by Kate Iorpenda

The 5^th symposium on children and HIV Start Early Start Now was one of several key pre-conferences to act as a curtain raiser to the 20^th International AIDS Conference.

Hosted by the Coalition for children affected by AIDS and the Teresa group, the two day meeting brought together funders, researchers, government staff and community based programmers to talk about the need for urgent attention to the youngest children born into HIV-affected families.

The audience were presented with the latest research in neuroscience that is influencing our response to families affected by HIV. Dr Pia Britto, Senior Adviser in the Early Childhood Development Unit at UNICEF, shared evidence on the impacts of toxic stress on brain development caused by multiple adversity in children’s lives from poverty, poor nutrition, abuse, and parental loss so often linked with lives affected by HIV.

She described how the brain develops at its most rapid pace forming new connections at the astounding rate of 700-1000 a second. “‘These early synaptic connections form the basis of the brain’s plasticity and the child’s physical and mental health, lifelong capacity to learn and adapt and change and develop psychological resilience,” she told the group.

Dr Britto advocated for early interventions as it becomes progressively hard to fix the problems by the age of seven because “if a child’s brain does not get what it needs to develop during that period, the amount of effort required to set it back on track is enormous and optimal outcomes are far less likely.”

She shared the new frontier of epigenetics and how it’s demonstrating that the way children are parented and cared for the in the first years of their lives can affect brain function for the rest of their lives and even future generations. According to Dr Britto, adequate nutrition and sustained supportive adult caregiving are the best ways to offset the effects of multiple e adversity and to support healthy brain development.

So why does this matter so much to children born into HIV-affected households? We know that the impact of ill caregivers and economic stress in the household can mean that children don’t have consistent caregivers, may be poorly nourished and, according to research by Lucie Cluver in South Africa, may be up to three times more likely to experience abuse living in an affected household.

We need health workers, funders, governments to understand child development and how HIV is impacting on this development from pregnancy and the early years of a child’s life.

Treatment alone will not address the multiple and clustered impacts of HIV in young children. We need to ensure that care, protection and support are integral to the HIV response for children and can address the increased risk of abuse , mental health impacts and support parenting and the economic strength of families. And above all, we need to share this knowledge with communities, and with affected families.

The author Kate Iorpenda is Senior Advisor on HIV and children at the International HIV/AIDS Alliance and Chair of The Coalition for Children Affected by AIDS.