HIV

Why it is important ?

• HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV touches the lives of children and families in every country in the world. Over 2 million children under age 15 are living with HIV (infected with HIV). Millions more are affected by HIV (not infected but living in families with infected members). An estimated 17.5 million children have lost one or both parents to AIDS; more than 14 million of these children live in sub-Saharan Africa. (Latest data available, 2007)
• HIV is transmitted through (1) unprotected sex with an HIV-infected person; (2) an HIV-infected woman to her baby during pregnancy, childbirth or breastfeeding; and (3) blood from HIV-contaminated syringes, needles or other sharp instruments and from transfusion with HIV-contaminated blood. HIV is not transmitted through casual contact or by other means.
• Children are among the most vulnerable to HIV. But they typically receive the fewest services. The disease can progress rapidly in young children. Antiretroviral drugs are used to treat HIV because they restore the immune system and delay progression to AIDS. However, most children infected with HIV do not begin taking these drugs until they are 5–9 years old. This is too late. Without antiretroviral treatment, half of all babies born with HIV will die by their second birthday.
• Although HIV is still incurable, it is a manageable condition. If infected infants and children are diagnosed early, receive effective treatment and take antiretroviral drugs as prescribed, they have a better chance to grow, learn, develop and have dreams for the future.
• Families and communities, especially women and girls, are the first lines of protection and care for children living with or affected by HIV. Families should receive the support they need to provide their children with a nurturing and protective environment. Keeping HIV-positive mothers and fathers alive and healthy is vital for children's growth, development and stability. Without the security of the family, children run a greater risk of being exploited and discriminated against.
• Adolescents and young people 15–24 years old accounted for about 45 per cent of all new HIV infections among people aged 15 and older in 2007. HIV is more common among adolescent girls and young women than adolescent boys and young men. Life skills education is critical for children, adolescents and young people so that they acquire the knowledge and skills to make healthy life choices.
• Governments, with support from families, communities and non-governmental and faith-based organizations, have a responsibility to ensure people's right to information on HIV prevention, treatment and care. They also have the responsibility to ensure the rights of children living with or affected by HIV to protection, care and support. It is important that children, families and communities help stop the spread of HIV.

What every family and community has a right to know ?

1. HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). It is preventable and treatable, but incurable. People can become infected with HIV through (1) unprotected sexual contact with an HIV-infected person (sex without the use of a male or female condom); (2) transmission from an infected mother to her child during pregnancy, childbirth or breastfeeding; and (3) blood from HIV-contaminated syringes, needles or other sharp instruments and transfusion with HIV-contaminated blood. It is not transmitted by casual contact or other means.
2. Anyone who wants to know how to prevent HIV or thinks he or she has HIV should contact a health-care provider or an AIDS centre to obtain information on HIV prevention and/or advice on where to receive HIV testing, counselling, care and support.
3. All pregnant women should talk to their health-care providers about HIV. All pregnant women who think they, their partners or family members are infected with HIV, have been exposed to HIV or live in a setting with a generalized HIV epidemic should get an HIV test and counselling to learn how to protect or care for themselves and their children, partners and family members.
4. All children born to HIV-positive mothers or to parents with symptoms, signs or conditions associated with HIV infection should be tested for HIV. If found to be HIV-positive, they should be referred for follow-up care and treatment and given loving care and support.
5. Parents or other caregivers should talk with their daughters and sons about relationships, sex and their vulnerability to HIV infection. Girls and young women are especially vulnerable to HIV infection. Girls and boys need to learn how to avoid, reject or defend themselves against sexual harassment, violence and peer pressure. They need to understand the importance of equality and respect in relationships.
6. Parents, teachers, peer leaders and other role models should provide adolescents with a safe environment and a range of life skills that can help them make healthy choices and practise healthy behaviour.
7. Children and adolescents should actively participate in making and implementing decisions on HIV prevention, care and support that affect them, their families and their communities.
8. Families affected by HIV may need income support and social welfare services to help them take care of sick family members and children. Families should be guided and assisted in accessing these services.
9. No child or adult living with or affected by HIV should ever be stigmatized or discriminated against. Parents, teachers and leaders have a key role to play in HIV education and prevention and in reducing fear, stigma and discrimination.
10. All people living with HIV should know their rights.

