The HIV/AIDS Pandemic and Children: Regional Overview Children and young people are affected by HIV/AIDS in different ways in different regions of the world. What is common to all regions is a lack of focus on how the pandemic is affecting children.
Note: The estimates have been rounded therefore global totals are not the exact sums of the rounded regional estimates.
*Source: 2004 Report on the Global AIDS Epidemic. UNAIDS. **Source: AIDS Epidemic Update: Dec 2004, UNAIDS
Africa The world’s hardest-hit region, Sub-Saharan Africa has just over 10% of the world’s population, but is home to more than 60% of all people living with HIV and more than 85% of all children under 15 living with the disease.
From 1990 to 2003, the number of children in sub-Saharan Africa who had lost at least one parent to HIV/AIDS grew from fewer than 1 million to more than 12 million. Eight out of 10 children who have been orphaned by AIDS live in sub-Saharan Africa.
As AIDS mortality reflects HIV incidence roughly a decade or so earlier, current high prevalence means that even in countries that see a stabilization or decline of HIV rates, the number of orphans will continue to rise for many years.
There is great diversity throughout Africa in the levels and trends of HIV infection. Across the region, women are disproportionately affected by HIV. On average, there are 13 women living with HIV for every 10 infected men and the gap continues to grow. African women are being infected with HIV at earlier ages than men. The difference in infection levels between women and men are most pronounced among young people (aged 15–24 years).
In countries in the Middle East and North Africa potential epidemics are being overlooked, in part because of cultural inhibitions against discussing sexual and reproductive health. With the exception of a few countries, systematic surveillance of the epidemic is not well developed, particularly among high-risk groups such as injecting drug users. Yet in some countries, HIV infection appears concentrated among this group. There is also concern that HIV may be spreading undetected among men who have sex with men, as male-male sex is illegal and widely condemned in the region.
South Asia and East Asia Children in South and East Asia are the second largest group of children living with AIDS and dying from the disease. National HIV infection levels in Asia are low compared with some other regions, notably Africa. But the populations of many Asian nations, such as India and China, are so large that even low national HIV prevalence means large numbers of people are living with HIV. UNAIDS estimates that about 5.1 million people were living with HIV in India in 2003. Home to 60 percent of the world’s population, Asia is witnessing a rapidly escalating epidemic that has huge implications globally. Indonesia, Nepal, Viet Nam and parts of China have seen sharp increases in the number of infections among injecting drug users. South Asia has some of the fastest-growing epidemics in the world, among groups such as injecting drug users, sex workers and their clients. There is still widespread ignorance about HIV/AIDS in the region and a great need to reduce the stigma surrounding the disease.
Asian countries such as Thailand and Cambodia, which have chosen to tackle openly high-risk behavior such as sex work, and reduce stigma and discrimination, have had notable success in fighting HIV. Recent trends in Thailand, however, are showing increased risk behaviours among adolescent boys and girls, and increasing proportion of new HIV and STI infections among young people.
Latin America and Caribbean
In Latin America, region-wide statistics mask wide disparities in HIV prevalence and the level and quality of response. The UNAIDS 2004 AIDS Epidemic Update shows that most countries in the region are now facing predominantly heterosexual epidemics, with potential for exponential growth. Already, HIV/AIDS has leapt from high-risk groups into the general population in Honduras, where an estimated 1.9 percent of the adult population is infected, and Brazil, where heterosexual sex has become the dominant mode of transmission in the country’s southern region. Argentina is the only country reporting injecting drug use as the number-one mode of transmission.
Young people aged 15 to 24 are particularly vulnerable to HIV infection. There are an estimated 40 million children in Latin America who live and work on the street, many of whom engage in “survival sex” to secure food, clothing and shelter. Sex tourism is a rising problem in the region, and local governments are doing little to protect these children, who are increasingly vulnerable to HIV infection.
The Caribbean has the world’s second-highest prevalence of HIV/AIDS. Among people aged 15–44, AIDS has become the leading cause of death. The worst affected country is Haiti, where more than one in 20 people age 15 to 49 are infected. Of the 280,000 people living with HIV/AIDS in Haiti, over 6 percent are children under the age of 15. HIV transmission in the Caribbean is occurring largely through heterosexual intercourse, although sex between men, which is heavily stigmatized, and in some places illegal, remains a significant—but still neglected—aspect of the epidemics.
Although the overall number of orphans across Latin America and the Caribbean declined between 1990 and 2003, the number has increased in countries most affected by AIDS. An estimated one child in six is an orphan in Haiti, while 9 per cent of children are orphans in Guyana.
Eastern Europe and Central Asia In Eastern Europe and Central Asia the number of people living with HIV has risen dramatically in just a few years. Strikingly, more than 80% of reported HIV infections are among people under the age of 30. Estonia, Latvia, the Russian Federation and Ukraine are the worst-affected countries, but HIV also continues to spread in Belarus, Kazakhstan and Moldova. The growing epidemic in this region is largely fueled by intravenous drug use. But in some countries sexual transmission is becoming increasingly common, especially among injecting drug users and their partners. In Russia, women account for an increasing share of newly diagnosed cases of HIV – up from one in four in 2001 to just one in three two years later in 2003.
High-income countries Unlike the situation in other regions, the great majority of people living with HIV in high-income countries who need antiretroviral therapy have access to it, so they are staying healthy and surviving longer than infected people elsewhere.
According to UNAIDS 2004 Report on the Global AIDS Epidemic, infections are on the rise in the United States and Western Europe. In the US, an estimated 950,000 people were living with HIV in 2003 – up from 900,000 in 2001. Half of all new infections in recent years have been among African Americans. In Western Europe, 580,000 people were living with HIV in 2003 compared to 540,000 in 2001.