Only one in 20 of the HIV-infected children worldwide who need life-prolonging drugs gets them. Only one out of 100 gets a cheap antibiotic that can nearly halve death rates from secondary infections like diarrhea and malaria. Less than one in 10 mothers infected with the HIV virus are given drugs that can stop transmission to their babies.
Every minute of every day a child dies of an AIDS-related illness.
Ten agencies of the UN, including the UN Children's Fund and UNAIDS, announced a campaign on Tuesday to raise the profile of children with HIV/AIDS, firing off text messages to millions of cellphone users in Africa to spread the word.
"Twenty-five years into the pandemic, this very visible disease continues to have an invisible face, a missing face, a child's face," said UNICEF's executive director, Ann Veneman.
The UN effort on behalf of HIV-infected children reflects the broadening scope of efforts to tackle AIDS, said Peter Piot, head of UNAIDS. Early on, when money was scarce, public health efforts focused on prostitutes who were at highest risk of spreading the disease.
Also, he said, as the pandemic matures, the necessity of helping growing multitudes of children orphaned by AIDS becomes ever more pressing. Fifteen million children have now lost one or both parents to AIDS.
There are simple, inexpensive steps that can make a difference quickly, said Peter McDermott, chief of HIV/AIDS programs for UNICEF. For example, 4 million HIV-infected children need the widely available antibiotic cotrimoxazole, but only 1 percent get it. For about US$10 a year, it can help halve deaths of HIV-infected children who are vulnerable to malaria, diarrhea and other secondary infections because of their weakened immune systems.
But there is also a need for intensified research to develop simpler, cheaper tests to diagnose AIDS in babies and young children and combination drugs to treat children with AIDS that are easy and cheap to administer in syrup forms. Syrups are available, but they are expensive compared with adult medicines, difficult to handle and bad-tasting.
Research to help children infected with HIV has received less attention than that for adults, in part because children are a smaller market. In rich countries, HIV infections in children have almost been eliminated. Most of the 40 million people infected with HIV are adults, though children under 15 account for one in six AIDS-related deaths globally.
Also, Piot noted, clinical trials of drugs for children are ethically complicated to operate.
"How do you get informed consent for three-year-olds?" he asked.
Adults are now more than three times more likely to get drug treatment for AIDS than are children, according to UNICEF. An estimated 660,000 children need the drugs.
Cipla, the Indian manufacturer of generic drugs, has a triple drug cocktail for children in trials in Zambia. The goal is to win a stamp of approval from the WHO.
The treatment combines three medicines, each patented by a different multinational corporation, into one tablet that can be dissolved in water and given to children twice a day.
"It's very cheap," said Yusef Hamied, Cipla's chief executive officer. "It will cost less than US$10 per child per month."
Pamela Barnes, the chief operating officer of the Washington-based Elizabeth Glaser Pediatric AIDS Foundation, noted that even a simplified drug regimen like the one Cipla is testing has the disadvantage of requiring the addition of water -- a problem in countries where water quality is low and water often carries disease. Syrups are safer.