Supporting information

Key Messages - HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). It is preventable and treatable, but incurable.

• People infected with HIV usually live for years without any signs of the disease. They may look and feel healthy, but they can still pass on the virus to others. Timely initiation of antiretroviral therapy (ART), a group of medicines used to treat HIV, allows a person to handle HIV as a chronic disease and lead a relatively healthy life.
• AIDS is the late stage of HIV infection. People who have AIDS grow weaker because their bodies lose the ability to fight off illnesses. In adults not receiving antiretroviral treatment, AIDS develops 7–10 years after HIV infection, on average. In young children it usually develops much faster. There is no cure for AIDS, but new medicines can help people with AIDS live longer.
• In most cases, HIV is passed from one person to another through unprotected sexual intercourse, during which the semen, vaginal fluid or blood of an infected person passes into the body of another person.
• HIV can also pass from one person to another through the use of non-sterile, HIV-contaminated needles and syringes (most often among drug users sharing needles and syringes), razor blades, knives or other instruments for injecting, cutting or piercing the body.
• People may also become infected by HIV through transfusions of infected blood. All blood for transfusions should be screened for HIV.
• HIV is passed to infants and young children primarily from the mother during pregnancy or childbirth or through breastfeeding.
• It is not possible to get HIV from working, socializing or living side by side with HIV-positive people. Touching those who are infected with HIV, hugging, shaking hands, coughing and sneezing will not spread the disease. HIV cannot be transmitted through toilet seats, telephones, plates, cups, eating utensils, towels, bed linen, swimming pools or public baths. HIV is not spread by mosquitoes or other insects.

Key Messages - Anyone who wants to know how to prevent HIV or thinks he or she has HIV should contact a health care provider or an AIDS centre to obtain information on HIV prevention and / or advice on where to receive HIV testing, counselling, care and support.

Information on HIV and on services and education to learn how to prevent or reduce the risk of infection is increasingly available in almost every country. Information can be found at health centres, fixed and mobile HIV care units, testing and counselling centres, youth centres and in many schools. Information is also available through the internet and other media.

HIV testing and counselling can help in early detection of infection. It can enable those who are infected to:

• Get the support services they need
• Manage other infections they might have
• Learn about living with HIV
• Learn how to avoid infecting others.

Anyone who thinks that he or she might be infected with HIV should contact a health-care provider or an AIDS centre to receive confidential testing and counselling. Anyone who lives in an area where HIV is prevalent and has had unprotected sex should be encouraged to be tested and counselled.

Voluntary HIV testing and counselling can help people make informed choices about their health and their sexual behaviour. It can help couples decide whether or not to have children. If one partner has HIV there is a risk the other partner can become infected while trying to conceive. If a couple is expecting a baby, testing and counselling can help them make decisions regarding the health of their baby.

Counselling and testing can also help those not infected to remain uninfected through education about ways to avoid risk, including safer sex choices.

There are many types of HIV tests. It is important to talk to a professional to learn about the type of test being used and its accuracy.

If the result of an HIV test is negative, this means the person tested is not infected or it is too early to detect the virus. In adults, the HIV blood test may not detect infection for up to six weeks after exposure. Depending on the test, detection in babies may take up to 18 months after birth. However, early infant diagnosis (EID) can be conducted as early as six weeks.

Families and communities should insist on and support confidential HIV testing, counselling and information. Confidentiality helps protect children, adolescents and adults from experiencing stigma, discrimination, exclusion and isolation.

Counselling can help to empower women and adolescent girls, promote safer sex and condom use, and help detect and facilitate treatment of sexually transmitted infections – all of which can reduce the chances of HIV infection. If a woman or adolescent girl is diagnosed with HIV and has children or is pregnant, assistance may be required to help her protect, care for and support her children. Community support groups and NGOs often provide assistance.

Increasing access to testing followed by treatment, care and support can help to reduce stigma by demonstrating that HIV is not a 'death sentence' and that many people infected with HIV can lead relatively healthy, happy and productive lives.

Key Messages - All pregnant women should talk to their health-care providers about HIV. All pregnant women who think they, their partners or family members are infected with HIV, have been exposed to HIV or live in a setting with a generalized HIV epidemic should get an HIV test and counselling to learn how to protect or care for themselves and their children, partners and family members.

