIV infection in children is most effectively prevented when the mother is on effective anti-retroviral medication throughout the pregnancy when indicated, when C-section delivery is considered and when breastfeeding is avoided.

The stark contrast in most of the world is sobering. In most of the world, access to necessary medications remains unattainable. In addition, barriers such as access to even basic healthcare, childhood immunizations, and resources for formula and even availability of clean water add to the risk factors that put HIV positive children at risk.

Although the history for children born with HIV has been bleak, there is hope for the future. There are medications and treatments available to prevent HIV transmission, and medications available specifically for children to manage HIV infection. Nonetheless, research involving children, especially children in resource-limited settings is dismally scant and the continuing research of therapeutics specifically designed for children is a continued challenge requiring advocacy and continued support.

While there is much work to do, there is hope and a future available to the most vulnerable members of society. The mobilized church brings hopes it comes alongside children and families providing necessary prevention, treatment and support, emphasizing wholistic care that promotes growth and development. The church also plays a critical role in early testing, educating mothers on the medication that are available to prevent transmission, making way for treatment for themselves and their children. The church is made up of families who can adopt children who are HIV positive and provide them with the loving care and support of a family.