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Faith: “My greatest birthday present was my CD4 count reaching 500″

Monday, December 29th, 2008

August 2008 (PlusNews)

“Everything was okay until I went to boarding school”

KAMPALA, Faith is a member of the Ariel Children’s Club, a group for HIV-positive children supported by the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF). She talked to IRIN/PlusNews about the challenges of growing up with HIV.

“Before I knew about my HIV status I used to be very sick with skin rashes, on-and-off fevers, cough, and diarrhoea. In 2000, when I was nine years old, I tested and was told that I was HIV-positive. My CD4 count [which measures the strength of the immune system] at the time was only 39.

“By 10 years of age I had had seven hospital admissions for severe pneumonia; I had also had TB [tuberculosis] and meningitis. It was then that I was referred to Kampala-Mengo [Joint Clinical Research Centre] for further treatment.

“In 2001, I was started on antiretroviral (ARV) drugs. It was hard to get used to taking drugs daily; however, I was able to get back to school and study.

“Everything was okay until I went to boarding school [two years later]. There was a lot of stigma and discrimination, especially by the matron and some children, who made life impossible for me.

“Children ask questions: they ask about the skin rash, why I go to hospital. You sometimes tell them lies, but for how long can you lie? Not forever.

“I could not adhere [to my treatment regimen] because of fear of being seen taking the drugs. Timing was also difficult [ARVs have to taken at the same time every day]. During my second term I fell very sick, as I developed treatment failure [the virus became resistant to her medication].

“The drugs I was taking changed and now there were seven or eight tablets a day; they were difficult to swallow. In 2007 I changed to Alluvia [another ARV drug]. The drugs are smaller in size and easier to take.

“I thank those who are helping children, to give us life. The children’s support group [Ariel Children's Club] has helped me a lot in coping with stigma and adherence.

“Before I joined the group, apart from other people stigmatising me, I also used to have a lot of self-stigma because of what I have gone through.

“But in the club we learn many things: how to face challenges and get solutions, how to deal with stigma and discrimination at home, at school and in the community. We also have fun activities - we dance, play and laugh.

“I am also helping other children to cope with their HIV status and stigma. I use my personal experience to teach them about adherence; I emphasise the importance of taking drugs on time and according to doctor’s instructions.

“On 22nd July, on top of cutting a cake, I got the greatest birthday present ever: my CD4 count was 500 for the first time.”

This article is published according to the terms of use of The Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs.

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SOUTHERN AFRICA: Skipping class, skipping treatment

Monday, December 29th, 2008

Photo: Laura Lopez Gonzalez/IRIN

Increasingly, universities are moving to offer VCT services on campus. The University of Pretoria has been offering VCT to students and staff since 2005

JOHANNESBURG, 30 September 2008 (PlusNews) - Adjusting to college or university life can be rough – moving into residence, living with roommates, balancing academic demands with those of a social life. Now try taking your antiretroviral (ARV) medication without the whole world knowing you’re positive, and things get even more complicated. Disclosing to fellow students and lecturers can help, but is by no means a cure-all.

Treatment adherence, proper nutrition and treating opportunistic infections are all problematic in the campus environment, according to positive students who gathered in Johannesburg, South Africa, as part of the recent Imagined Futures III conference held by the Centre for the Study of AIDS to discuss the impact of HIV on college students in southern Africa.

Keeping up appearances

University is a pretty public place and when you’re trying to keep your antiretrovirals (ARVs) - and your status - under wraps, adherence can be rough.

“The taking of ARVs is usually done in secret but last December I had problems because one of my lectures was clashing with the time I take my medication,” said Bernard Kampolombo, the first student at the University of Zambia to go public with his positive HIV status.

An awkward timetable left Kampolombo with some serious choices: take his pills in class, drop the lecture, or come late. “In the end, my lecturer simply said, ‘If you come five minutes late, don’t dare come at all.’”

Living in a student residence can also be difficult: ”Let’s take a situation that you are in your room, your friends have come, and it’s time for you to take your drugs. If they sit there, you will not take the drugs,” he told IRIN/PlusNews.

