The Intergenerational Impact of a Slow Pandemic: HIV and Children.

Human immunodeficiency virus (HIV) has, over the last four decades, infected millions of young women and their children. Interventions developed in parallel with the spread of the virus have been able to reduce rates of vertical transmission from mother to child. The impact of HIV in children can be direct in children living with HIV (CLHIV) and exposed to HIV and uninfected, or indirect through impacts on their parents, caregivers, and family. In 2018, the United Nations joint programme on AIDS (UNAIDS) estimated that 1.7 million children were living with HIV, 160,000 were newly infected with HIV, and 100,000 died from HIV. Improvement in treatment regimens can improve the life chances of children, but adherence to treatment is a problem, especially for adolescents. Injectable long acting treatments, or interventions to improve service delivery and support for adolescents living with HIV may improve treatment success. In addition to failures of HIV prevention and treatment in CLHIV, there are concerns over exposure to the virus and antivirals leading to delayed child development. To improve the wellbeing of children affected by HIV, social support is necessary, but we need to find ways of enhancing the impact of interventions, perhaps through combining them.