The most effective way to reduce transmission of HIV from the mother to the child is to prevent women from becoming infected with HIV. Access to family planning services and condoms for women and men are critical to prevent HIV transmission.

In many countries, pregnancy is the only time when women seek health services. This provides them an important opportunity to receive an HIV test and counselling whether in high- or low-level epidemic areas. If a woman is found to be HIV-positive, she should have access to counselling, referrals, HIV care and treatment, and other health-care services. Health-care and support services for the mother will help reduce the risk of HIV transmission to the baby.

The HIV-positive woman should be encouraged to have her partner and other children tested and counselled. If any test results are positive, HIV care, treatment, and other prevention and health-care services should be offered.

A pregnant woman infected with HIV can take antiretroviral drugs. This can help improve her own health and also reduce the chances of her child becoming infected.

The risk of transmitting HIV to infants may be reduced to less than 2 per cent if pregnant women receive comprehensive counselling, health care and antiretroviral treatment during pregnancy and through the first six months after childbirth. This is often part of a comprehensive programme called Prevention of Mother-to-Child Transmission (PMTCT).

An HIV-positive mother of a newborn should be provided with information and skills to select the best feeding option for her baby. She should receive nutrition and health-care counselling for the newborn and herself and be supported in having her child tested and treated for exposure to HIV. She should be informed that babies born to HIV-positive women who have not taken antiretroviral medicines during pregnancy have about a 1 in 3 chance of being born with HIV. Without intervention, half of the babies infected with HIV die before they are 2 years of age.

A pregnant woman infected with HIV needs to know that:

• Taking specific medicines (antiretroviral drugs) during pregnancy can help improve her health and reduce the risk of passing the infection to the infant
• Prenatal and post-natal care – visiting a skilled birth attendant for checkups before and after the birth of the baby and receiving care during pregnancy and childbirth – can help reduce the risk of passing the infection to the infant
• Starting HIV-exposed newborns on cotrimoxazole or Bactrim between 4 and 6 weeks of age and continuing it until HIV infection can be definitively ruled out can help prevent 'opportunistic' infections (infections that take advantage of a weakened immune system)
• There are various infant feeding practices, each with advantages and risks.

The mother needs to decide which infant feeding practice is the safest and the most manageable for her circumstances:

• Exclusive breastfeeding for the first six months of the child's life protects the infant from death due to diarrhoea, pneumonia and malnutrition. There is, however, a risk of HIV infection through the breast milk. The risk of transmitting HIV to the infant is much lower with exclusive breastfeeding than with mixed feeding (breast milk and other foods and drinks). The risk can also be reduced by shortening the duration of breastfeeding once a nutritionally adequate and safe diet without breast milk can be provided to the child.
• Feeding the baby a breast milk substitute (infant formula) alone eliminates the risk of transmitting HIV through breast milk but can greatly increase the risk of dying from infections such as diarrhoea or pneumonia, especially in the first 6 months of life. This is a good option only if the mother has access to clean water and the means to obtain the formula for at least 12 months, and the use of infant formula is acceptable to her and her community.
• Breast feeding beyond 6 months should continue until safe and adequate replacement foods, including infant formula and other milks and foods, are available. Once a nutritionally adequate and safe diet can be provided, all breastfeeding should stop.
• All infants, whether they are receiving breast milk or breast milk substitutes, should receive other nutritious foods and drinks from 6 months of age onward to provide the energy and nutrients needed to support their growth and development.

Key Messages - All children born to HIV-positive mothers or to parents with symptoms, signs or conditions associated with HIV infection should be tested for HIV. If found to be HIV-positive, they should be referred for follow-up care and treatment and given loving care and support.

