This section looks at health and nutrition issues which particularly affect children living with HIV/AIDS. More general issues of health and nutrition and how they affect all orphans and other vulnerable children are covered in other sections. Other sections give more details on access to antiretroviral treatment in children, which drugs to use in children and practical tips on how to give such treatment in children.

Key points about the health and nutrition of children living with HIV/AIDS are:

1. UNAIDS estimates that more than 1500 children per day are being infected with HIV globally.

2. Most HIV infection in children occurs through mother to child transmission (MTCT). Other routes of infection include through sexual activity and unsafe health practices.

3. HIV test results in children under the age of 15-18 months do not give a clear result. Children born to HIV positive women have HIV antibodies from their mother in their blood until this age.

4. HIV has serious effects on the health of children. They often grow poorly and are more at risk of infectious diseases. These are often more severe than in other children.

5. Without antiretroviral treatment, 60-75% of children with HIV die before the age of five years. With effective antiretroviral treatment, this figure can be reduced below 20%.

6. Children with HIV have a range of health needs in addition to access to antiretroviral treatment. These include immunization and prevention and early treatment of all infections. These things can help a child with HIV stay healthy even where there is no access to antiretroviral drugs.

In this section, the term children living with HIV/AIDS is used to mean HIV positive children. However, some documents use the term more broadly to describe all children who are affected by HIV/AIDS.

UNAIDS estimates that 1500 children per day are being infected with HIV globally.

Routes of Transmission

Most HIV infection in children occurs through mother to child transmission (MTCT). This can occur during pregnancy, at the time of birth or through breastfeeding. In developing countries, approximately one in every three children born to an HIV positive mother is themselves infected with HIV. In developed countries, less than one child in fifty born to an HIV positive mother is themselves infected. This is because of health practices including delivery by Caesarean Section, treatment with antiretroviral drugs and safe alternatives to breastfeeding. Children may also be infected with HIV through sex and unsafe health practices. Sexual spread of HIV is most common in older children/young people but can occur in younger children through sexual abuse. Unsafe health practices include use of non-sterile needles and unsafe blood products. These practices may also occur in the traditional health sector and include activities such as circumcision and ear piercing.

Most HIV Infection in Children is Unrecognised

Most children in developing countries who have HIV infection do not know that they are infected. There are many reasons for this. Many of these apply to adults also. HIV tests may not be available. People may not see the benefit of having a test, particularly if the child or adult does not feel ill. However, UNAIDS report that 'early awareness that a child has HIV infection, combined with good care and support, can enhance survival and quality of life'.

HIV Testing in Children

A child may be suspected of having HIV infection if the child is born to a woman who is know to be HIV positive herself or if the child becomes ill themselves. However, it is difficult to understand HIV tests in children under the age of 15-18 months. Standard HIV tests detect antibodies to HIV. Children born to HIV positive women have HIV antibodies from their mother in their blood until this age. These are called maternal antibodies. In a very few cases, these maternal antibodies are found in the blood of children aged more than 18 months. It is possible to detect HIV directly. However, these tests are very expensive and not widely available in developing countries. One of the tests used is the HIV DNA polymerase chain reaction (PCR). In the United States, children born to HIV positive mothers receive PCR tests at birth and again at 1-2 months and at 4-6 months. Two positive tests are taken as evidence of HIV infection. Two negative tests are evidence that the child does not have HIV infection. This can be confirmed using standard HIV antibody tests, which become negative after the age of about 18 months.

There are many issues to consider before testing a child for HIV:

• HIV testing should only be carried out if it brings some clear benefit to the child. For example, this might be better care and support.
• Counselling needs to be provided for children and their care givers. The counselling provided should be appropriate for the age of the child.
• Most children who are HIV positive have been infected through mother to child transmission. Therefore, finding out that a child has HIV infection means that the child's mother (and the father) may also be HIV positive.
• HIV testing needs to be carried out in a way which ensures that results are kept confidential.

It is also possible to decide how severe a child's HIV infection is. This is particularly important when deciding whether or not to treat a child with antiretroviral drugs.

Effects of HIV Infection on Children

HIV infection affects children in a number of ways:

• Children with HIV infection often fail to grow properly. This is sometimes referred to as failure to thrive.
• Children with HIV infection are more frequently affected by infectious diseases. These are often more severe than in other children.
• Without antiretroviral treatment, 60-75% of children with HIV die before the age of 5 years. With treatment with antiretroviral drugs, this figure can be reduced to about 20%.
• Children with HIV often face stigma and discrimination as a result of their infection.

