How children become infected with HIV

How children become infected with HIV

Mother-to-child transmission

An HIV positive mother with her HIV positive child in South Africa

Nine out of ten children infected with HIV were infected through their mother either during pregnancy, labour and delivery or breastfeeding.⁸ Without treatment, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery and a further 5-20% will become infected through breastfeeding.⁹ In high-income countries, preventive measures ensure that the transmission of HIV from mother-to-child is relatively rare, and in those cases where it does occur a range of treatment options mean that the child can survive - often into adulthood. This shows that with funding, trained staff and resources, the infections and deaths of many thousands of children could be avoided.

Blood transfusions

HIV infection can occur in medical settings; for instance, through needles that have not been sterilised or through blood transfusions where infected blood is used. In wealthier countries this problem has virtually been eliminated, but in resource-poor communities it is still an issue. The most large scale case of infections among children resulting from contaminated injections and unscreened blood transfusion occurred in Romania between 1987 to 1991 when more than 10,000 babies and children were infected with HIV as a result of unsafe medical practices.¹⁰

Unsafe blood transfusions have also led to hundreds of HIV infections in countries in the Central Asia region, namely Kazakhstan,¹¹ Kyrgyzstan¹² and Uzbekistan¹³ from 2006-2008. The widespread reuse of injection equipment as well as encouragement by doctors motivated by financial reasons to carry out 'unnecessary blood transfusions', led to the infection of at least 119 children in Kazakhstan and at least 150 in Uzbekistan from 2007-2008.

Although official statistics claim that unsafe injections account for a small percentage (2.5%) of HIV infections in sub-Saharan Africa, ¹⁴ this is contested by a number of researchers. HIV prevalence in children can be 1 to 3 times higher than that of pregnant women in antenatal clinics¹⁵ and in one study as many as a fifth of children who were not sexually active had HIV negative mothers¹⁶: suggesting that the children were infected through contaminated medical procedures.

Injecting drug use

In central and Eastern Europe, where injecting drug use fuels the spread of HIV, young people living on the street are found to be especially vulnerable to HIV through injecting drug use. In St Petersburg, a study of more than three hundred 15-19 year olds living on the street found that 40 percent of them were HIV positive.¹⁷ In Ukraine, one study found a variety of HIV risk behaviours like sharing needles and unprotected and forced sex were prevalent among 10-19 year old street children,¹⁸ while a multicity study found an HIV prevalence of 18 % among street youth (aged 15-24).¹⁹ Police harassment and the general attitude of society that sees street children as ‘outcasts’ and ‘criminals’ means that that they are difficult to reach with health and social services.

Sexual transmission

Sexual transmission does not account for a high proportion of child infections but in some countries children are sexually active at an early age. This is potentially conducive to the sexual spread of HIV among children, especially in areas where condom use is low and HIV prevalence is high. In sub-Saharan Africa 16% of young females (aged 15-19) and 12% of young males reported having sex before they were 15 in 2007. In Lesotho, these figures are 16% and 30%, respectively; in Kenya, 15% and 31%.²⁰ In developing countries overall it is estimated that 6% of boys and 11% of girls have had sex by age 15.²¹

The lower the age of first sex, the higher the lifetime risk of HIV infection. This is because early sexual debut is often associated with older lifetime partners, higher rates of coerced sex and lower rates of condom usage.²²

Children are also at risk of becoming infected with HIV through sexual abuse and rape. In some parts of Africa, the myth that HIV can be cured through sex with a virgin has led to rapes, sometimes of very young children by infected men - although whether or not this is a significant factor in child sexual abuse in the region is disputed.^{23 24 25 26} In some cases, young children are trafficked into sex work, which can put them at a very high risk of becoming infected with HIV.