• The earlier a child is tested, diagnosed with HIV and started on HIV treatment, the better the chance of his or her survival and living a longer and healthier life.
• The health-care provider should recommend HIV testing and counselling as part of standard care to all children, adolescents and adults who exhibit signs, symptoms or medical conditions that could indicate HIV infection or who have been exposed to HIV. HIV testing and counselling should be recommended for all children seen in health services in settings where there is a generalized HIV epidemic.
• A child whose mother is known to be HIV-positive should be tested for HIV within six weeks of birth or as soon as possible. Infants have their mother's antibodies for several weeks after birth, and therefore standard antibody tests are not accurate for them. A special polymerase chain reaction (PCR) test is required to tell if an infant has the virus around 6 weeks of age. If positive, the child needs to begin treatment immediately. The health-care provider can help the family set up a feasible and appropriate antiretroviral therapy regimen for the child. The parents should receive counselling and social services.
• An important part of HIV care and antiretroviral treatment (ART) for children is the antibiotic cotrimoxazole. It helps prevent 'opportunistic' infections related to HIV, especially PCP (pneumocystis pneumonia). This treatment is called cotrimoxazole preventive therapy, or CPT.
• Children with HIV should be given ART in fixed-dose combinations. These can be prescribed by a trained health worker, who can also provide follow-up support. If the child is going to school, the school can also provide support to make sure that the child takes the medicines while at school.
• It is critical to encourage children taking ART to keep taking the medicines on the recommended schedule. This will help ensure the treatment remains effective.
• Children need a healthy, balanced diet under any circumstances, but when they receive HIV treatment, ensuring proper nutrition is especially important.
• HIV or opportunistic infections may cause reduced food intake due to decreased appetite, difficulty swallowing or poor absorption. Therefore extra attention should be given to the nutrition of children who are HIV-positive to make sure they receive high-quality, easily digestible foods. Without proper nutrition, their growth and development can be hindered. This could lead to more opportunistic infections that further deplete children's energy and increase their nutritional needs.
• Once children who are HIV-positive are old enough to understand, they need to be involved in decisions about their medical care and support. They also should be made aware of the importance of prompt care and treatment of infections. This is a critical part of developing their ability to make healthy decisions in the future.

Key Messages - Parents or other caregivers should talk with their daughters and sons about relationships, sex and their vulnerability to HIV infection. Girls and young women are especially vulnerable to HIV infection. Girls and boys need to learn how to avoid, reject or defend themselves against sexual harassment, violence and peer pressure. They need to understand the importance of equality and respect in relationships.

While children need to know the biological facts about sex, they also need to understand that sexual relationships involve caring and responsibility. Discussing and stressing the emotional aspect of a sexual relationship with children can help them make healthy decisions and resist peer pressure as they grow and develop. It is important to talk about sex in a way that fits the child's age and stage of development, and conveys values.

Everyone needs to be aware of the fact that adolescent girls and young women are especially vulnerable to HIV infection. Adolescent girls and young women need support to protect themselves from unwanted and unsafe sex.

In many countries, HIV rates are higher among adolescent girls than adolescent boys.

Adolescent girls are more susceptible to HIV infection because:

• They may not have a choice about when to have sex or whether a condom is used
• Their vaginal membranes are thinner than those of mature women and thus susceptible to lesions from sexual activity that can allow HIV infection and other sexually transmitted infections (STIs) to enter
• They sometimes are targeted by and engage in relationships with older men who may be infected
• They are vulnerable to being sexually exploited and trafficked, which puts them in high-risk situations.

Girls and women have the right to refuse unwanted and unprotected sex. They also have the right to learn skills on how to avoid, reject or defend themselves against unwanted sexual advances.

Girls and women need to know what to do and where to go if they have been victims of sexual assault. They should seek the support of a trained health worker or go to a health facility for medical attention and counselling. Health-care providers and social workers should be trained to be understanding of girls and women in these situations. This information also applies to cases involving boys.

To effectively address violence, boys and men need to be actively engaged in finding solutions. Their full engagement with girls and women is needed to work on preventing violence and sexual harassment, resisting peer pressure and achieving gender equality. This should include an understanding of gender stereotypes and inequalities.

Discussions at home, in school and in the community between children and adolescents and their parents, teachers, community leaders and other role models can help develop healthy attitudes and behaviours. They can contribute to:

• Respect for girls and women and their rights
• Equality in decision-making and relationships
• Skills development on how to confront peer pressure, sexual harassment, violence and stereotypes.

Key Messages - Parents, teachers, peer leaders and other role models should provide adolescents with a safe environment and a range of life skills that can help them make healthy choices and practise healthy behaviour.