Health Needs of Children Living with HIV

Children with HIV have a variety of health needs. These include:

• Early and effective treatment of common infections. Prevention and treatment of common infections are particularly important for children with HIV. Work is currently being undertaken to integrate issues relating to HIV into the approach to childhood illness currently recommended by the World Health Organisation. This is called the integrated management of childhood illnesses (IMCI).
• Prevention and treatment of infections which would not cause illness in a child who does not have HIV. Infections which may be minor in a child without HIV may be very severe in a child with HIV. Infections of this type are called opportunistic infections.
• Medicines which can prevent opportunistic infections occurring. This is called prophylaxis. It is particularly important that children with HIV receive medicines to prevent TB and a particular form of pneumonia (called pneumocystis pneumonia or PCP). PCP and other infections can be prevented by giving Cotrimoxazole to all children born to HIV positive women from the age of 6 weeks to one year, and all HIV positive children. Even in areas of high Cotrimoxazole resistance there is still benefit in prescribing it to HIV positive children. Although it is known that this would help keep children with HIV healthy, most children with HIV in developing countries are not receiving these medicines.
• Immunisation. Children with HIV should receive immunizations in the same way as other children. These help protect the child against infectious diseases. This is particularly important in children with HIV because they are particularly vulnerable to infections. They should receive an additional dose of measles vaccine at six months of age. Children who are ill because of HIV should not receive BCG or yellow fever vaccination. They should receive injectable polio vaccine rather than oral polio vaccine.
• Good nutrition. This has been shown to reduce infections in children with HIV and to slow the onset of HIV-related illness and AIDS. Vitamin A supplementation may be helpful.
• Good hygiene
• A balance between exercise and rest
• Psychosocial Support including care, comfort and counselling

All of the items mentioned above contribute to the health and well-being of children with HIV. This contribution may be as important as providing them with antiretroviral treatment. For example, some people argue that it would be more cost-effective to ensure that all children with HIV receive medicines to prevent TB and pneumocystis pneumonia, rather than focusing exclusively on providing antiretroviral drugs.

http://www.ovcsupport.net/sw3699.asp

http://www.dcsf.gov.uk/index.htm

The Secretary of State for Children, Schools and Families (Ed Balls): The issues that Personal, Social, Health and Economic (PSHE) education covers are all central to children and young people’s well-being and to their healthy development as they grow up. They are nutrition and physical activity; drugs, alcohol and tobacco; sex and relationships; emotional health and well-being; safety; careers education; work-related learning; and personal finance.

Sex and Relationship Education (SRE) is one important constituent element of PSHE education. As well as being crucial to the drive to reduce teenage pregnancy it is vital for the healthy development of every child and young person.

I set out my intention to review SRE in the Children’s Plan, which was published in December 2007. A review group was established early in 2008 to this end, comprised of experts and representatives of faith groups, including the Church of England and the Catholic Education Service. The group was jointly chaired by the then Minister of State for Schools and Learners, my right hon. Friend the Member for South Dorset (Jim Knight); Jackie Fisher, principal of Newcastle college; and a representative of the UK Youth Parliament, in recognition of the importance of the review being informed by the views and experiences of young people, as well as those of parents and experts in SRE.

The review group completed its work in the summer of 2008. The review provided evidence, including from young people themselves, that the quality of SRE being delivered was too variable and was failing to meet young people’s needs on a consistent basis.

The group stressed that PSHE education was not given sufficient priority in schools and that its lack of status, specifically its non-statutory national curriculum status, was a key factor in explaining why schools did not prioritise it. The group was clear and unanimous in its view that making PSHE education statutory was necessary to achieve a step-change in the quality and status of the PSHE education children that young people receive.

The group recommended that this statutory content (for secondary schools) should be based on the current non-statutory programmes of study for “personal well-being”, on which it based its work. It also made it clear that the statutory content for primary schools should be based on new programmes of study for personal well-being, developed by the Qualification and Curriculum Authority (QCA) in the context of Jim Rose’s review of the primary curriculum. I am placing a copy of the SRE content of the PSHE programmes of study in the House Libraries for information, alongside this statement.

A review group which focused on drug and alcohol education, another key

component of PSHE education, and which ran to the same time scale as the SRE review group, also included among its recommendations that PSHE education should be made statutory.

