Jim Yong Kim organized the event.
While antiretroviral drugs are being made available to more people globally, and new infection rates are decreasing in some countries, Piot noted that adequate data on children with HIV are lacking - making it difficult to address the problem in a meaningful way.
"I was asked to present you with data on HIV and children, and I am unable to do that," he told the gathering of international experts on September 24 at the conference, "Meeting Children's Needs in a World with HIV/AIDS: An International Symposium."
"We just don't have data worldwide for children" on specific aspects of the epidemic, he said.
The conference was organized by the FXB Center for Health and Human Rights at HSPH and was sponsored by the Joint Learning Initiative on Children and HIV/AIDS, a global collaborative of HIV researchers, policymakers, and practitioners charged with finding new ways to serve the needs of children with HIV. Speakers included HSPH Professors Jim Yong Kim and Jack Shonkoff.
Piot said that approximately 500,000 children are born infected each year and that people between the ages of 15 and 24 account for 40 percent of all new infections worldwide. But statistics don't exist on the numbers of children who become infected as children through rape, incest, abuse, teenage sexual activity, or drug use.
Adding to the scope of the problem is the huge number of orphaned and vulnerable children who have lost a parent or parents to AIDS. Piot estimated that there may be 15 million worldwide. "These are the ones who have been left behind," he said.
Peter Piot
"We have failed repeatedly up to now to address the long term when it comes to this epidemic," he concluded. "We must take steps so that a girl born today doesn't grow up infected and transmit it to her child later on. We must act today also so that a 15-year-old boy or girl has a better chance of living a long and healthy life. That means taking a hard and cold look at what works and what doesn't and identifying an agenda for the future."
JLICA comprises four learning groups on - strengthening families and communities, expanding access to services, and social and economic policies. Each group held a panel discussion at the symposium where ideas were debated.
While $8.3 billion was made available in 2005 to respond to the AIDS epidemic, it is not known exactly how much has gone to children. One panel debated whether poor countries should dedicate a portion of their budgets to the care and support of orphaned and vulnerable children. Malcolm McPherson, an economist at the Kennedy School of Government, said that these countries can't afford to do so. But Shanta Devarajan, an economist with the World Bank, argued that they can't afford not to.
Some activists urged government cash transfers or grants to families, particularly those raising orphaned children. But data exist showing that orphans do as well or better than non-orphans on many measures including education and nutrition, noted John Donnelly, a Boston Globe health reporter who served as the moderator of the event.
Kim, director of the Francóis-Xavier Bagnoud (FXB) Center for Health and Human Rights at HSPH, said good ideas exist but are not being implemented.
"On the one hand, we don't have nearly the quality of statistics we need, but we also know the burden is extraordinary, and we're really not reaching the people that we need to reach," he said, during the panel on expanding access to services.
He said that a big problem has been taking successful small pilot programs and implementing them on a larger scale. "There are so many interventions we are not delivering," he said. "We call it the implementation bottleneck. What [we'd like to see in every country] is seamless integration of families into HIV services and education and social protection for vulnerable children."
Kim said that such children desperately need support and intervention. "It's not just that children are affected by HIV/AIDS, but that HIV/AIDS has fundamentally altered the experience of childhood [in the highest-burden countries]," he said.
Jack Shonkoff
"Children with HIV/AIDS or in families with the stresses of HIV/AIDS are experiencing a level of adversity that is threatening their brain development," he said.
Such children are more likely to experience mental and physical problems down the line, he said.
Yet society has failed to step up to help these children, he noted. "Our investment in the health and development of vulnerable children has been inadequate," he said. "What do we do about it? We need to broaden the base of champions. We need more people to stand up for this. We need a more powerful message. It's a matter of using the science to show that this not just about other people's children. The health of other people's children affects everybody's future. Doing something about it is a moral response and a wise social and economic investment."
—ML
Copyright, 2009, President and Fellows of Harvard College
