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Children may be affected by HIV/AIDS in numerous ways. When parents fall ill from HIVrelated infections, household income falls or is diverted to medical expenses, food insecurity increases and children may have to drop out of school to take on care responsibilities. When parents die, children are orphaned and, besides coping with grief at the loss of their mother or father, they face new care arrangements which may involve separation from siblings and migration to a new location. Most of the children who are orphaned and made vulnerable by HIV/AIDS live in sub-Saharan Africa. UNAIDS (2010, p. 180) estimates that 67.6 percent of people living with HIV globally are found in sub-Saharan Africa, but nearly 90 percent of all children orphaned by AIDS 12.1 million children live in sub-Saharan Africa (UNAIDS, 2010, p. 186). Children may be infected with HIV through mother to child transmission (MTCT) during pregnancy, at birth or through breast milk. Such paediatric AIDS is increasingly being discovered and treated through programmes to prevent MTCT (PMTCT). Adolescents may be living with HIV: they may have been infected by MTCT and survived through childhood or they may have been infected through sexual intercourse, sadly often through being raped. UNICEF et al. (2010, p. 15) call this a “hidden epidemic” because many adolescents living with HIV do not know they are infected, they have never been tested and do not access treatment. UNICEF et al. (2010, p. 41) estimate that in 2009 92 percent of children (under the age of 15) who were living with HIV were in sub-Saharan Africa (nearly 2 million children) and 70 percent of these were found in East and southern Africa. In sub-Saharan Africa in 2009 only 26 percent of children deemed to require antiretroviral treatment (ART) were estimated to receive it (UNICEF, et al., 2010, p. 41). Sub-Saharan Africa clearly bears a disproportionate burden when it comes to the effects of HIV/AIDS, particularly on children. This chapter gives an overview of the impact of HIV/AIDS on the well-being of affected and infected children, and reviews the responses at community, national and international levels.

Growing Up in the Era of AIDS: The Well-Being of Children Affected and Infected by HIV/AIDS in Sub-Saharan Africa