Gift Mangwende, from the University of Zimbabwe, said the pressure he felt to keep both his treatment and his status secret led to missed doses and untreated opportunistic infections because he was too afraid to disclose to campus health workers.

While his health deteriorated, so did his relationships with classmates, as more friends meant a greater risk that someone would catch him in the act of taking his medication.

Finally, Mangwende said, his only hope was disclosure and he went public with his status in 2005. Both he and Kampolombo said being open about their condition paved the way to getting the support they needed from deans, teachers and peers, but many other students on southern Africa’s campuses may be falling through the cracks.

Mirroring society

ARVs are not offered at Zimbabwe’s universities, and low levels of testing among students mean those advocating for ARV clinics on campuses have few statistics to back their claims of a need for such centres, said Tayson Mudarikiri of Students And Youths Working on reproductive Health Action Team, also known as SAYWHAT Zimbabwe, a national organisation.

Universities are microcosms of societies. What’s going on in terms of sex, behaviour, access to services, power dynamics - all of that - is happening in our universities.

“Being HIV-positive equals wasting away and a painful death for many,” Mudarikiri said. “As such, an HIV-positive status is still a cause for stigma.”

In high-prevalence countries like Zimbabwe (about 15 percent) or South Africa (about 18 percent), it is unlikely that HIV is not a problem among students, but specific information on the level of HIV infection on campuses in southern Africa is almost non-existent.

South Africa has taken steps to bridge this gap. Earlier this year the country began one of the largest national HIV-prevalence studies ever undertaken, in which 25,000 randomly selected students and staff on more than 20 tertiary institutions will be tested.

Johan Maritz, a senior manager at the Centre for the Study of AIDS of the University of Pretoria, which has more than 50,000 students, said about 300 lined up at the voluntary testing and counselling (VCT) centre on the campus every month to be tested.

Although the exact numbers of students living with HIV remain elusive for the time being, Pierre Brouard, the centre’s deputy director, commented: “Universities are microcosms of societies. What’s going on in terms of sex, behaviour, access to services, power dynamics – all of that - is happening in our universities.”

This article is published according to the terms of use of The Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs.

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RWANDA: Aggressive campaign to protect mums and babies

Monday, December 29th, 2008

Photo: Keishamaza Rukikaire/IRIN

Béata Mukankundiye’s fifth child will be born at a health centre

KIGALI, 3 November 2008 (PlusNews) - While neighbouring countries struggle to get pregnant women to visit antenatal centres, women in Rwanda seem to be flocking to them.

Rwanda manages to reach 72 percent of pregnant women with HIV testing and counselling and other prevention of mother-to-child services (PMTCT), but fewer than 20 percent of Burundi’s health centres offer PMTCT services, while Kenya is reaching half its pregnant women.

In Uganda, 70 percent of women still give birth in their homes, assisted by non-medically trained traditional birth attendants (TBAs), compared to 40 percent in neighbouring Rwanda.

Between 1999, when the first PMTCT site was opened, and 2001, just over 11,000 Rwandan women were tested for HIV; by 2006 the number had grown to well over 200,000 annually.

Rwanda’s HIV prevalence rate is about three percent, but in urban areas it can be as high as seven percent. Experts have attributed the country’s success in combating HIV/AIDS to an energetic campaign to reduce the number of paediatric infections; the government is hoping to more than halve the number of babies born with HIV by 2012.

“PMTCT services are now based at all three healthcare levels: the national referral hospitals, district hospitals and health centres,” said Dr Martha Mukaminega, associate technical director of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), which has supported the government in providing PMTCT services to more than 100,000 women over the past seven years.

“The focus on eradicating paediatric HIV means that we have had to focus on prevention among adults, so that we reduce the probability of infant infection,” she said.

“We have also boosted the number of people on ART [antiretroviral therapy], because if people are on ART they are less likely to transmit the virus to sexual partners, and pregnant women to transmit it their unborn children … almost all areas of the HIV response affect paediatric HIV.”