It is important for children to learn about HIV at an early age. When children become adolescents, they need accurate and full information on making and negotiating healthy life choices. This will help them avoid becoming infected with HIV and other sexually transmitted infections (STIs).

Adolescents need to be supported in learning the life skills that can help them protect themselves in situations where they could be vulnerable to HIV infection. These skills include problem solving, decision-making, goal setting, critical thinking, communication, assertiveness and self-awareness. Adolescents also need skills for coping with stressful or confrontational situations.

Adolescents and young people look to parents, teachers, peer leaders and other role models for guidance. These role models should develop their base of knowledge on HIV so they will know how to communicate about HIV and how to share important life skills.

Adolescents need to know the risks of HIV. They need to understand how it is passed through unprotected sex with an infected person or through the use of contaminated needles or syringes for injecting drugs. They should know about safer practices and the consequences of lifestyle choices. They should also know how HIV is not transmitted so they can reject myths and prevent discrimination against people living with HIV that is based on unfounded fears of contagion.

It is important to know and reduce the risks of getting HIV from unprotected sex:

The risk of getting HIV can be reduced if people do not have sex. If they have sex, correct and consistent use of male or female condoms is important. To reduce risk, people can:

• Decrease their number of sex partners
• Stay in a mutually faithful relationship with a partner(s) who is not infected
• Have safer sex – sex without penetration (where the penis does not enter the vagina, rectum or mouth) or penetrative sex using a condom correctly (as the directions indicate) and consistently (during every act of penetrative sex).

In combination with safer practices, male circumcision reduces the possibility of transmission of HIV infection from female to male.

The more sex partners people have, the greater the risk that one of them will have HIV and pass it on (if they do not use male or female condoms consistently and correctly).

However, anyone can have HIV – it is not restricted to those with many sex partners. People who do not show signs of infection may carry the virus. Testing is the only sure way to tell.

A well-lubricated condom is essential for protection during vaginal or anal intercourse.

• The male condoms that come with lubrication (slippery liquid or gel) are less likely to tear during handling or use. If the condom is not lubricated enough, a water-based lubricant, such as silicone or glycerin, should be added. If such lubricants are not available, saliva can be used (although this can transmit other infections, such as herpes). Lubricants made from oil or petroleum should never be used with a male condom because they can damage the condom. Oil or petroleum lubricants include cooking oil, shortening, mineral oil, baby oil, petroleum jellies and most lotions.
• The female condom is a safe alternative to the male condom. The most commonly used female condom is a soft, loose-fitting sheath that lines the vagina. It has a soft ring at each end. The ring at the closed end is used to put the device inside the vagina; it holds the condom in place during sex. The other ring stays outside the vagina and partly covers the labia. Before sex begins, the woman inserts the female condom with her fingers. Only water-based lubricants should be used with female condoms made of latex, whereas water-based or oil-based lubricants can be used with female condoms made of polyurethane or artificial latex (nitrile).

HIV can be transmitted through oral sex, although available information suggests the risk is minimal as compared to vaginal and anal sex. However, oral sex can transmit STIs which can increase the risk of HIV transmission. In the case of oral-penile sex, a male condom is recommended.

Because most sexually transmitted infections can be spread through genital contact, a condom should be used before genital contact begins.

Drinking alcohol or taking drugs interferes with judgment. Even those who understand the risks of HIV and the importance of safer sex may become careless after drinking or using drugs.

People who have sexually transmitted infections (STIs) are at greater risk of getting HIV and spreading HIV to others:

STIs, including HIV, are infections that are spread through sexual contact. They can be spread through the exchange of body fluids (semen, vaginal fluid or blood) or by contact with the skin of the genital area. STIs are spread more easily if there are lesions such as blisters, abrasions or cuts. STIs often cause lesions, which contribute to spreading the infection.

STIs often cause serious physical suffering and damage.

Any STI, such as gonorrhoea or syphilis, can increase the risk of HIV infection or HIV transmission. Anyone suffering from an STI has a much higher risk of becoming infected with HIV if they have unprotected sexual intercourse with an HIV-infected person.

