Background: There are an estimated half-million children living with HIV in sub-Saharan Africa. The predominant source of
infection is presumed to be perinatal mother-to-child transmission, but general population data about paediatric HIV are
sparse. We characterise the epidemiology of HIV in children in sub-Saharan Africa by describing the prevalence, possible
source of infection, and effects of paediatric HIV in a southern African population.
Methods: From 2009 to 2011, we conducted a household-based survey of 3389 children (aged 2–14 years) in Manicaland,
eastern Zimbabwe (response rate: 73.5%). Data about socio-demographic correlates of HIV, risk factors for infection, and
effects on child health were analysed using multi-variable logistic regression. To assess the plausibility of mother-to-child
transmission, child HIV infection was linked to maternal survival and HIV status using data from a 12-year adult HIV cohort.
Results: HIV prevalence was (2.2%, 95% CI: 1.6–2.8%) and did not differ significantly by sex, socio-economic status, location,
religion, or child age. Infected children were more likely to be underweight (19.6% versus 10.0%, p = 0.03) or stunted (39.1%
versus 30.6%, p = 0.04) but did not report poorer physical or psychological ill-health. Where maternal data were available,
reported mothers of 61/62 HIV-positive children were deceased or HIV-positive. Risk factors for other sources of infection
were not associated with child HIV infection, including blood transfusion, vaccinations, caring for a sick relative, and sexual
abuse. The observed flat age-pattern of HIV prevalence was consistent with UNAIDS estimates which assumes perinatal
mother-to-child transmission, although modelled prevalence was higher than observed prevalence. Only 19/73 HIV-positive
children (26.0%) were diagnosed, but, of these, 17 were on antiretroviral therapy.
Conclusions: Childhood HIV infection likely arises predominantly from mother-to-child transmission and is associated with
poorer physical development. Overall antiretroviral therapy uptake was low, with the primary barrier to treatment
appearing to be lack of diagnosis