Health centres are using routine opt-out HIV testing for all pregnant women, which offers the women the choice of being tested or not, and are actively encouraging men to accompany their wives on antenatal visits.

The country has also involved traditional birth attendants in their PMTCT campaign. At Nzige health centre, about 50km outside the Rwandan capital, Kigali, traditional birth attendants are taught to encourage women to visit the centre.

“Each village in our catchment area has two TBAs trained as community health workers; they accompany expectant mothers to the health centre for delivery, rather than helping them to deliver at home,” said Gaspard Maburanturo, who manages the Nzige centre.

EGPAF and the government give the TBAs allowances to facilitate their work and ensure that they do not lose income because more women are giving birth at health centres.

A growing number of men are also being tested along with their partners. Jean-Claude Gasana and Béata Mukankundiye, both 35, are now expecting their fifth child; this is the first time Mukankundiye has visited a health centre for antenatal care.

“My children have all been born at home, but this time we were told by community workers that we had to come for testing and I had to have the baby at the health centre,” she told IRIN/PlusNews.

Need for more thorough education

However, a staff member at the health centre, who preferred anonymity, noted that the PMTCT programme was being made routine to bring up the numbers, but the population was not being adequately informed of the advantages.

“Many people in the villages only come here because they are told to do so - no one takes the time to explain to them the benefits of the test or of giving birth at the health centre. Unless people understand the benefits, they will only come under pressure, not because they really understand the point,” he said.

“If you are HIV-positive a health centre delivery can protect your baby from infection, but I don’t know why one needs to deliver here if they are HIV-negative,” Mukankundiye said.

Staff at Nzige said post-natal HIV transmission during breastfeeding posed problems, but the biggest problem was widespread poverty among rural people, many of whom could not afford to eat a healthy diet, which often forced them to abandon their ART regimen.

This article is published according to the terms of use of The Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs.

Tags: antiretrovirals, arv
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Monday, December 29th, 2008

IN-DEPTH: AIDS and childhood in southern Africa

Photo: Eva-Lotta Jansson/IRIN

Lineo Makojoa, 15, from Ha Majoro Village in Lesotho cooks dinner for her grandparents and older brother. Her parents died of AIDS-related diseases

JOHANNESBURG, 27 June 2007 (PlusNews) - The term ‘AIDS orphan’ is misleading. It suggests the child itself is HIV-positive, which invariably is not the case, and perpetuates the stigma and discrimination experienced by AIDS-affected children.

The term ‘orphans and vulnerable children’ is now more commonly used to better express the devastating impact of the pandemic on households, even before parents die. The definition of an orphan is generally a child under the age of 18 who has lost either one or both parents (a double orphan). Surveys suggest the age of orphans is fairly consistent: around 50 percent are 10-14 years old; 35 percent are 5-9 years old, and 15 percent are 0-4 years old. Tragically, children who are HIV-positive do not survive long enough to make up a sizeable proportion of the numbers.

In Angola, Malawi and Zambia, the majority of orphans are found in urban centres; in Namibia, Zimbabwe, Botswana, Lesotho, Swaziland and South Africa, parentless children live mainly in the countryside, reflecting the migration of sick parents back to their villages to die.

Most orphans stay with their surviving parent, but women are much more likely to take on the responsibility of their own children as well as other orphans. Fathers are usually more prepared to look after orphaned sons than daughters, and grandparents are the safety net when all else fails.

AIDS impoverishes families, and female-headed households are the poorest of all. Productive assets like draught animals are often sold, so land under cultivation may drop, exacerbating the crisis.

Poverty makes it so much worse

Plummeting family incomes and the additional work expected of children reduce their chances of attending school, while anxiety over sick adults and the trauma of loss may mean they don’t do as well in class as their peers. “It is common for teachers to report that they find orphaned children daydreaming, coming to school infrequently, arriving at school unprepared and late, or being nonresponsive in the classroom,” a United States Congressional report commented.

