HIV testing and associated factors among children younger than 15 years in South Africa: Findings from the 2017 and 2022 HIV National population-based household surveys

In the global effort to end the AIDS epidemic, a critical piece of the puzzle remains incomplete: the health of children. While medical advances have made it possible to prevent mothers from passing the virus to their babies and to treat infected individuals effectively, many children still fall through the cracks. The first step in saving a child's life is knowing they are infected, which requires a simple blood test. Without this diagnosis, a child cannot receive the life-saving medication that keeps them healthy. In countries where the virus is widespread, public health officials rely on large-scale surveys to understand who is getting tested and who is being missed. These surveys act as a mirror, reflecting the real-world reach of medical programs and highlighting where the system is failing. The goal is not just to count cases, but to ensure that every child, regardless of their age or where they live, has the opportunity to know their status and receive care.

A recent study conducted in South Africa, a nation with the largest number of children living with HIV in the world, examined this exact challenge. Researchers analyzed data from two massive surveys, one taken in 2017 and another in 2022, to see if the situation for children under fifteen had improved. They looked at the records of over forty thousand children, asking caregivers and older children themselves whether they had ever been tested for the virus. The results show a story of slow progress mixed with stubborn gaps. Between 2017 and 2022, the percentage of children who had ever been tested for HIV rose from roughly thirty-seven percent to forty-one percent. While this increase is a positive sign, it means that more than half of all children in the country still have never been tested, leaving a vast number of them unaware of their health status.

The study revealed that the likelihood of a child being tested depends heavily on their age. The youngest children, those between zero and four years old, were the most likely to have been tested. This is largely because these children are often tested as part of routine programs designed to prevent mothers from passing the virus to their infants. However, as children grow older, the chances of them being tested drop significantly. By the time children reach their teenage years, the testing rates are much lower. The researchers found that older children are frequently missed by the standard medical systems that catch infants, creating a dangerous blind spot in the health network.

Where a child lives and who they are also plays a major role. Children living in rural areas, particularly in remote farming communities or tribal lands, were less likely to have been tested than those living in cities. Similarly, children from racial groups other than Black Africans were tested less often than their Black African peers. The study suggests this disparity may be because public health programs are more deeply integrated into government clinics, which serve the majority of the population, while private healthcare facilities, used by some other groups, do not offer testing as routinely. Furthermore, children who had not seen a doctor in the last six months were far less likely to have been tested, highlighting that regular contact with a healthcare provider is the most reliable way to ensure a child gets tested.

Interestingly, the data showed that children who were perceived by their caregivers to be in fair or poor health were more likely to have been tested than those considered healthy. This suggests that when a child is visibly sick, parents are more motivated to seek medical help, which leads to testing. However, this also implies that children who look healthy but might still be infected are being overlooked. The researchers noted that the improvements seen between the two surveys were driven mostly by better testing for infants, while the testing rates for older children, those in rural areas, and those using private healthcare remained stubbornly low.

The authors conclude that while the country has made strides, the current pace is not enough to meet international goals for ending AIDS in children by 2030. To close the gap, health services need to change how they reach older children and those in underserved areas. This means doctors and nurses must be more proactive, offering tests to every child who walks into a clinic, not just those who are sick or very young. It also requires extending these efforts into rural communities and ensuring that private healthcare providers are part of the solution. Without these targeted changes, a significant portion of the pediatric population will continue to be left behind, unaware of their status and unable to access the treatment that could save their lives.