NAIROBI, 1 December 2009 (PlusNews) - Phoebe Rajula is grateful
that she and her daughter have access to life-prolonging
antiretroviral medication, but the frequent trips to Mbagathi
District Hospital in the capital, Nairobi, for their medication
take a toll on her meagre finances and her energy levels.
"You cannot be given many drugs for the child because they are
difficult to keep; I come from very far and I just walk to this
place because I have no money to take a matatu [public
transportation]," she told IRIN/PlusNews. "But at times when I
feel like giving up, the desire to see her alive makes me force
my tired legs to carry on. To me it is a journey of life."
Rajula has benefited from a regional expansion in the number of
children receiving ARVs. According to Children and AIDS: The
Fourth Stocktaking Report, 2009, released by the UN Children's
Fund (UNICEF), UNAIDS and the UN World Health Organization on 30
November, the numbers jumped from 158,000 in 2007 to 225,000 in
2008. During the same period, 45 percent of pregnant mothers in
sub-Saharan Africa received antiretroviral treatment to prevent
infection in their unborn children, up from 35 percent in 2007.
The report noted, however, that the progress had been uneven,
with inequalities in access and service coverage.
"There are a combination of factors that have contributed to the
scenario where not many children are on treatment, ranging from
stigma, both from parents and the community, [to] complicated
formulations of drugs and inadequate training of healthcare
workers on paediatric antiretroviral therapy," said David
Alnwick, UNICEF's regional adviser for HIV/AIDS. "It is also very
difficult to diagnose HIV in children and it is far more
expensive for many countries."
According to Juliane Kippenberg, a senior researcher with Human
Rights Watch (HRW), although treatment for children is free in
most countries in the region, it is mostly offered in high-level
facilities that are not easily accessible, meaning high transport
"There is a need to link health facilities to communities to
ensure support and follow-up for children already on treatment so
that they do not drop out and miss the opportunity to live," she
said. "This is where community health workers come in handy; even
if you increase availability of drugs, without tackling obstacles
to access the increase will not necessarily translate into high
Lack of access to drugs is not the only problem children living
with HIV face; without psychological support, they and their
parents suffer emotional turmoil. Shadrack Mutisya, who lives in
Nairobi, took his daughter out of school because of the incessant
bullying she faced when her fellow students learned she was
"When she joined the school, I shared with the teachers her
condition because I thought that would help, but the teacher
ended up telling other pupils thinking he was helping by letting
them know," he said. "They started teasing her, telling her she
is a loose girl and that is why she got the disease; to these
children, people only get HIV from sex, and they associated this
young girl with prostitution."
According to UNICEF's Alnwick, involving communities and families
in psycho-social support for HIV-positive children would go some
way toward reducing stigma levels. Parents, for instance, need
help in understanding how best to disclose their children's
status to them.
"Many parents still fear having their children tested for HIV
because they believe if a child is positive, then it is most
likely they too are positive," said Irene Mukui, ART programme
manager at Kenya's National AIDS and Sexually Transmitted
Infection Control Programme.
"When children are kept in the dark, it violates their rights to
know and there should be ways that disclosure can be [made] so
that they do not [grow] into adulthood with guilt," HRW's
According to Alnwick, it will be important for countries in
Africa to follow the lead set by success stories such as Rwanda,
which, has achieved higher numbers of children on ARVs by
scaling-up healthcare information systems and training large
numbers of health workers. He stressed, however, that the key to
fewer paediatric infections would be to ensure that more women
received prevention of mother-to-child transmission (PTMCT)
"While it is good to focus on offering treatment to children,
strengthening PMTCT programmes will ensure fewer paediatric
infections and ease the provision of paediatric ART," he said.