In the written ministerial statement on 23 October 2008, Official Report, column 15WS, my right hon. Friend the Member for South Dorset made clear our intention to accept the recommendations from both these review groups to make PSHE education statutory. The statement also announced that I had commissioned Sir Alasdair Macdonald CBE, the outstanding head teacher of Morpeth school, to conduct an independent review to address the question of how the principle that PSHE education should have statutory status could best be taken forward into practice. In particular, I asked Sir Alasdair to examine how we could best ensure that in the sensitive area of SRE:

schools can continue to be able to tailor the curriculum in the ways they think best suit their pupils;

school governing bodies can retain their right to determine their own approach, in accordance with the ethos of their school; and

the arrangements put in place appropriately recognise and respect the rights of the very small minority of parents who already withdraw their children, and of those parents who might want to do so in future.

In carrying out his review Sir Alasdair talked to children and young people, parents, schools, faith groups and expert organisations involved in the development and provision of PSHE education. His findings were also informed by the results of a call for written evidence; field visits to a wide range of schools and professionals in local areas, selected on the basis of recommendations from expert organisations, including Ofsted; and focus groups with children and young people.

Sir Alasdair delivered his report to me in March 2009 and I set out his findings and the Government’s response in a written statement laid on 27 April 2009, Official Report, column 31WS . Sir Alasdair’s key recommendations were that, in making PSHE education statutory:

PSHE education must be an integral element of all initial teacher training courses and of the continuing professional development of teachers, school support staff and the wider children’s work force involved in its delivery;

Governing bodies should retain the right to determine their school’s approach to SRE and in doing so:

i. They should ensure this can be delivered in line with the context, values and ethos of the school, but in a way that is also consistent with the core entitlement to PSHE education.

ii. Governing bodies should also retain the duty to maintain an up-to-date SRE policy, which is made available to inspectors, parents and young people.

iii. Governing bodies should involve parents and young people (in the secondary phase) in developing their SRE policy, to ensure that this meets the needs of their pupils, and reflects parents’ wishes and the culture of the communities they serve.

The existing right of parental withdrawal from SRE should be maintained.

In my statement to the House on 27 April 2009 I confirmed the Government’s intention to accept all of Sir Alasdair’s recommendations. The right to statutory PSHE was included in the pupil guarantee in the White Paper published by my Department in June and I confirmed that it would apply to all state funded schools.

In my April statement I also said we would now consult on the detail of these recommendations, prior to moving to legislate on these matters. That consultation process has now been carried out and completed, by the Qualifications and Curriculum Development Agency (QCDA), on my Department’s behalf, covering a wide range of detailed issues relevant to PSHE, and I am placing copies of their report setting out the results in the House Libraries.

This report makes clear that a wide range of views and opinions were expressed, which the QCDA gathered through a variety of means, including an online consultation to which 6,000 people responded. QCDA also consulted through conferences; focus groups; and specially designed surveys of children and parents. The QCDA report also sets out their view that the results of their online consultation were influenced by campaigns on these matters conducted by several specific interest groups. The report explains that the QCDA sought to take this into account in their analysis and interpretation of the data.

I have considered carefully the outcomes of this consultation, together with Sir Alasdair Macdonald’s report and all the other information that has become available about these matters since my decision to review SRE in November 2007.

As a result, I can confirm our decision to accept the recommendations of the SRE review group and to proceed with legislation to make PSHE education part of the statutory national curriculum in both the primary and secondary phases. As the SRE group established in 2008 recommended, PSHE education will therefore be a foundation subject in the national curriculum in key stages 3 and 4, with the existing non-statutory programmes of study forming the basis for a core entitlement that all pupils should receive. At primary level the proposed new programme of learning, “Understanding Physical Development, Health and Well-being” will be the basis of the core entitlement that all pupils should receive.

Over the last few months an issue has arisen about the age up to which parents should be able to withdraw their children from SRE, if they wish to exercise their right to do so. Currently parents have the right to withdraw their children up to the age of 19. In practice, only a very small minority of parents choose to exercise this right. However, I believe it is very important that this right is maintained. This is all the more necessary once, subject to the will of Parliament, PSHE education becomes a statutory part of the national curriculum.

It is important that parents, schools and young people are all clear about the age that is set, and that this is supported by parents and young people, as well as being practically deliverable and legally enforceable. We have, therefore, consulted experts in SRE and representatives of faith groups, among others, about this. In addition, my Department commissioned some further quantitative and qualitative research in October 2009 to gather further relevant information. I am placing reports of the outcomes from that research in the House Libraries.

