Starting Early, Starting Now

August 12, 2014

Starting early with the right interventions at the right time lays the foundation for children to thrive, and saves money in the long run. In this way, the effects of HIV are mitigated early. The 5th symposium on children and HIV Start Early Start Now was one of several key pre-conferences to act as a curtain raiser to the 20th International AIDS Conference. The symposium pled to invest in the early years of children born into HIV-affected families.

By Kate Iorpenda

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.

700-1000 new synaptic connections per second

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.

Hard to fix the problems by the age of seven

Dr Britto advocated for early interventions as it becomes progressively hard to fix the problems by the age of seven. “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.”

Start Early Start Now panel 

Adequate caregiving supports healthy brain development

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 adversity and to support healthy brain development.

Why this matters so much to children born into HIV-affected households

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.

Ensure integration of care, protection and support to the HIV response for children

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.

Hosted by the Coalition for children affected by AIDS and the Teresa group, the two day Start Early Start Now  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 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.

Further reading:
The Melbourne Statement on young children born into HIV-affected families
New implementers’ brochure to improve our response to the youngest children: Now more than ever! A need to reach the youngest children affected by HIV and AIDS 
Special issue of the peer-reviewd journal AIDS called “Children born into families affected by HIV”.  Co-edited by Professor Linda Richter and Dr. Lynne Mofenson

This article has appeared in the STOP AIDS NOW! Children and AIDS e-news August 2014