HIV and children

HIV/AIDS is a chronic debilitating illness, popularly known to occur from promiscuous sexual activity. What is less known is affection of innocent infants and toddlers by HIV for no fault of their own! It is estimated that there are about 1.7 to 3.5 million HIV affected children worldwide, out of which about 70% or more live in the under developed countries. New born babies and toddlers acquire the infection predominantly from their mothers. HIV virus can pass from the mother to child across the placenta during pregnancy or through vagina during normal delivery. The child can also be infected while breast feeding. Rarely a small child can be infected via transfusion of infected blood or receiving injections by contaminated syringe or needles. An adolescent can acquire the infection through infected blood or syringe and needle or by sexual activity with an infected person. Intravenous drug abuse is yet another reason for infection among adolescents. Children infected by HIV/AIDS pose a set of medico -social problems, different from adults. A small child is more prone to organ damage caused by the replication of the virus inside the body. The immune system of the children being weak makes them more susceptible to various opportunistic infections. These infections occur with greater severity and are more resistant to treatment as compared to adults. These unfortunate children usually have a short life span because they succumb to opportunistic infections. If they survive they face a life time risk of recurrent infections. It is important for the family of such a child to maintain utmost hygiene both personal and environmental to minimize the risk of the child getting infected by any means. Child should also receive necessary immunization as advised, to protect from illnesses. Brain damage induced by the virus leads to retarded psychomotor development of the child. In severe cases there is encephalopathy, i.e. infection of the entire brain substance. Thus the affected child does not talk or understand anything. He is unable to walk or carry out voluntary movements. Nothing much can be done for these unfortunate children. Their care givers have to be counseled regarding management of such children. Feeding of HIV positive children is also a problem. They have no appetite because of the HIV infection itself and various other systemic infections. If put on antiretroviral therapy, they experience further anorexia and gastritis due to drugs, Infections of the mouth like stomatitis (ulcers in oral cavity), fungal infections, or swelling of gums(gingivitis), cause difficulty in eating. All these factors add up and result in malnutrition. Thus a HIV affected child is highly prone to malnutrition which affects his physical and mental growth. Similarly giving regular medicines to the child is also a problem. The child has to be coaxed lovingly to take his medicines regularly. The family needs to give him small frequent meals which can be easily swallowed and assimilated by him. They have to be educated about the nutritional value of various food items, so that in their available resources and the ability of the child to eat, they can give him nutritionally rich food. This means supplying him with plenty of calories, proteins, vitamins, minerals, iron and other micronutrients. Green vegetables, fruits, whole grains and cereals, milk and milk products, eggs and meat usually fulfill this requirement. The key issue in these cases is whether and when to disclose the HIV positive status to this child. Ideally the parents in accordance with professional counselors should slowly disclose the condition to the child and help him to accept it mentally. This has to be done according to the child’s mental ability. Adolescent children have to be advised on safe sexual practices and told about the harms of unsafe sex. These children should never be stigmatized neither at home nor outside, and should be accepted in mainstream society as equals, because their infected status is not their fault. To prevent HIV in children, all pregnant women are advised to be tested for HIV during pregnancy, so that the in uterine child can be protected from HIV, by taking antiretroviral therapy. There is no reason why HIV positive children cannot grow up to be suitable, productive citizens of society. The only thing needed is suitable attention to their nutrition and prevention of infections during childhood. –rachna212002@yahoo.co.uk