Thanks to treatment interventions such as the President's Emergency Plan for AIDS Relief (PEPFAR), HIV-positive children in the developing world have been given significant assistance. PEPFAR currently provides antiretroviral medication for more than 2.1 million people while supporting care for more than 4 million orphans and vulnerable children in developing countries.

However, a new report by the Joint Learning Initiative on Children and HIV/AIDS (JLICA) states that far more needs to be done to properly address 2 million children living with the virus worldwide.

“Home Truths: Facing the Facts on Children, AIDS and Poverty” was released February 10. The JLICA report represents a two-year independent convergence of researchers, implementers, policymakers, activists and people living with HIV/AIDS. The report found that most current responses for HIV-positive children have been scattershot, largely due to misdirected financial initiatives and a failure to support children's families and communities.

According to the report, there is a misperception that children who lose parents as a result of HIV/AIDS lack social and familial networks, thus requiring non-family or orphanage care, which can be up to 10 times more costly than community support. Roughly 88 percent of children designated as orphans have a surviving parent, and 95 percent of all children directly affected by HIV continue to live with extended family members.

Researchers recommend that the United Nations reevaluate its definition of the term “AIDS orphan”—which they claim to be misleading—and instead divert attention toward relief efforts that target children in AIDS-affected communities in general regardless of their orphan or HIV status.

“When we make relief too narrowly AIDS-specific, we miss a large portion of children impoverished by the epidemic,” said Jim Yong Kim, MD, co-chair of the JLICA Learning Group on Expanding Access to Services and Protecting Human Rights and director of the François-Xavier Bagnoud Center for Health and Human Rights at Harvard University.

“In fact,” he said, “providing benefits only for people living with HIV or with family members who are living with or who are dying from HIV is probably counterproductive. It can create stigmatization and abuse of those in need of help.

“This report calls for AIDS-sensitive but not AIDS-exclusive programming policies,” Kim continued.

Researchers hope that strengthening the social infrastructures of AIDS-affected communities in developing countries—through income transfers to those living in extreme poverty, child support grants and food distribution—will benefit children further with HIV prevention, support and education programs.

“Over 60 percent of children in southern Africa live in poverty,” Kim noted. “Failure to implement basic measures to address this extreme poverty is limiting the uptake of HIV services and reducing the impact of large global investments in AIDS programs. Alleviating poverty, then, is the key.”