In this third decade of HIV/AIDS, the world community continues to stagger under the impacts of the pandemic, but no group carries a heavier burden than children. Worldwide, children affected by HIV/AIDS are disproportionately poor and malnourished. They are more likely to lack shelter, education, and health care. They are vulnerable to sexual abuse by adults. They are used for child labor in domestic or field work. In the developing world, as infants they may have acquired HIV infection from their mothers; if infected they typically die young, without access to life-prolonging treatment. In the United States and other developed countries, perinatal transmission has been dramatically reduced through the identification of HIV-infected pregnant women and administration of antiretrovirals during pregnancy and labor and after delivery.

Those who escape HIV infection, however, do not escape the impact of the disease. They may suffer the pain of the death of a parent. They may serve as caregivers to their ill parents – washing and feeding bedridden mothers or fathers – and often assume adult responsibilities for household maintenance. Older children may seek paid employment to support their family when no adult is well enough to work, and may raise their younger siblings in the place of their parents. When they are orphaned, they depend on the goodwill and resources of family, friends, or neighbors to take them in and care for them.