This report examines data on progress, emerging evidence, and current knowledge and practice for children as they relate to the ‘Four Ps’: preventing mother-to-child transmission of HIV; providing paediatric HIV care and treatment; preventing infection among adolescents and young people; and protecting and supporting children affected by HIV and AIDS. It provides the child-specific statistics and analysis, and calls for several focused, concrete, achievable actions that can significantly improve prospects for children and women and help nations move towards their goals. This third report since the effort was launched in 2005 is a co-publication of the United Nations Children's Fund (UNICEF), the Joint United Nations Programme on HIV/AID (UNAIDS), the World Health Organization (WHO), and the United Nation Population Fund (UNFPA).

To address children affected and infected by HIV and AIDS, this document recommends determining which children are vulnerable to HIV and AIDS; which children are affected by the epidemic and what impact it has on them; how to reach children affected by AIDS; how to prevent them from getting infected with HIV and how to treat them; how to care for their mothers and how to support them when their mothers or fathers have died; and how to help all children grow safely and develop into adulthood. It examines areas of improved support for children and those in need of better strategies and more attention, including:

• encouraging governments to invest in social protection in the form of safety nets for families, communities, and particularly children affected by HIV, including direct assistance for people living with HIV;
• giving focused assistance to adolescents and maintaining antiretroviral therapy access during periods of upheaval;
• providing counselling and services for the prevention of mother-to-child transmission and paediatric HIV testing and antiretroviral treatment of infants at 6 weeks of age and older; and
• providing programmes for youth that address life skills, HIV and AIDS, and essential service, particularly in Sub-Saharan Africa and particularly where girls are vulnerable.

Among the document's recommendations are the following:

• Scale up programmes that provide early diagnosis of infants exposed to HIV and treatment of children who are infected. There is a need to develop and use innovative mechanisms such as mobile phones to reach families in a timely manner when test results are positive.
• Expand access to antiretroviral drugs for pregnant women in need of treatment.
• Integrate HIV and AIDS services with primary health-care programmes within existing health infrastructure for antiretroviral treatment sites and maternal, neonatal and child health (MNCH) care services.
• Accelerate efforts to support optimal and safe infant and young child feeding practices. The quality of counselling provided by health-care providers and lay counsellors as it relates to infant feeding and HIV in many countries will need to be improved in line with new evidence on infant feeding and AIDS-related mortality and in light of the global food crisis. Counsellors will need to be re-trained to be able to provide clear guidance on infant feeding options, including exclusive breastfeeding and appropriate weaning foods. Programmes should engage communities in promoting safe feeding practices and supporting mothers’ choices, and policies should facilitate the exercise of appropriate infant feeding options depending on individual circumstances.
• Make prevention programmes more relevant to the needs of adolescents and young people. Prevention approaches must respond to evidence and understanding of the epidemic in different contexts and be tailored to the specific needs of adolescents and young people. Prevention policies and programmes focused on adolescents and young people engaging in high risk behaviours are a critical priority. A supportive policy environment will facilitate the work of the education sector in adapting and updating life skills-based programmes in schools, especially where their content covers potentially sensitive issues. National strategic plans with a focus on HIV prevention should include clear targets and mechanisms for monitoring progress. Evaluation is needed, as well, to assess the impact of HIV prevention efforts through the mass media, sports, and celebrity involvement.
• Combine prevention strategies for a more effective response. To be effective, HIV prevention programmes must combine information, life skills, and behavioural change activities with actions to address the social issues that make adolescents and young people vulnerable to HIV and lead them to engage in risky behaviours. Although male circumcision has been shown to contribute to reducing HIV risk among men, it should be seen as an additional strategy rather than as a substitute for current prevention measures such as condom use, reduction in number of partners, and delay of sexual activity.
• Understand and address the greater vulnerability of girls. Along with working to change individual behaviour, national governments and partners must openly address the social and cultural factors driving the particular vulnerability of girls, such as concurrent partnerships, intergenerational sex, transactional sex, and violence against women and girls. Being in school reduces the risk of HIV infection among girls, so efforts to keep girls in school until secondary-school graduation must be intensified.
• Prioritise the collection and disaggregation of high-quality data.
• Invest in the social sector to improve protection of the most vulnerable children.

Email from Catherine Langevin-Falcon to The Communication Initiative on December 1 2008.