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The Scourge of Pediatric AIDS in Kenya
November 1, 2005
Accompanied by Waweru, an HIV counselor, a woman walks into a consultation room of the Doctors Without Borders/Médecins Sans Frontières (MSF) 'Blue House' clinic in Nairobi. She is carrying a child and looks weary. Her loosely tied headscarf looks as if it is about to fall off. She has her hands full with a traditional woven bag–a "kiondo"–hanging from her shoulder and her three-year-old son, Titus, all swaddled up on her arms. He has a fever and is wrapped in two pieces of cloth; one wool and the other a light cotton fabric, locally known as "lesso." He looks a lot bigger than his actual size.
He is living with HIV/AIDS and is already taking the antiretroviral (ARV) therapy, which slows the process of the disease and should allow him to live a normal life.
On asking Elizabeth how Titus is doing, she picks a paper bag out of the "kiondo." She pulls out Lamivudine and Zidovudine syrups, followed by a little plastic bag with big bright yellow Stocrin 200 mg capsules. She explains that the syrups are administered twice a day in equal amounts of 12.5ml each time. Titus also takes one capsule of Effavirenz daily as well.
This is never easy with a small child when living in a cramped one-room shack. The procedure is challenging, as it requires basic things such as clean water, which is not readily available in the slums. Children who are a little older than Titus are prescribed tablets, taken once daily. Mothers have to break a tablet into two for accuracy. Most children are unable to swallow the half tablet so it is crushed up and mixed into food, one half in the morning and the other at bedtime. The measurements need to be precise or the treatment will fail. And of course, as the child grows, the dosage also has to be constantly adjusted.
Elizabeth explains that Titus prefers to swallow the pill rather than break it open and mix it up due to the undesirable taste. But the capsules look enormous for the tiny child.
"Adults have to take only two pills a day and this has a clear positive effect on adherence," says Christine Genevier, MSF's head of mission in Kenya. "Children are denied the same luxury because an adapted treatment does not exist. Until they are big enough to cope with adult treatment they take a mixture of syrups and pills that are difficult to administer in the required precise dosage. It is more like the job of a chemist than a mother."
Offering Treatment Amidst Extreme Poverty
Like the vast majority of the 250,000 people in the Mathare slum who the Blue House serves, Elizabeth and Titus live on barely a dollar a day. The slum itself is made up of little mud walled rooms with roofs made of scrap metal, with all the houses tightly packed together. A huge number of the residents are unemployed and those that do work do so irregularly.
There are no roads, but rather narrow dirt walkways dotted with human waste. The few shared pit latrines are never cleaned due to inaccessibility to water. The entire slum is littered with dirty tattered plastic and paper waste. During the rainy season the dirt paths become virtually impassable. The air is characterized by an offensive smell. MSF offers free consultations as well as treatment. Otherwise, it would not be affordable for them.
More Children Infected Every Day
In Kenya, children continue to be born HIV positive. It seems a ridiculous statement given the overwhelming prevalence of AIDS in Africa, but this is specifically a developing world problem. In the west, the number of children born with the HIV/AIDS is very low due to the prevention of mother-to-child-transmission (MTCT) programs where HIV-positive mothers can receive treatment that will limit the chance of passing on the infection to their unborn children.
In Kenya, where there is not even an adapted diagnostic tool that exists for children below 18 months of age, the situation is catastrophic. Thirty-three percent of children with HIV- positive mothers are born themselves with the disease and 50 percent of suspected HIV- positive children are dead by the time they reach two years of age.
"Avoiding transmission is possible, but it requires a basic health-care system which many parts of Kenya lack," says Genevier. "Coupled with a lack of diagnostic tools, it is a deadly combination."
Even if a child avoids transmission during birth, the virus can be caught through breast-feeding and many mothers are too poor to buy substitute milk formula.
Lactating mothers who come to Blue House are fortunate; they get a supply of dry tinned milk until the baby is six months old. Above that age they are weaned onto 'unimix,' a compound of ground maize and soya beans, rich in mineral and vitamins.
MSF recommends that HIV-positive mothers avoid breastfeeding because their children could contract the virus through the breast milk. The chance of transmission is even greater when the child is being given food and breastfed at the same time. Micro lesions in the stomach caused by the change in diet may allow the virus to be transmitted. Whichever the method of transmission, AIDS is a terribly efficient killer of children
This is starkly clear to Elizabeth. She has horror in her eyes as she begins to recount how at six years old, her daughter had fallen sick and died. She never got to know the cause, but it is not hard to guess. Then she lost her second child at birth. Also cause unknown. "Titus is the only child I have now," she says, "I am hoping that he will get better." This is a phrase that she repeats several times as she speaks.
Overcoming the Stigma of HIV/AIDS
What is notable is that Elizabeth makes an effort not to speak of her own HIV status. Being afraid of HIV/AIDS testing is commonplace amongst women in Kenya and especially with those who are married for fear of being abandoned by their husbands who are the sole breadwinners. Consequently, the woman is left with no income but still caring for the children. More often than not, one or more of them will also be HIV positive. The mother has to juggle her time between seeking good health care for herself and her children, putting food on the table and working. It is a Herculean task.
Lack of Adapted Drugs Hampers Treatment
It is estimated that over 150,000 children are living with HIV/AIDS in Kenya. Currently, the Blue House clinic has a total of 450 pediatric patients. Of the total number, 158 are currently on ARVs. "The number may seem small," says Genevier, "but due to the extreme difficulty of care, these children are amongst the very few receiving treatment in Kenya."
In a strange way Titus is lucky. As well as receiving treatment, he has a mother and father to care for him. But unless the situation changes dramatically in terms of diagnostics and treatment, the vast majority of the children outside the MSF projects will not even reach 10 years of age.
As it stands now, children in the developing world are left to their fate.