• People who suspect they have an STI should see a trained health worker promptly to be diagnosed and treated. They should avoid sexual intercourse or practise safer sex (non-penetrative sex or sex using a male or female condom).
• Correct and consistent use of male and female condoms when engaging in sexual intercourse – vaginal, anal or oral – can greatly reduce the spread of most STIs, including HIV.
• People who have an STI should tell their partner(s). Unless both partners are treated for an STI, they will continue infecting each other. Most STIs are curable.

Some STI symptoms:

• A man may have pain while urinating; a discharge from his penis; or sores, blisters, bumps or rashes on the genitals or inside the mouth.
• A woman may have vaginal discharge that has a strange colour or bad smell, pain or itching around the genital area, and pain or bleeding from the vagina during or after intercourse. More severe infections can cause fever, pain in the abdomen and infertility.
• Many STIs in women and some in men produce no noticeable symptoms.

Not every problem in the genital area is an STI. Some infections, such as candidiasis (yeast infection) and urinary tract infections, are not spread by sexual intercourse. But they can cause great discomfort in the genital area.

HIV can be spread by unsterilized, contaminated needles or syringes, most often those used for injecting drugs, and by other instruments:

An unsterilized needle or syringe can pass HIV and other infections, such as hepatitis, from one person to another if contaminated with infected blood. Nothing should be used to pierce a person's skin unless it has been sterilized.

People who inject themselves with drugs or have unprotected sex with injecting drug users are at high risk of becoming infected with HIV. People who inject drugs should always use a clean needle and syringe. They should never use another person's needle or syringe.

Injections should be given only by a trained health worker using an auto-disable syringe (a syringe that can be used only once).

Any kind of cut using an unsterilized object such as a razor or knife can transmit HIV. The cutting instrument must be fully sterilized for each person, including family members, or rinsed with bleach and/or boiling water.

Equipment for dental treatment, tattooing, facial marking, ear or body piercing, and acupuncture is not safe unless the equipment is sterilized for each person. The person performing the procedure should take care to avoid any contact with blood during the procedure.

Key Messages - Children and adolescents should actively participate in making and implementing decisions on HIV prevention, care and support that affect them, their families and their communities.

Children, adolescents, youth and families can be powerful agents of change in HIV prevention and education and reducing stigma and discrimination. They need to be a central part of defining and implementing responses to HIV.

Children and young people can raise awareness of HIV and compassion for those living with HIV. They often gain confidence and self-esteem in the process of working with their peers and in their communities.

• Child forums and other events provide opportunities for children and young people to mobilize communities to create supportive and caring environments for children and families living with and affected by HIV.
• Schools and non-formal educational activities can help children form peer-to-peer support groups and children's clubs. These can bring together children who, with support from teachers or community workers, take on responsibility to conduct HIV prevention and life skills education.

Children, young people, parents, other caregivers and families affected by HIV can find support by joining or organizing self-help groups, peer groups and community support groups. These groups can:

• Provide a social network that gives members psychological support
• Share practical information and help families access social welfare services
• Offer opportunities for members to become active in efforts to find innovative ways to address HIV prevention, protection, care and support.

In collaboration with local authorities and governments, non-governmental and faith-based organizations often help support these groups.

When groups join to form a network, they can help to create a movement to raise awareness and understanding of HIV and promote protection, care and support of orphans and vulnerable children and families affected by HIV. Such efforts can help to address the exclusion, stigma and discrimination experienced by those living with or affected by HIV.

Key Messages - Families affected by HIV may need income support and social welfare services to help them take care of sick family members and children. Families should be guided and assisted in accessing these services.

Families provide the 'first line' response for protecting, caring for and supporting children infected with or affected by HIV. Families and relatives absorb almost all the costs involved in caring for these children.

Families are generally recognized as the best source of the loving care, protection and support that children need. Mothers, fathers or other primary caregivers infected with HIV need support to live longer. Prolonging their lives and keeping them healthy helps to keep a family together.

The majority of children who have lost one or both parents are living in families that are often stretched economically and in need of support. Caregivers tend to be female, including some who are children themselves and many who are elderly, such as grandmothers.

Partnerships involving the government and community or non-governmental or faith-based organizations can provide support to improve the economic situation of families affected by HIV. Support might include access to microcredit, low-interest bank loans and social grants.

