HIV: Majority of childhood cases occur in girls, says UNICEF

Evan Walker
Evan Walker TheMediTary.Com |
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Why are more girls and boys acquiring HIV infections? Image credit: Luke Dray/Getty Images.
  • A new global snapshot from UNICEF finds that the burden of HIV is falling disproportionately on adolescent girls and children in some areas of the world.
  • Children are primarily becoming infected with HIV by contracting it from often adolescent-age mothers, who have acquired the disease as a result of multiple intertwining factors.
  • Children and adolescents aged 19 years and under account for just 7% of those with HIV, but they make up 15% of those who die from AIDS-related disease.

Overall, the incidence of HIV has fallen from what it once was globally. However, a new and troubling “global snapshot” from UNICEF finds that, for adolescent girls and children in many areas, the crisis persists.

It accounts for the deaths of 99,000 adolescent girls and children from causes related to AIDS, or stage 3 HIV — the most advanced and severe stage of infection with this virus — in 2022.

Particularly affected are adolescent girls and children from birth to 19 years in Eastern and Southern Africa. The areas next most affected are West and Central Africa, East Asia and the Pacific, Latin America and the Caribbean, and South Asia.

“It is unacceptable that adolescent girls, who should be planning their futures, continue to bear the heaviest burden of HIV infection.”

— Anurita Bains, UNICEF associate director of HIV/AIDS, in a press release

Jennifer Arney, senior technical advisor at FHI 360 — a global organization promoting public health — who was not involved in the UNICEF report, spoke to Medical News Today about its findings.

She told us that “[a]dolescent girls and young women in sub-Saharan Africa are much more likely to acquire HIV than their male peers due to multiple interrelated risk factors which contribute to increased vulnerability.”

According to her, these factors include:

  • early start to their sexual life
  • intergenerational sexual relationships
  • high socioeconomic vulnerability
  • transactional sex
  • early marriages
  • low levels of education and schooling
  • gender-related power imbalances and violence
  • a lack of availability of adolescent and youth-responsive services.

Dr. Tetyana Vasylyeva of U.C. Irvine’s Department of Population Health & Disease Prevention, not involved in the UNICEF report, explained to MNT that “[s]exual violence, and particularly intimate partner violence, often puts young women at risk.”

HIV among adolescent girls and young women from 10 to 24 years of age is over three times higher than among males of the same age, says the UNICEF snapshot.

“Young women,” said Dr. Vasylyeva, “are at higher risk for HIV than other groups in Southern African countries.” She cited “partners who are decades older in age, and thus have longer lifetime exposure to HIV.”

Arney further noted that:

“Even where appropriate and respectful sexual and reproductive health services exist, adolescent girls and young women are often unaware of available services, unable to access due to distance or clinic hours, or afraid to seek care because of concerns around confidentiality or judgement and poor treatment by providers who may disapprove of them engaging in sex.”

Even where educational opportunities exist, said Dr. Caterina Casalini, senior technical advisor in Clinical Services at FHI 360, not involved in the report, “[s]chool commitment, communication with schoolteachers and negative teacher attitudes also play a deterring role in disclosing HIV status and accessing treatment.”

“Poor access to sex education and reproductive care also contribute to young women’s vulnerabilities to HIV,” added Dr. Vasylyeva.

Once in care, however, “women [in Southern African countries] are actually generally better at staying in care and thus be virally suppressed once diagnosed,” she noted.

The World Health Organization (WHO) says that there were an estimated 1.8 million children aged 0–14 years living with HIV at the end of 2019, with 150,000 children newly infected.

Without better access to diagnoses and treatment, says the WHO, 50% of children with HIV will die before they are 2 years old, with 80% not living to see their fifth birthday.

More than 90% of cases of childhood HIV infections are due to transmission from infected mothers during pregnancy, childbirth, or breastfeeding.

HIV hits children particularly hard, since their young immune systems cannot fight infections as well as those of adults can.

These children experience various subsequent Health issues, including ear and sinus infections, sepsis, pneumonias, tuberculosis, urinary tract infections, intestinal illness, skin disease, and meningitis.

The WHO recommends that infants born to mothers living with HIV should be tested by 2 months of age, during breastfeeding, and also when the breastfeeding phase ends, considering the continued transmission risk.

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