The State of HIV in Children in South Africa

NACOSA supports the Global Alliance’s mission to end AIDS in Children by 2030. The Global Alliance to end AIDS it is a commitment signed by 12 countries, including South Africa, aimed at ending AIDS in children by 2030 through a strong, strategic and action-oriented alliance of multisectoral stakeholders at national, regional and global levels.

HIV is still a critical issue in South Africa. While rates of HIV in children have declined significantly since the early 2000s, an estimated 270 000 children aged 0 –14 are living with HIV, 10 000 become newly infected and 2100 die from AIDS each year, according to UNAIDS. The majority of HIV-positive children are infected before and during birth, whereas others acquire HIV later through breastfeeding.

NACOSA emphasises the importance of preventing the passing of HIV from a mother to child during pregnancy, childbirth, or breastfeeding (known as vertical transmission). “It is in the best interest of the child that parents protect their children from HIV,” says Colleen Wagner, NACOSA’s Catalytic Grant Manager who is also a midwife and nursing sister. “But also that children who become HIV positive are quickly put onto life-saving treatment. Primary caregivers must know the HIV status of the child, and clinicians must check this status during routine health visits.”

Testing for HIV is crucial when planning for pregnancy. If HIV-negative, high risk mothers should consider taking PrEP (pre-exposure prophylaxis) throughout the pregnancy and breastfeeding period. Regular retesting and consistent use of condoms during this time is also important.

Only 50% of young mothers admitted to having tested for HIV before they became pregnant at a recent workshop NACOSA held in Mitchells Plain. Teenage pregnancy and the lack of knowledge and support young mothers receive is a contributing factor to HIV transmission. Preventing early pregnancy and supporting young mothers is therefore an important part of the strategy to end AIDS in children. “Lack of knowledge and information about family planning and preventing pregnancy led me to being pregnant,” said one of the mothers NACOSA spoke to.

“It takes a village! Let’s prioritise the health of our children,” urges NACOSA. The organisation advocates for the involvement of parents and communities in creating a supportive environment for young mothers, families and children affected by HIV. “I faced discrimination both at school and at home,” says Priscilla Mokwala, a young mother. “Friends were gossiping about me at school, and my father chased me out of the house when he found out I was pregnant.”

Priscilla was part of NACOSA’s adolescent and youth programme, funded by the Global Fund, which reaches over 200,000 young people across the country. She now has support and is working to help other young people while raising awareness about HIV, pregnancy prevention, and other important issues affecting her community.

“Children with HIV can live a good quality life with ART treatment,” says Wagner. “It’s important for mothers to consistently take their antiretroviral therapy (ART) medications.” This helps them keep the virus under control and keeps their children safe. If someone is on ART and the virus is undetectable, they cannot pass HIV on to their children during pregnancy or breastfeeding.

NACOSA believes that investing in children’s health has long-term advantages. Protecting children from discrimination and creating a safer, more just environment in which they can develop without fear of stigma is critical.

NACOSA calls on society to ensure equality for children, stating, “Ensuring equality for children is not just a responsibility of parents but of society as a whole.” The organisation also highlights the importance of talking openly about HIV status with children to remove stigma and shame. “Knowing your child’s status means that you can protect and care for them better,” Concludes Wagner.

It is crucial to prevent HIV transmission from mothers to children, encourage regular testing to know every child’s HIV status, and ensure HIV-positive children receive proper antiretroviral therapy (ART) for a good quality of life. Investing in children’s health, involving fathers, and creating a supportive, discrimination-free environment are key parts of providing comprehensive care and support. Ultimately, society must prioritise the protection of children today to secure a healthier and more productive future.