Living in the shadows.

Every day, 1,000 children become infected with HIV. UNAIDS estimates that, by the end of 1997, 1 million children under the age of 15 will be living with the virus and suffering the physical and psychological consequences of infection. Since the beginning of the epidemic, well over 2 million HIV-positive children have been born to HIV-positive mothers, and hundreds of thousands of children have acquired HIV from blood transfusions and through sex or drug use. Over 9 million children are estimated to have lost their mothers to AIDS.

"AIDS is the most recognized disease in the world today", said Dr. Peter Piot, Executive Director of UNAIDS, in launching the campaign, "but the disastrous impact it is having on children has not been given enough attention. If the spread of HIV is not rapidly contained, the gains made in reducing infant and child death rates will be reversed in many countries." Estimates quoted in the report indicate that by the year 2010 AIDS may increase infant mortality by as much as 75 per cent and under-five child mortality by more than 100 per cent in the most hard-hit countries in the world.

"Within a little more than a decade, AIDS will be a major cause of death among children", stresses Carol Bellamy, Executive Director of the United Nations Children's Fund (UNICEF). "But children do not have to contract HIV to be profoundly harmed by it. The number of orphans are growing dramatically, children are traumatized by watching parents die, forced out of school to take the place of adults at home, and often suffer from discrimination. HIV has become a real threat to children's rights."

According to the report, more children than ever before are contracting HIV, and there is no sign that the infection rate is slowing. In 1996 alone, 400,000 children under the age of 15 years became infected worldwide. Around 90 per cent of these children acquire the virus from their HIV-positive mothers, whether before or during birth or through breastfeeding. And women of child-bearing age are now making up an ever-increasing proportion of people with HIV worldwide: today, AIDS kills more women than men in sub-Saharan Africa.

In the longer term, therefore, reducing the vulnerability of infants to HIV infection means increasing women's control over their situations, improving their ability to take decisions about their own reproductive and sexual health, and increasing the knowledge and sense of responsibility of both men and women about HIV prevention. It also means increasing women's access to anti-viral drug regimens which can cut the risk of mother-to-child transmission.

For children who are already infected and sick, the report shows that the situation remains very grave. This is particularly so in many poorer countries, which have been unable to benefit from the recent advances made in anti-viral therapy, and where even inexpensive medicines to treat HIV-related illnesses and reduce suffering are often unavailable. In Europe, more than 20 per cent of HIV-positive children are still alive at the age of 10. In Zambia, in contrast, a recent study showed that nearly 50 per cent of HIV-positive children had died by the age of two.

Children are not only infected by HIV, they are also affected. More than 90 per cent of the 9 million children who are currently estimated to have lost their mothers to AIDS live in sub-Saharan Africa. Experts in Zimbabwe, for example, estimate that by 1996 approximately 8 per cent of children in the country were in this situation. In Uganda, 1,000 children every week lose one of their parents to AIDS.

Children living in communities struck by AIDS feel its impact as their parents and teachers become infected, as health and social services are stretched beyond their limits, and as their families also take in other children who have been orphaned by the epidemic. Says Elizabeth Mataka, Executive Director of Family Health Trust in Zambia: "In some of the worst-hit African communities, there are only children and old people - the age groups in between have been almost wiped out. No one yet knows what effect this will have on the children and their future."

In all countries, families and the traditional safety net of the extended family are coming under increasing pressure - a recent survey of social care in seven countries participating in the European Collaborative Study showed that, by age eight, 60 per cent of children born to HIV-positive mothers lived in alternative care.

When an HIV diagnosis occurs in the family, the household often also suffers disproportionately from stigma, isolation and impoverishment, the report notes. A recent study in Thailand found that many parents had lost jobs as a result of AIDS and that stigmatization, due largely to incorrect beliefs about HIV transmission, was widespread. "Despite the almost universal ratification of the UN Convention on the Rights of the Child, in many countries children are still suffering from gross discrimination and exploitation as a result of their HIV status or that of members of their families", said Dr. Piot. "Children have a right to be better informed and better protected."

No one knows how many child sex workers there are in the world, but recent figures indicate that more than 1 million children enter the sex trade every year. The HIV/AIDS epidemic has made child sexual abuse and child prostitution more dangerous than ever, and the belief that children are less likely to be infected has raised the demand for younger sex workers.

Awareness is also growing of the scale of child abuse that takes place in or near the home. A study of children under 12 being treated for a sexually transmitted disease at a clinic in Zimbabwe showed that the majority had been abused and infected by neighbours or close relatives, the report states.

But if children are an increasing part of the AIDS problem, they are also a critical part of the solution. Information and the promotion of children's rights are important keys to reducing risk behaviour. Said Bill Roedy, President of MTV Networks International: "There is an essential need to communicate with young people in a manner which they will understand, appreciate and relate to. HIV and AIDS demand that we talk about some pretty tricky subjects, but I can see no reason for preventing potentially life-saving information from reaching those with most to lose."

The report recommends a number of areas in which sustained efforts can improve the situation for children, including: providing sexual health education; expanding both educational and employment opportunities; and strengthening health and social services to families and communities.

"AIDS has changed the world for children", said Dr Piot. "It is the responsibility of everyone - Governments, communities and individuals - to rise to this new challenge and to bring urgent support to children and their families as they face the uniquely painful realities of life in a world with AIDS."