In Brazil as elsewhere, most children who live with HIV are infected by mother-to-child (hereafter vertical) transmission.
Although vertical transmission of HIV is preventable with existing testing and treatment technologies, and transmission in this way has dropped to less than 2 per cent in most developed countries, only approximately 5–10 per cent of all women in developing countries have access to preventing mother-to-child transmission (PMTCT) (Prendergast et al. 2007; UNAIDS 2006a). In the absence of any intervention, the probability that women pass HIV to their infants is approximately 15–30 per cent in developed countries but 25–40 per cent in sub Saharan Africa (Prendergast et al. 2007; Connor et al. 1994; Italian Multicentre Study 1988). Without interventions, approximately 66 per cent of vertical transmission takes place in the peripartum period. Most peripartum transmission (66 per cent) takes place during childbirth and a third of cases take place in utero, usually during the last trimester of pregnancy (Prendergast et al. 2007). Much of the remainder is attributable to postpartum and longer-term breastfeeding. However, the risk of vertical transmission of HIV can be radically reduced by providing highly active antiretroviral therapy (HAART) to HIV-positive pregnant women before childbirth and to their infants for several weeks after birth (Prendergast et al. 2007; Tonwe-Gold et al. 2007). Since most children who are infected with HIV are infected by their mothers, the single most effective way to address the paediatric HIV/AIDS epidemic is to prevent vertical transmission of HIV (Prendergast et al. 2007).
Preventing vertical transmission of HIV and responding to the health and welfare needs of children living with and affected by HIV/AIDS requires significant resources as well as a robust political commitment. As a result of its policies to provide pregnant women and their newborns with prophylactic HAART, Brazil has successfully reduced vertical transmission of HIV/AIDS in recent years (Figure 1). However, much less is known about the welfare of children orphaned by AIDS in Brazil and Latin America more broadly. Although a 2000 study estimates that 32,000 children have been orphaned as a result of the AIDS epidemic in Brazil (Szwarcwald et al. 2000), few studies since have examined either the social or medical needs of children infected and affected by HIV/AIDS. Other research has attempted to update the estimates on AIDS orphans (França Junior et al. 2006), but the conclusions of recent studies have been somewhat limited by the paucity of information on paediatric HIV/AIDS and AIDS orphans in Brazil.
This article appraises the available evidence to answer the question: ‘Can a developing country support the welfare needs of children affected by AIDS?’, for the case of Brazil. Based on the Brazilian experience, we argue that a developing country can indeed take proactive steps to support the welfare needs of children affected by HIV/AIDS. We hold that irrespective of some uncertainties about the welfare of children living with HIV/AIDS, Brazil’s commitments to policies supporting these children are best demonstrated by the country’s success in dramatically reducing vertical transmission of HIV. In turn, we attribute Brazil’s success in reducing vertical transmission of HIV to its long-standing political commitments to AIDS treatment, including prophylactic antiretroviral therapy, which the country adopted over the objections of international donors in the 1990s. Although Brazil supplemented development of its HIV/AIDS programmes with World Bank loans, the interventions which have had the most demonstrable impact on child welfare, including providing widespread access to HAART for pregnant women and their infants, have been wholly financed with local resources. This demonstrates Brazil’s commitment and proactive, effective response to addressing the welfare needs of children affected and infected by HIV/AIDS.
This article comes from the IDS Bulletin 39.5 (2008) Financing the Welfare Needs of Children Affected by HIV/AIDS: The Case of Brazil