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Photo: Greg Marinovich/South Photographs

Sixteen-year-old Sifiso Hlongwe irons his clothes for the funeral of his mother

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The psychological impact of a loss of a parent is heightened if siblings are separated when families share rearing duties. Parcelled out to new households, they may feel they do not receive enough love or attention. Girl children are at increased risk of sexual abuse, but are under pressure to remain silent because they have nowhere else to turn.

New research suggests that poverty is the over-riding factor that bedevils care of orphans and non-orphans alike. A study in South Africa’s KwaZulu-Natal Province, testing some of the commonly held assumptions about orphan welfare, found there was no significant difference in how the extended kin cared for children in a household, whether or not they had lost a biological parent.

According to Timothy Quinlan, research director of the University of KwaZulu-Natal’s Health Economics and HIV/AIDS Research Division: “The welfare of a child can be very bad just because the parents are poor.”

Studies on AIDS-affected children have tended to be anecdotal, often focusing on the perceived threat orphans pose to society as an angry and maladjusted generation. What psychosocial research is available suggests that children in AIDS-affected families exhibit more symptoms of depression, anxiety, psychosomatic reactions and post-traumatic stress disorder; they are more likely to have low self-esteem than display aggressive behaviour.

Poverty deepens their vulnerability: a rapid assessment in Zambia found a high proportion of orphans among child sex workers and street children. Child labour exploitation is another area of concern. The problem is not the threat parentless children pose to the community, but rather the dangers that societal neglect and discrimination pose to them.

What is to be done?

The Convention on the Rights of the Child recognises children as rights holders, and affirms that governments have the principal responsibility in ensuring that those rights are protected.

The United Nations Children’s Fund (UNICEF) has highlighted five priority areas to meet those goals:

• Strengthen the capacity of families - rather than institutions - to protect and care for orphans and other children made vulnerable by HIV and AIDS
• Mobilise and improve community-based responses
• Ensure access to essential services for orphans, particularly education
• Ensure that governments protect the most vulnerable children
• Raise awareness to create a supportive environment for affected children

All these remedial actions need to work alongside far broader access to antiretroviral drugs to keep parents alive for longer, and more effective prevention programmes to guard against HIV infection in the first place.

This article is published according to the terms of use of The Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs.

Tags: antiretrorviral, antiretroviral drugs, arv drugs
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MOZAMBIQUE: Property grabbing leaves orphans destitute

Monday, December 29th, 2008

Photo: Mercedes Sayagues/PlusNews

AIDS takes their parents, relatives often take their inheritance

CATANDICA, 27 December 2007 (PlusNews) - On a farm in the district of Bárue, in the central province of Manica, 16-year-old Helena Ivan hurries home with a small bundle on her head. After hours packaging potatoes, she’s allowed to take a few for herself and the two brothers she has been supporting since her parents died of AIDS-related diseases in 2005.

Of the possessions Ivan’s mother and father left – a kiosk, a house, a minibus and some goats – only the house was handed over to the children, and only because it had been registered in the name of the youngest child, Januário, who is now 12.

“My uncles took the rest. They said we weren’t old enough to take care of business, but they never come to leave us money to live on, and when we go to ask them for provisions they say they don’t have any money,” said Ivan.

According to a recent study by international nonprofit organisation, Save the Children conducted in four Mozambican districts, including Bárue, widows and orphans are often stripped of their belongings by family members. The goods taken are rarely recovered.

The country’s high AIDS-related mortality rate has made cases of disinheritance widespread. Government statistics reveal that 1.6 million of the more than 10 million Mozambicans under 18 years of age are orphans. Of this total, 380,000 are thought to have lost one or both parents to AIDS.

The study showed that the explosion in the number of orphans has caused a breakdown in family support structures that traditionally provided a safety net for widows and orphans.

Little knowledge of the law

Mozambique’s civil code and a 2004 family law stipulate that when someone dies, their children and spouse are the first in line to inherit any goods or property.

My uncles…said we weren’t old enough to take care of business, but they never come to leave us money to live on.

