The effect of maternal HIV on infant development is a major concern because the virus has become so widespread among women of childbearing age. According to a United Nations report published in October 2003, half the new cases of HIV infection that occur across the world each year are among 15–24 year olds.¹ This group, constituting two and a half million people, are the next generation of parents. The situation is particularly catastrophic in sub-Saharan Africa where widespread poverty and underdevelopment already undermine children’s health and wellbeing.² It is estimated that 10 million people in this region between the ages of 15 and 24, and up to 45% of pregnant women, are infected.³

With this recognition of the high prevalence of HIV in pregnant women in parts of sub-Saharan Africa, major efforts have been directed at developing and implementing interventions to prevent mother-to-child transmission. These efforts have been largely successful: antiretroviral medication, caesarean section, and locally appropriate feeding practice can now reduce transmission from 40% to below 10%.⁴ In sub-Saharan Africa these interventions are unfortunately not widely available, but nonetheless, it is still the minority of children who are infected.⁴

Orphaning is increasing in sub-Saharan Africa as rates of adult mortality have started to accelerate.⁵ However, by far the largest group of vulnerable young children are those living with an HIV infected mother. In sub-Saharan Africa approximately 70% of infected mothers survive for at least the first five years of their children’s lives,⁶ and this number will increase with the rollout of antiretroviral medication. It is known that the early years of life are crucial for a child’s development, and it is likely that maternal HIV disrupts the rearing environment, thereby putting these children at risk.

A key …