Adoption and HIV, Part 1: Know the Facts

AfricaAIDsRibbonMany families are now choosing to adopt children who are HIV positive. The children can come from any country, but the majority of HIV positive children come from Africa.  About 3 million children in sub-Saharan Africa are infected with the HIV virus, and 90% of all children with HIV come from this region.

Because of parents dying from AIDS there are an estimated 25 million more children who are orphaned. [1] In Uganda, there are about 2 million orphans. Of those, 1.2 million have lost one or both parents to AIDS. [2] There are millions more who will become orphans.

In the U.S. and Western Europe, the incidence of HIV infection in children has been drastically reduced due to pregnant women taking what are called antiretroviral drugs, which lower the rate substantially of a mother’s passing on the infection to her unborn child.

Even in poorer countries, such as Uganda, this medication is available. However, many people, especially those in rural areas, do not have access to the medication.  Unlike children in Western countries, those in sub-Saharan Africa are much more likely to die from the infection. For these children who do become HIV infected, 50% will die before they reach their second birthday. In fact, the mortality rate due to HIV/AIDS in children under 5 years old has increased by 20-40%. [3]Most children become infected through mother-child transmission during pregnancy and birth. Furthermore, breastfeeding also greatly increases the risk transmitting the virus to the infant.  It is estimated that one-third to half of all HIV infection in children is transmitted through breast milk. For poor mothers without access to formula or the means to buy it (infant formula costs about the same in poor countries as it does here in the US), a mother is forced to breast-feed her child. A child who may not be HIV positive at birth can become so through breast milk. (Interestingly, babies who received both breast milk and other sources of nutrition had the highest rate of HIV infection [68%].[4])

Early diagnosis and treatment are essential if these children are to live and thrive. The best test to determine an n infant’s HIV status is called the real time Polymerase Chain Reaction (PCA), which detects HIV RNA in infants under 18 months old.[5] Children in Uganda being placed for adoption are tested using the PCA method to determine if they are HIV positive. It can properly diagnose the presence of the HIV virus in 90% of infants by the time they are 2 months old and 95% by 3-months old. [6] Because this test has a high rate of false positive (the patient does not have the HIV viruses  tests positive), adults are not recommended to take this test. Of course, some babies can test positive as well when they do not have the HIV virus. Normally adults are tested using the ELISA test, which tests for the antibodies (the organisms in the body which fight the virus). Infants whose mothers are HIV infected will test positive using the ELISA test because these children carry the antibodies –even if they are not infected with the HIV virus. For an easy to read article from RainbowKids on HIV testing.

Children who are diagnosed with the HIV virus tend to show one of two patterns: About 20% of children are very seriously ill during the first year of life and most die by the time they are 4-years old; the other 80% have a slower progression of the disease and may remain symptomless until they are 6 years old or even until they are teenagers. Children most at risk to develop serious symptoms are those with lowered CD4+ T cell levels and a higher viral load. [7]

Because HIV infection is so serious, and children and adults alike are more prone to other infections, keeping a child strong and healthy is very important. And because children do not have the same reserves as adults, good nutrition is especially important for them.  In poorer countries and in orphanages, where children oftentimes receive less than optimum nutrition, their bodies are further compromised and more prone to infection.

That is why in other countries, orphanages dedicated to the care of HIV positive children receive extra funding and attention so that the children can receive the extra medical and nutritional care that they need.


[1] Sharland, M., & Handforth, J. (2005, ). Paediatric HIV Infection. Medicine, 33(6), 28-29.

[2]  Eggertson, L. (2010, October 19, 2010). Caring for HIV/AIDs orphans in Uganda. Canadian Medical Association Journal, 182(15), 707-708. Retrieved from www.cmaj.ca Sept 15

[3] (2004, July). HIV infection in infants and Children. National Institute of Allergy and Infectious Dieseases, 6(1), 15-25. doi: 10.1300/J499v06n01_02

[4] (2004, July). HIV infection in infants and Children. National Institute of Allergy and Infectious Dieseases, 6(1), 15-25. doi: 10.1300/J499v06n01_02

[5] Chohan, B. H., Emery, S., Walnalwa, D., John-Stewart, G., Majwa, M., Ng ayo, M., … Overbaugh, J. (2011). Evaluation of a single round polymerase chain reaction assay using dried blood spots for diagnosis of HIV-1 infection in infants in African setting. BMC Pediatrics, 11(18), 1-8. Retrieved from http://www.biomedcentral.com11471-2431/11/18

[6]  (2004, July). HIV infection in infants and Children. National Institute of Allergy and Infectious Diseases, 6(1), 15-25. doi: 10.1300/J499v06n01_02

[7] (2004, July). HIV infection in infants and Children. National Institute of Allergy and Infectious Diseases, 6(1), 15-25. doi: 10.1300/J499v06n01_02

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