How to access income support, such as social grants and social welfare services, should be clearly detailed in national guidelines. These should be well communicated, understood and administered at the local level. Information provided by families when applying for social grants and services should be kept confidential.

As part of the social welfare services, health-care providers should make sure that HIV-positive children and adults from the same family can obtain treatment and support in the same health facility. This helps conserve the family's time, energy and resources.

Social welfare services, with support from community and non-governmental and faith-based organizations, should help parents and other caregivers develop the skills needed to care for children affected by or infected with HIV.

If the child is HIV-positive, the caregivers need help to:

• Learn about the HIV infection
• Know how to care for and support the child, including ensuring adherence to an ART regimen
• Reduce their fear of contracting HIV from the child
• Know how to protect themselves when caring for the child
• Understand and respond to the emotional needs of the child.

A child who has lost a parent, other caregiver or sibling because of AIDS needs psychosocial support from his or her family and possibly counselling to work through the trauma and grief. A parent or other caregiver may need support to understand the stages of a child's grief relative to his or her age, as well as appropriate psychosocial responses.

Parents living with HIV should make sure that each of their children has a birth certificate. Parents should make a will to establish 1) who will be the guardians of their children and 2) if they have money land or livestock how these assets will be distributed. If the children are old enough to understand, they should be involved in these deliberations with their parents.

Key Messages - No child or adult living with or affected by HIV should ever be stigmatized or discriminated against. Parents, teachers and leaders have a key role to play in HIV education and prevention and in reducing fear, stigma and discrimination.

Educating children, families and communities about HIV is an essential way to help reduce fear, stigma and discrimination against the child and his or her family living with or affected by HIV, as well as the child's own fears and self-stigma.

Children, parents, other family members, teachers, community and faith based organizations, local leaders and authorities, and the government have a significant role to play in HIV education and prevention and in reducing fear, isolation, stigma and discrimination.

HIV prevention and education should include:

• Raising awareness and support for the rights of children and family members living with or affected by HIV Children, adolescents and adults living with or affected by HIV have the same rights as any other person to education, health care, housing and appropriate representation in the media. They should also have access to fair and equal treatment in the justice system.
• Ensuring that all children and young people understand the risks of HIV and know that they cannot get it from ordinary social contact with someone who is infected with HIV Children and young people need to be informed that HIV has no vaccination or cure, but that people can lead relatively healthy and productive lives with treatment. It is important that they understand how to prevent HIV infection and how to protect themselves and their loved ones.
• Empowering adolescents and youth to make decisions on when to have or not to have sex and how to negotiate condom use Talking with and listening to young people is very important to understand their situation and how best to provide them with protection, care and support. It can sometimes be awkward for adults to discuss sexual issues with children and adolescents. One way to begin the discussion with school-aged children is to ask them what they have heard about HIV and AIDS. If any of their information is wrong, it provides an opportunity to give them the correct information.
• Stimulating ideas and providing guidance on ways children, adolescents and youth can show their compassion and friendship with children and families they know who are living with or affected by HIV.

Key Messages - All people living with HIV should know their rights.

• Governments have a responsibility to ensure protection of the rights of children and their family members infected with or affected by HIV and to collaborate with families, communities and non-governmental and faith-based organizations.
• Where AIDS intersects with extreme poverty, conflict and large families, comprehensive support to all orphans and vulnerable children is wise and cost-effective. Children infected with or affected by HIV should be fully included in such strategies and their rights should be protected – including rights to privacy, confidentiality and non-discrimination.
• Many children live in difficult circumstances without full protection of their rights. They may be infected with HIV or at risk of exposure. They may live on the streets, in orphanages or in extreme poverty or exploitative situations. These children have the right to live in a family. Their families may need help reuniting and/or staying together. All these children should receive support to go to school and/or get vocational training. They should also receive support to access health and nutritional care as well as legal and social welfare services. They have a right to these services.
• Local authorities and non-governmental, faith-based and community-based organizations can help mothers, fathers, other caregivers, children and adolescents living with or affected by HIV know their rights and understand how to advocate for them in relation to the country's judicial and administrative systems, as well as with government authorities responsible for policies, programmes and services.

Source: UNICEF

Related resources

State wise fact sheets on HIV 2013-14