However, legitimate heirs rarely lodge criminal complaints when other relatives grab property because they fear retaliation or are simply unaware of their rights and of the institutions that can help them.

The study found that fewer than half of the 376 individuals interviewed in Bárue knew about the laws relating to inheritance.

The study also noted that, in Mozambique, as in nearly all of Africa, three systems simultaneously, and often conflictingly, regulate inheritance: written law, customary law and religious law.

According to customary law, in a patrilineal society such as that in Bárue, property and lineage are passed on through males. It is presumed that daughters and widows may marry again, in which case the inherited goods would no longer belong to the deceased’s family. As a result, men inherit the house, the land, the livestock and most of the money; women receive the kitchenware, clothing and any other lands or properties.

Polygamy, which is common in the four districts studied, is another complicating factor. A man may have three or more wives and many children. Generally, the first wife has more power and influence and may be the only one with a full knowledge of the husband’s goods.

A further problem is the fact that few people leave written wills. Eight out of 10 people interviewed in Bárue considered it normal for people to make only oral declarations regarding who should be given their possessions. However, only a written document holds weight in the eyes of the law.

In Catandica, the seat of the district of Bárue, youths from a local NGO, the Rukariro Association, visit patients suffering from AIDS-related illnesses to encourage them to make wills. They explain the advantages and how to write them, but the response has been slow.

“To make a will is a complicated process in the courts, which have to deal with cases of crimes and litigation,” explained the group’s coordinator, Alberto Mapondera. “This obliges them to go back to the court lots of times to acquire a will.”

High prevalence, scant assistance

With approximately 96,000 inhabitants, Bárue has an estimated HIV prevalence rate of 19.3 percent, higher than the national average of 16.2 percent.

“With more adults dying of AIDS, children are left without family protection and are vulnerable to child abuse, sexual exploitation and labour,” said Judas Massingue, an HIV and AIDS assistant at Save the Children-Norway in Manica.

Castigo Américo, 13, and Frederico Manuel, 16, were taken in by neighbours when they lost their parents. In exchange for sustenance, they stopped going to school and began working on farms and selling pastries at the Bárue market.

“I don’t know where the possessions that were in our house went. All I know is that the house is being rented out. My uncle never came to see me again. He was the one who asked me to stay at the neighbours’ house,” Manuel said.

“I stopped going to school because the woman I was living with said I should help out with the garden and sell in the market to contribute to the household income,” he added.

In Massingue’s view, “it is urgent for organisations providing assistance to orphans to be given legal knowledge in order to defend them.”

Since 2004, local NGO, Foro Mulher has been distributing a manual on inheritance rights and family law in local languages in order to guide community leaders on how to protect widows and orphans.

The good news from the study is that in some villages, traditional practices are adapting to take into account the law and the impact of the epidemic.

“Culture is dynamic […], and there are cases in which traditional leaders really do help children and women,” concluded the survey.

This is published according to the terms of use of The Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs.

Tags: children with aids, mozambique
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MOZAMBIQUE: “I am in the darkness” - AIDS orphan

Monday, December 29th, 2008

Photo: Alfredo Mueche/IRIN

Custodio Julio, 16, and his sister Edita, 5. Every day is a scramble for food

TETE, 15 March 2007 (PlusNews) - Laurita Fernando’s father left her just two mud huts and a badly tended maize field when he died. Once he was gone - after two months of suffering from AIDS-related symptoms - Laurita’s stepmother walked out of the family home.

Laurita, 14, and her sister, Sofia, 11, live in a rural community, in the Chiuta district of Tete Province in northwestern Mozambique.

HIV prevalence in the province is 17 percent, so AIDS has made its presence felt here. Free antiretroviral (ARV) therapy began in Tete last year, but HIV testing facilities opened in Chiuta just two months ago. Lack of awareness means stigma is a huge problem. The extended family has traditionally stepped in to help when kin hit hard times, but fear of AIDS has introduced a new arms-length approach by some relatives.

“I worked a lot with children traumatised by war,” said Maria dos Anjos Fabiao Borges, the Mozambique Red Cross’s lead HIV/AIDS officer in Tete. “We reintegrated them with family members and foster parents. But this is something else, this is discrimination.”

