Since April 2014, Swedish medical doctor Ann Sellberg has worked with pediatric HIV patients at the Doctors Without Borders/ Médecins Sans Frontières (MSF) clinic in Epworth, Zimbabwe. All of Ann’s patients are under twenty years old. Many are orphans and have suffered stigma from their community—or even family—because they are HIV positive. Support groups help these young people to reclaim their dignity. Here, Ann remembers a particular patient at the clinic.
The psychologist and I had prepared questions and a tape recorder, and engaged a peer counselor (also HIV positive) for translation. We were doing focus group discussions with the HIV positive teens, and the first interview, the one with the children under twelve, I would do on my own. I was nervous and excited. This was my first chance to really talk to our patients.
We were recruiting the children from the HIV-positive adolescent support group. I was with the little ones, and after about an hour of play I asked the peer counselor to ask if any of them were interested in participating in the focus group. To my disappointment, only one girl raised her hand. I asked the counselor to insist, but she explained to me that the rest were quite happy and wanted to go out and play football. The counselor and I took the girl to one of our open-air shades and I brought out the tape recorder.
“Chiri sei?” How are you?
“Chiri bvo.” I’m fine.
“Makore mangani?” How old are you?
“Ndine." Eleven years.
She was pretty, with a square face and a sweet smile, but what struck me was her gaze. It was clear and awake, and filled with knowing. Those were not happy eyes.
“How do you like coming to the support group?”
The girl answered in Shona, directing herself to the counselor.
“She says it makes her happy,” the counselor said. “She always looks forward to coming here.”
“What do you like about it?”
I was curious, as the girl answered at length. She had struck me as a shy girl, but her voice was clear, without hesitation.
“She likes being around the other kids, she doesn’t remember about the past, the bad memories doesn’t come up. She also forgets about her experiences at home.”
This answer made me concerned, and I asked about her family situation. Not surprisingly, she lived with her mom, her step-dad, and three step-siblings. Her dad and two older siblings had died when she was very young. I wanted to go further into this, but we had prepared a long list of questions that I needed to get through.
“When did you find out that you had HIV?”
“When she was eight she came here to the clinic with her mother. She had sores all over her body. After that she got tested and her mother told her that she was HIV positive but that she must not tell anyone because it wouldn’t be good for her.”
“How did you feel about that?”
“She says it was painful, she was hurt. She asked her mom, 'How did it come into me? How did this happen?’ but her mom wasn’t in the right space to answer, she couldn’t say anything.”
“Does anyone else know?”
“She’s saying that her aunt knows, but she’s not allowed to talk about it with her step-father or her siblings. The church and the community don’t know about it either.”
“Are you ever treated differently than other children?”
“At her aunt’s place she is treated like any other kid, but at home, whenever the little ones gets gifts she never gets gifts.”
The girl must have understood some English, because when the counselor translated her words she put a hand to her face and started crying.
“Oh come here,” I said, indicating the space next to me. She edged closer and I put an arm around her. She kept crying for a while, her face hidden in her hands.
“Are there any other ways that you feel that you are treated differently?”
“When her step-father comes home from work, she welcomes him, but he doesn’t give any sign of seeing her. But when her sister Julie says 'You’re welcome,' there’s welcoming, there’s warm feelings, and when the other siblings get money for school items, small amounts, this one doesn’t get anything.”
The counselor was holding the girl’s hand and I could see how much she was feeling with her.
“And how does that make you feel?”
“She says she doesn’t do anything, but sometimes she asks her sister for money, just a few Rands, but she always refuses to give it to her.”
“Have you ever told anyone about this before?”
She shook her head.
“How does it feel to talk about it?”
“She says it makes her feel better.”
In 2014, in Epworth, 165 HIV-positive patients under the age of 20 have been initiated on antiretroviral therapy (ART). To date, only 8 percent of the cohort is under 15 years of age.
Epworth is a semi-urban area located just outside the capital city of Harare. The majority of the population is believed to live below the poverty line. Here, just below 20 percent of the population is HIV-positive, which is higher than reported at the national level (15 percent). In the coming months the MSF team will advocate to increase access to HIV testing and ART for children and adolescents.