Many Ugandan parents are reluctant to have their children tested for HIV, hampering pediatric prevention, treatment, and care efforts in the East African nation, health experts say.

"Testing is still eluding us and stigma is still very high, said Dr. Zainab Akol, national program manager for Uganda's AIDS control program. "Also, parents do not know yet how to pass this information [that they are HIV-positive] to their children. That's why early diagnosis is still lagging behind." Ministry of Health data show 1.15 million Ugandans were living with HIV as of December 2008, including 88,919 children ages zero to 14. Of these children, 33,152 have CD4 counts that would indicate the need for antiretroviral treatment (ART). However, just 40 percent of severely immune-compromised children were receiving treatment by the end of September that year, mostly in urban areas.

In June 2008, the World Health Organization set guidelines calling for all children confirmed to be HIV-positive and under one year of age to be started on ART to reduce related morbidity and mortality rates. Without treatment and care, more than 80 percent of children with HIV die before reaching their second birthday.

"We have introduced 'Early Infant Diagnosis' with the hope that we catch the infection early and treat the children and also try to follow them up," said Akol.

Fear and guilt are the main reasons parents are reluctant to have their children tested, said psychologist Dr. Janet Nambi, head of the mental health and community psychology department at Makerere University. "Even when there are signs that the child may be HIV-positive, parents are reluctant to confirm that reality because that reality has consequences," she noted.

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