Children and the fight against HIV in Zim

In fact, watching as the young man chats to some friends among the group of people gathered here at Parirenyatwa Group of Hospitals Opportunistic Infection Clinic to collect their monthly supplies of cotrimoxazole or the more powerful ARVs, one could be forgiven for thinking Johnson is only here accompanying a sick relative or friend.

One of more than 40 000 young children and teenagers in the country receiving cotrimoxazole, an antibiotic which delays AIDS-related illnesses in young people, Johnson should be top of any anti-HIV/AIDS campaigners wish-list a walking advert of how a positive attitude and adherence to treatment regimen are all that one requires to relegate HIV/AIDS to just another ailment.

Fit as a fiddle

I grew up sick. I was tested for HIV in 2007, when I was 15 years old and my results were positive, said Johnson, who stays with an aunt in Masasa Park suburb, east of Harare city centre.

I had counselling sessions with nurses and I accepted my status as they told me that it was something that I was born with. I was put on cotrimoxazole free of charge. I developed sores on my face and hands but after that all was fine. I am still taking the cotrimoxazole twice a day at 6.30 in the morning and evening, said Johnson who one can only describe as fit as a fiddle, to use the old clich.

According to the United Nations Childrens Fund (UNICEF) there are 105 740 young Zimbabweans living with HIV but only 45 692 are receiving cotrimoxazole, while the Health Ministry says at least 35 189 children in the country are in need of antiretroviral therapy (ART) but only 10 185 are on treatment.

Cotrimoxazole, a broad spectrum antibiotic which guards against opportunistic infections, is usually given to younger people whose CD4 cell count is above 200 while those with a CD4 cell count below 100 are put on ART. CD4 cells are a type of white blood cell that fights infection. Also known as T-helper cells their count helps indicate the stage of HIV or AIDS in a patient.

Caregiver

While the provision of cotrimoxazole has enabled young people like Johnson to have normal lives despite living with the virus, Ministry of Health permanent secretary Gerald Gwinji said stigma remained a major obstacle to efforts to extend the programme to more young people, with many families still reluctant to have their children tested for HIV.

As a result many children only got to know of their HIV-positive status quite at a late stage, often when they are already seriously sick with full-blown AIDS. In the worst cases some children have died before they could be put on anti-retroviral treatment, according to Gwinji.

In addition, he said, treatment programmes for minor children are often disrupted in cases where a child is moved from the custody of one caregiver to another.

Zimbabwe is one of the countries in the world with the highest number of HIV and AIDS orphans. Orphans are taken care of by caregivers who may not be knowledgeable of the childs condition, he said.

A local doctor specialising in pediatric ARV therapy at the University of Zimbabwes (UZ) medical school, who declined to be named for professional reasons, concurred with Gwinji, saying that whether an HIV-positive child gets cotrimoxazole or ART is often dependent on who is their caregiver.

In some cases orphans are put in the care of grandparents who may not have the resources to take children to hospital for testing and to collect drugs, while in other cases the elderly caregivers often fail to keep the strict treatment regimen a key requirement if therapy is to be successful, the UZ doctor said.

She said: Sometimes the child relies on grandparents who may not be able to provide for them adequately. Or the child is left with different caregivers, and the treatment is interrupted. Adherence is very important, as the child will develop resistance to the ARVs if doses are forgotten.

Early diagnosis

But on a more positive note, Gwinji said the government was on a programme to equip more public health centres across the country with technology and facilities to make early diagnosis of HIV from six-week-old babies so that children do not have to first become seriously ill before they can be put on treatment.

Presently only a limited number of health centres are able to test for HIV in babies younger than one year, a situation that has seen many sick children whose lives could have been saved with cotrimoxazole or ART dying because they were considered too young to be tested, said Gwinji.

Early diagnoses of HIV in babies will strengthen Zimbabwes efforts to combat the virus. The country through the National AIDS Council also runs a successful Prevention of Parent to Child Transmission (PPCT) programme that is credited with helping drastically reduce the HIV prevalence rate in children.

Under the programme expecting mothers are tested for HIV with those testing positive immediately put on Nevirapine treatment before they give birth to protect the child from being infected.

Infection rate

Introduction of PPCT programme has contributed to the decline of the prevalence rate in children as some of the children would receive early infant diagnosis, said NAC communications officer Orirando Manwere.

Zimbabwes efforts against HIV/AIDS have indeed paid off with the country only one of two sub-Saharan countries the other one being Uganda to be able to reverse HIV infections among its population. But the country remains one of the worst hit by the scourge which kills at least 3 000 Zimbabweans per week.

A decade of severe food shortages and unprecedented economic recession, critics blame on mismanagement by President Robert Mugabes previous government, has helped compound the HIV/AIDS pandemic in Zimbabwe.

A power-sharing government formed by Mugabe, Prime Minister Morgan Tsvangirai and Deputy Premier Mutambara has promised to rebuild the countrys economy and to restore public health and other basic services that had collapsed after years of neglect and under-funding.

But failure by the Harare administration to win direct financial support from major Western donor governments has hampered its reconstruction programme and in the long run could hurt plans to rebuild the public health sector that is key to any effort to combat HIV/AIDS and other diseases.