Heading a household is hard

The Fernando children have been largely abandoned by their relatives: instead of help, one uncle sent seven young cousins to live with the girls so they could be closer to the school they attended. He provides his children with food, but not Laurita and Sofia.

A child orphaned by AIDS has already weathered the sickness and then death of one or both parents, and may become the primary caregiver if the remaining parent also falls ill, as well as the effective guardian of any siblings.

Even with forewarning, dying parents often neglect to make provision for their children. In many cases, parents are too ill and weak to work their fields and food stocks fall short.

The mother of Custodio Julio, 16, died last July, after just two weeks of acute sickness. Not long afterwards he found his father collapsed in their maize field. Custodio became responsible for the care of three younger siblings.

Before worrying about their wellbeing, he had to pay for his father’s funeral. He sold the tin panels from the roof of his hut and borrowed money from friends. To pay the debts incurred by the funeral, he sold some of the family’s maize reserve; by January, his store was exhausted. “Some friends help, but not always,” he said.

For Custodio and other children heading households, every day is a new scramble for food. They may sell off their goats - often their only assets - for maize, the staple food; they may work day-jobs, which take them out of school; they may forage in the forest for greens and limit their meals to one per day.

In September 2006, the Mozambique Red Cross initiated a programme in Tete to help vulnerable children by supplying families stricken by AIDS with basic items, such as maizemeal, cooking oil and soap. Red Cross volunteers, chosen by community leaders, visit the children to help them cope with the emotional stress of a parent’s death and the practical realities of living without their mother or father, or both.

Only 1,400 children, including Custodio, are registered in the programme so far, but a lack of funding means only 400 children are actually receiving supplies. Custodio is not yet one of them.

No future plans

Alberto Silva Chassata was 16 when his father died, but he was able to stay in school. When he lost his mother in November 2006 he was 19, but he also lost his future because he was needed at home to care for his four younger brothers and sisters. His aunts and uncles did not answer his appeals for help.

Alberto was in tenth grade at a school about 100km from home when he heard the news of his mother’s death. Few students in Tete reach this level, and Alberto had hopes of going further. Now it is his job to keep his younger brothers and sisters in school, and fed. Three of them are being schooled elsewhere, and he regularly sends them food.

Like most other AIDS orphans, and the rest of the community in the area where he lives, Alberto has not been tested for HIV and neither have his siblings. “Sure they should,” he acknowledged, but it costs US$2 per person to take the bus to the health center and back.

Perhaps he thinks knowing would not make a difference in his life. “I am in the darkness,” he said. “I am alone.”

This is published according to the terms of use of The Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs.

Tags: aids, aids baby, aids orphan, hiv
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MOZAMBIQUE: Orphans getting caught in HIV cycle

Monday, December 29th, 2008

Photo: André Catueira/PlusNews

More than 380,000 children in Mozambique are thought to have lost their parents to AIDS-related illnesses

CHIMOIO, 19 December 2008 (PlusNews) - With her make-up touched up, a basin filled with seasoned chicken on her head and a bundle of sharpened bamboo sticks in her hand, Lucrécia*, 16, makes her way to an old petrol station near a major truck stop in Chimoio, capital of Mozambique’s central province of Manica.

“I sell appetisers to a lot of the people who come here to drink,” she told IRIN/PlusNews. “On the weekends it’s very busy, and I can earn a reasonable amount of money to help pay for household expenses.”

Lucrécia’s parents died of AIDS-related illnesses in 2005. Since then, she has cared for three younger siblings and her elderly grandmother. Her small business makes a monthly profit of about 1,650 Meticais (US$66), which has to pay for food, education and health care for the family.

“My business isn’t that profitable, but it was the only way I could find of surviving and not falling into the mistake of selling my body, which happens with other girls in my situation,” she said.

But night-time commerce comes with its own set of dangers, like a high rate of physical and sexual violence that can also place her at risk of HIV infection.

