Global Push to Treat HIV Leaves Children Behind

The stories told by mothers gathered at Awend Health Center in western Kenya are a catalog of small failures, missed opportunities and devastating consequences. Children unite her 20 or so women who meet regularly on the wooden benches in the exposed clinic or under the trees in the courtyard. Everyone is infected with HIV.

It has been 20 years since sub-Saharan Africa began a major effort to prevent the transmission of HIV, the virus that causes AIDS, from mother to child during pregnancy and childbirth. However, approximately 130,000 babies are infected each year due to logistical problems such as shortages of medicines and more pernicious problems such as stigma that women are afraid to be tested and treated.

Many of the children infected with the virus then fail a second time. Efforts to get adults on HIV treatment have been very successful across the region, but many children are undetected and untreated.

According to UNAIDS, a United Nations programme, 76% of adults living with HIV in sub-Saharan Africa are on treatment.But only half of the children.

In 2021, the last year for which data are available, an estimated 99,000 children in sub-Saharan Africa died from AIDS-related causes. An additional 2.4 million children and adolescents are infected with the virus in the region, but just over half have been diagnosed. AIDS is the leading cause of death among adolescents in her 12 countries in East and South Africa.

Anulita Baines, Head of UNICEF’s Global HIV/AIDS Program, said: “But children aren’t going to spread HIV, so they’ve been deprioritized. They’re largely forgotten.”

She added: “Children with HIV are harder to spot than adults, have fewer tools to test and treat, and rely on caregivers for access to healthcare.”

In theory, preventing the transmission of HIV from a woman to her child during childbirth is relatively straightforward. National policies in all sub-Saharan African countries with high HIV prevalence stipulate that all pregnant women should be screened for the virus and those who test positive should begin treatment immediately. increase.

Women are to be tested again during labor to catch missed cases. If you test positive and have not been treated, you will be given drugs to stop the infection. Your baby should be given different medications for the first 6 weeks of life. In more than 90% of cases, children can be prevented from becoming infected with this protocol. Mothers on HIV treatment have a lower risk of infecting their children while breastfeeding.

But progress has plateaued in several countries over the past five years, and the Covid pandemic has led to disruptions in testing and drug supplies, clinic closures, staff shortages and a shift in focus to fighting AIDS. I pushed it further back.

“It’s so hard to be with a pregnant woman who’s about to give birth, without medication, and wondering if the child is positive.” I’m doing the same kind of counseling for a woman who was diagnosed as HIV-positive.

The stories of mothers at the Awend Clinic highlight the daily failures we see across our healthcare system. The clinic was out of scope. The clinic was out of drugs. One overworked nurse was too busy to deliver the amount of medicine the woman needed during labor.

“Prevention of mother-to-child transmission has made a lot of efforts to scale it up, but it’s not working as well as we should have,” said the director of medical services at the National Ministry of Health. said Dr. Andrew Malwa. in Nairobi.

Laurie Grade, UNICEF’s Nairobi-based Regional Advisor on HIV/AIDS, said that the problem here in Kenya and beyond is a combination of documented policies and the lack of government-funded and primary interventions such as Awend. He said it was the chasm between setting priorities and practicing in health centers.

“The intentions are good, but we don’t have the infrastructure, the resources, the training, the staff yet. Not the way we need it,” she said.

In Migori District, one of Kenya’s highest HIV prevalence areas, many public clinics have not tested pregnant women for HIV for several years. Depending on who you ask, this could be due to supply chain disruptions, disputes with donors, or poor planning by authorities. are taking antiretroviral drugs.

UNICEF’s Baines said countries need to double down on children. “We need to find, test and treat the children we missed,” she said. “To do this, we need resources, but we also need a robust health care system and capacity – nurses in clinics and community workers to support mothers.”

Political will is also needed to close the treatment gap for children, she added. We need to reach out and ask how it can be used to help.”

But as Joyce Achieng knows, even when medicine is available, it’s not always easy to take. When Achieng was pregnant with her first two children (now she’s 12 and she’s 10), she wasn’t tested for HIV.

But women in the region would be accused of adultery if they tested positive, Achien said, fearing they would beat her or throw her out of her home if she told her husband. .

Her husband was working in another part of the country at the time, so she was able to start HIV treatment and give her baby medicine after delivery. Her daughter tested negative for HIV when she was 2 years old. When the clinic encouraged her Ms. Achieng to bring her other children for testing, she was tested and found out they were negative as well.

A year later she was pregnant again, but this time her husband was at home. She could not always hide the medicines she needed for herself, her new baby, or another girl. (about $1) was hard to come up with. As such, neither she nor her baby were consistently on medication, and her infant tested positive for HIV at 6 weeks of age.

“I was crying all the time,” said Achieng. Her nurse, who broke her news, urged her to resume her treatment for herself and her daughter, but she was overwhelmed with her guilt and despair.

“I said, what good is it if I make my child sick?”

Eventually, some tenacious medical staff and volunteers helped her tell her husband that she had HIV and resume treatment. My daughter ran to my house and showed me a page where I had labeled and colored fruits and shapes. She chuckles softly as her brother puts her in her wheelbarrow.

Her daughter takes a pediatric formulation of a drug called dolutegravir. It is a highly effective antiretroviral drug and has recently become available as a strawberry flavored syrup. This saves parents from having to struggle to get their little ones to swallow pills every day.

“The new drug works wonders,” said Tom Kondiek, a pediatric clinical officer at Migori’s main public hospital. “When you start medsing children on their deathbed, they are so active that they don’t even realize they are suffering from HIV.”

But to start medicating them, health care workers must know that children have the virus. They may be brought to the clinic multiple times but never get tested either because the staff doesn’t think of children as young as 4 or 5 years old or because there are no tests available.

Even when individual women are diagnosed and tied to treatment, the health system too often doesn’t think about the family, said Grade. , are seen at 6 weeks of age for immunizations and nutritional screenings, but HIV testing is only included for babies known to have been exposed. You will not be able to see a doctor again until It is not standard practice to test every child, as the clinic did in her Ms. Achieng case.

Nancy Adhiambo, mother of five, learned she had HIV during her third pregnancy. She started her therapy, but she struggled to stay on her meds and was unable to consistently get them for her baby as she left a chaotic relationship and moved around. bottom.

The girl, now 8, had not been tested for HIV in years, despite frequent pneumonia as a child. Last year she found out that Ms. Adiambo lives down the street from the clinic in the town of Migori, and she joined a close-knit group of mothers to screen all the children and help her learned that the third child of was infected. She also had a one-year-old child, her last born (her two eldest sons and her fourth child were negative).

These days, her eldest daughter’s HIV is well under control, as is Adhiambo. Her face turned to a half-smile of delight when the clinic director congratulated her on her low virus count.

But when Adhiambo stopped at the pharmacy for children’s medicine, she heard the same answer she had been given for weeks. Free tablets were out of stock. Considering she earns at most a thousand shillings, about US$10 a month as a hairdresser, she couldn’t afford the pills sold in town, so she gave the rest of the pills away among her children. divided by

“Poverty complicates things,” she said bluntly. “We can only do our best.”