- Many children who are living with HIV have a poor response to treatment because they take anti-retroviral medication that are not correctly dosed or bitter to taste.
“How’s your grandson?” a nurse asks her at the clinic.
The elderly woman from Kosewe, Homa Bay County, does not have a simple answer. She shakes her head in tears. “We’re back in hospital. I’m overwhelmed and I don’t know what to do,” she says in a whisper.
“I thought I have been following all the doctors’ instructions. He’s getting worse every day.”
Her grandson is HIV positive. The fear of losing him is weighing down on her. “Please do everything possible to ensure he is back to his normal self,” requests the caregiver of the four-year-old.
The woman’s story is all too familiar. Many parents and caregivers raising children with HIV face the same challenges.
When you think about children’s medicine, a sweet syrup or a flavoured tablet comes to mind. However, for children with HIV this is not always the case.
According to a 2019 United Nations Children’s Fund (UNICEF) HIV report, The number of people living with HIV in Tanzania increased from 1.3 million in 2010 to 1.7 million in 2019, whereas 93,000 children aged 0 to 14 are affected by it.
The report further says there are 5,900 HIV/Aids related deaths among children aged 0–14 years.
According to Lifelight Foundation’s Dr Godlove Godwin, HIV can be quite brutal to children aged 0 to 14 compared to adults because of how different they are taken care of when they contact HIV.
“From being infants to being born, children care package is not the same as for the adults. When we are aware of the mother’s HIV status, it helps to protect the infant at the early stages until the mother gives birth. This is scientifically called Prevention of mother-to-child transmission (PMTCT) programs, which offer a range of services for women of reproductive age living with or at risk of HIV to maintain their health and stop their infants from acquiring HIV,” explains Dr Godwin.
According to the UNICEF report The percentage of pregnant women enrolled in prevention of mother-to-child transmission (PMTCT) services reached 92 per cent in 2019. However, poor retention rates among pregnant and lactating mothers (67 per cent and 83 per cent respectively) remain a challenge, contributing towards the mother-to-child HIV infection rate of 11 per cent in 2019 against the global target of 5 per cent.
The experts adds that there are stages that have to be followed to ensure safe delivery meaning to prevent the child to not contact HIV during birth, and when the child is already infected, drugs that will be taken timely will be administered right away by a doctor.
HIV contraction in children
Children who live with HIV may have contracted the disease during birth, from being breastfed or during pregnancy when the mother is affected by sexually transmitted diseases, which ease transmission of diseases through the placenta, explains Dr Godwin
“In all clinics, every pregnant woman must be firstly tested for, to know if her child would need protection from HIV. Most of the children who end up affected by HIV are a result of the mother being affected by sexually transmitted diseases including gonorrhea, chlamydia and others,” pointed out Dr Godwin
Adding that sometimes a child may get affected by HIV as a result of the laziness of the person in charge of assisting when the mother gives birth.
Dr Godwin revealed that doctors draw blood for testing from the infants’ feet right after they are born, another blood test is done a month later that would permit to continue or end HIV drug use continuation,” says Dr Godwin. The dosage is normally stopped immediately after results show the infant is HIV negative.
Dr Godwin emphasised that many children could be saved from contracting HIV but lack of enough knowledge among the affected pregnant women has highly led them to give birth to children who may get affected during breastfeeding.
Many children are infected while the mother is pregnant, at delivery or after delivery when the child is breastfeeding. Breastfeeding, especially in poor countries, is one of the best ways to improve infant survival, but is also an avenue for women to pass the Aids-causing virus on to their infants.
HIV symptoms in children
Dr Godwin explained HIV symptoms occur when the child’s parents or guardians have neglected their duties to administer dosage of HIV drugs timely to their child or when they are unaware of the child’s HIV status.
“Many symptoms prevail when the child’s self-immunity cannot hold after a long time without any prescribed drugs. These symptoms include poor brain and body growth, skin diseases, persistent diarrhoea, fever, fungal nail infections, herpes zoster, enlargement of parotid gland and pneumonia,” said Dr Godwin
He clarified that sometimes there are no direct symptoms that would hint the child’s HIV positive status without a blood test but every child is administered to HIV drugs when they are born until a test is done to prove they are HIV negative.
“This also goes for the adults, people would not be aware of neither their HIV status nor their children’s without testing,” said Dr Godwin.
He emphasised that children should never be tested at home, that includes self-testing HIV kits. “Testing children for HIV at home is not as friendly as people have normalised it. Self-testing kits are designed specifically for adults,” explained Dr Godwin
HIV treatment for children
An estimated 1.7 million children globally live with HIV, but only half receive any treatment and 100,000 die every year.
According to UNAIDS 2020 report on the global AIDS epidemic, at least 66 per cent of children living with HIV are on antiretroviral treatment in Tanzania in 2019, lagging behind the national target of achieving 90 per cent coverage by 2022.
Dr Godwin detailed that children have even fewer treatment options compared to adults.
“Children are usually prescribed watery Antiretroviral Drugs (ARVs), which they take until when they are able to swallow tablets,” said Dr Godwin.
He said parents and guardians following up on the tablets intake by children determine the child’s medical condition.
Dr Godwin added that ARVs are not sold like others over-the-counter medications, in fact, they are available in every health centre countrywide for free.
“Most centres give out ARVs freely because it’s a disease which can be quite expensive if a price is set on it,” he says.
Many Tanzanians are unaware about transmission of HIV to children, while, it’s a disease that can be prevented but it affects every person including children as young as infants, explains the expert.
He reiterated that many of the affected children usually end up depressed or can act on suicidal thoughts due to lack of conversations between parents and children when they grow up.
“Many children living with HIV can be lied to about their conditions at the early stages but we encourage parents and guardians to frequently be open to them and converse to them about their health condition as it boosts their confidence and help children embrace and normalise their condition,” advised Dr Godwin.
According to him, Tanzania’s health systems are keen on children living with HIV as the government’s long-term plan is for every citizen to be aware of how children living with HIV should be cared for as this will help the children live a healthy and long life.
Dr Godwin pointed out that many health sectors are educating the public about HIV transmission to children through seminars, free testing and participating in HIV ceremonies including the world HIV day celebrated yearly on December 01.
World Health Organisation says to reduce HIV-related mortality and morbidity among this highly vulnerable population, early testing and treatment is essential. Without access to testing and treatment, 50 per cent of children with HIV will die by the age of 2, and 80 per cent will not live to their fifth birthday.
And Angela Oketch