© UNICEF/NYHQ2011-2151/Esteve
coverage in low- and middle-income countries is low (44 per cent).87 Eastern and Southern Africa reported coverage of 56 per cent, and CEE/CIS reported 69 per cent in 2012; however, all other regions report very low coverage (3–43 per cent).88 Better integration and decentralization of such simple interventions as part of the broader management of childhood illness can significantly improve child health outcomes.89
Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013
6. A lign programming for all HIV-exposed children with broader efforts to promote child survival, growth and development Major progress in reducing maternal and child mortality has been made in the past 20 years: Between 1990 and 2010, maternal mortality in sub-Saharan Africa dropped by 41 per cent,84 and between 1990 and 2012, the under-five mortality rate declined by 47 per cent.85 The Countdown to 2015: Accountability for Maternal, Newborn and Child Survival report launched in 2013 recognized that HIV cannot be ignored in making progress on maternal mortality.86 The continuing global drive for accelerated and improved maternal and child survival – through routine child immunization programmes and initiatives such as Committing to Child Survival: A Promise Renewed – provides opportunities to create new entry points to HIV testing and enhanced care for both HIV-infected and uninfected children born to women living with HIV, especially in high HIV burden settings. Weaknesses in systems and services can mean that even where the effective course of action is clear, the intervention may not reach the child in time. Research has shown that mortality in children diagnosed with HIV can be reduced by 67 per cent with cotrimoxazole – an antibiotic – as prophylaxis, yet
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Provider-initiated HIV testing also needs to be more widely available in other services for children, such as routine immunization and early child health or nutrition programmes, as well as community-based and health facility-based services for infants. These services can play an especially important role in identifying children whose mothers did not access antenatal and PMTCT services during pregnancy.
7. Strengthen linkages between HIV programming and national social welfare and community-based support systems HIV has broad social and economic consequences for children and their families, but orphans and vulnerable children, including those living in families affected by HIV, frequently do not receive any type of support.90 Mitigating the impact of HIV on the estimated 17.8 million (16.1 million–21.6 million) of the world’s children who have lost one or both parents to AIDS91 – 85 per cent of whom live in sub-Saharan Africa92 – is a particularly formidable task. While comprehensive social support for children and families affected by HIV is an essential element of the response to HIV, it is frequently an afterthought in many HIV-specific programmes. Stronger linkages between HIV programming and broader national social protection efforts and community-based services are needed to ensure that more children and families receive the support they need. Such social protection programmes, particularly cash transfers, appear to be rapidly expanding, with some estimates suggesting they have doubled in Africa – from