This research, which was carried out with samples of parents and of adults, found quite a wide spectrum of opinion, against a context in which four out of five parent respondents (81 per cent.) to the surveys said they supported the principle that all children should receive SRE. When asked about the right of withdrawal, 20 per cent. of parents said there should be no right of withdrawal, 33 per cent. of parents said the right should end at age 11, 9 per cent. said it should end at age 14, and 7 per cent. at the age of 16. A clear majority therefore supported a reduction in the age to which a right of parental withdrawal should apply.

After careful consideration of the outcomes of discussions with experts and other interested parties, including representatives of faith groups, and of the findings of this research, I have concluded that parents’ right to withdraw their children from SRE should continue until their children reach the age of 15. I have come to this view because I believe that proceeding on this basis is balanced, practically deliverable and legally enforceable, and maintains the right of withdrawl for the small number of parents who wish to exercise it. I also believe that setting the age limit at 15 offers the best chance of building a strong consensus.

This means that every young person will receive at least one year of SRE before their 16th birthday.

It is of critical importance, in ensuring that PSHE helps children to achieve all their Every Child Matters outcomes, that the content of the new PSHE education curriculum is carefully thought through and constructed. This has already been the subject of detailed consultation with schools, young people, parents, faith groups and experts in the field, and through the work of the SRE review group. The proposed content of SRE that will be taught when PSHE education becomes statutory will now be subject to further formal statutory consultation on the detail, the process to be overseen by the QCDA and to be concluded by autumn 2010.

In order to implement the measures set out in this statement we will include provisions, as necessary, in the forthcoming Children, Schools and Families Bill.

http://www.publications.parliament.uk/pa/cm/cmtoday/cmwms/archive/091105.htm#hddr_2

http://www.edcm.org.uk/page.asp

The number of UK children living in "severe poverty" rose in the four years before the recession, research from a children's charity suggests.

Save the Children says the number of children in homes in this category rose 260,000 to 1.7m from 2004 to 2008.

The report warns there is a danger that severe poverty could rise even further.

The government says it has lifted half a million children out of relative poverty, and helped the very poorest, as defined by its own criteria.

It has pledged to halve child poverty by 2010 from the 1998/99 figure of 3.4 million and end it altogether by 2020.

'Shocking'

Lee Muir, who lives in Motherwell in Scotland with her six-year-old son Kai, told BBC Radio 5 live: "On a daily basis I've had to make decisions on whether to heat my house or whether to feed my son.

"Extra curriculum activities are just out the window completely, that's just not an option just now."

The government defines relative low-income poverty as less than 60% of contemporary household median income, and absolute low-income poverty as less than 60% of 1998/99 median household income.

However, Save the Children defines severe poverty as those living in households with incomes of less than 50% of the UK median income (disregarding housing costs) and who were also missing some basic possessions, such as a winter coat.

The charity used this method to try to analyse if help was reaching the very poorest families.

Save the Children calculated there were 1.46 million children in what they call severe poverty in 2004-05. Four years later the number had risen to 1.7 million.

The charity claims that at the end of 2008, 13% of the UK's children were living in severe poverty, up two percentage points on 2004 - and that not only have efforts to reduce child poverty stalled, they have gone into reverse.

The report predicts the recession is likely to have increased severe poverty by a further 100,000 children, but that benefit payments and tax credits would have brought numbers back down to pre-recession figures.

Save the Children's director of UK programmes Fergus Drake said: "It's shocking that at a time when the UK was experiencing unprecedented levels of wealth the number of children living in severe poverty - we're talking about children going without a winter coat, a bed and other day-to-day essentials - actually increased."

The story varies across the UK. In Northern Ireland, 8% of children are extremely poor. In Scotland it is 9% while in England and Wales it is 13% - a figure pushed up by the situation in London where 19% of youngsters live in severe poverty.

'More to do'

Work and pensions minister Helen Goodman said: "Families with children in the poorest fifth of the population are, on average, £5,000 better off as a result of personal tax and benefit changes.

"Without measures such as tax credits, employment help and the Sure Start programme, it is likely around 2 million more children would still be in poverty today.

"Significant investment made since the Budget of 2007 will lift a further 550,000 children out of poverty and we are helping to get parents into work by providing free childcare for three and four year olds.

"But there is still much more to do. We are determined to meet our ambitious goals and help break the cycle of deprivation - which is why we will enshrine in law our commitment to end child poverty by 2020."

http://news.bbc.co.uk/1/hi/education/8479364.stm