Children living with HIV/AIDS are the most heartbreakingly innocent victims in that almost all were infected during pregnancy, birth or through breastfeeding - over 400,000 new infections occurred in 2007, mostly in sub-Saharan Africa. The science of paediatric treatment lags that for adults; only about 10% of infected children receive proper treatment and one sixth of all AIDS deaths are children under age 15.

Children at the Nyaka school for AIDS orphans in Uganda © Nyaka AIDS Orphans School

Knowledge of prevention of mother-to-child transmission (PMTCT) is more advanced. In rich countries a combination of special drugs for both mother and child, caesarean delivery and formula milk reduces the risk to just 1%-2%. In the complete absence of treatment the risk is 30%-35% and this is the position for the majority of babies born to mothers with HIV in the highest risk countries. Although increasing efforts are made to provide at least some treatment, many mothers are faced with impossibly difficult choices between the risk of breastfeeding and the presence of contaminated water in milk substitutes.

There is perhaps greater public awareness of the problems of the 12 million children in sub-Saharan Africa who have escaped HIV but who have lost one or both parents. Although cultural traditions often support the security to be found in extended families or foster parenting, there are natural limits to the capacity of communities devastated by AIDS. For example, in Zambia it is estimated that one third of all children will be orphans by 2010.

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