Survival schemes

After losing their parents, most children turn to domestic work, agricultural work or informal commerce to survive, often dropping out of school to earn an income and manage household chores.

Helena Muando, a psychologist and provincial director of the Department of Women and Social Action (DPMAS) in Manica, said orphaned girls were especially at risk of physical, psychological and sexual abuse, and were more susceptible to coercion.

Many had no choice but to go into commercial sex work or marry early, both of which increased their vulnerability to HIV.

Orphaned in 2003 when her parents died in a traffic accident, Erica*, 15, accepted a marriage proposal from a truck driver because she could find no other way of supporting herself and her grandmother.

She became pregnant and discovered she was HIV positive during a pre-natal check-up. “I haven’t seen [my husband] for more than four months,” she told IRIN/PlusNews. “He never called me or came to see me after he found out I was living with HIV.”

A vicious cycle

More than 380,000 of the estimated 1.6 million orphaned children in Mozambique are thought to have lost their parents to AIDS-related illnesses. The United Nations children’s fund, UNICEF, estimates that another 650,000 children will lose their parents to AIDS in the next two years.

HIV is part of a vicious cycle that ensnares many such children and teenagers because it takes away their parents, without whom they too become more vulnerable to the virus.

“We are very concerned about the percentage of orphans in Manica Province. The number has risen dramatically in the past few years, in most cases because of HIV and AIDS,” said Mozambique’s First Lady, Maria da Luz Guebuza.

Many orphans are integrated into extended or substitute families, but a recent study by Save the Children, an international organisation working to improve the lives of disadvantaged children, found that this was not always the best solution.

The study documented abuse suffered by some orphans, especially those living with adoptive families. Some of the children interviewed said they were given less food than others in the household, suffered physical abuse, were obliged to take on a heavy load of household chores, and were not always sent to school.

Social support

The government’s DPMAS, in cooperation with various NGOs, provides support to approximately half the 400,000 orphaned children and teenagers in Manica through income-generating programmes like raising livestock, informal commerce and building houses.

A rehabilitation centre built by the Messenger of God Church in Chimoio offers health care, play therapy, life skills training and psycho-social support to orphaned and vulnerable children.

Read more:
“I am in darkness” - AIDS orphan
Property grabbing leaves orphans destitute
IN-DEPTH: AIDS and childhood in southern Africa

The centre also provides assistance with birth registrations, which are essential to ensuring that the children’s rights, including their inheritance rights, are respected.

Guebuza stressed that “Support at the community level plays a fundamental role in assuring that children will receive necessary care, and that their rights will be respected.”

This is published according to the terms of use of The Integrated Regional Information Networks (IRIN), the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs.

Tags: aids orphans, orphans, ovc
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Monday, December 29th, 2008

UGANDA: Home births hamper PMTCT programme

Photo: Manoocher Deghati/IRIN

About 50,000 Ugandan children need ARVs, but only 10,000 have access to them

KAMPALA, 26 August 2008 (PlusNews) - The number of Ugandan children becoming infected with HIV during pregnancy, childbirth and breastfeeding remains high despite the government’s ongoing rollout of services to prevent mother-to-child HIV transmission (PMTCT).

The provision of antiretroviral (ARV) drugs to pregnant women living with HIV can reduce transmission of the virus to below two percent, yet 20,000 children in Uganda become infected with HIV annually, accounting for an estimated 42 percent of all new infections in the country, according to government figures.

“The large and growing unmet need for paediatric HIV/AIDS [services] demonstrates the failure of our PMTCT programmes to avert parent-to-child transmission of HIV,” said Keith McKenzie, country representative for the UN Children’s Fund (UNICEF).

Of 100,000 people currently on ARV treatment in Uganda, only 10,000 are children, the Ministry of Health notes. An additional 40,000 children are thought to be in need of the drugs, but only just over half of Uganda’s 310 ARV sites provide paediatric treatment.

The World Health Organisation recommends that every HIV-positive child under one year old should be put on treatment, but Uganda would need to start at least 20,000 children on ARVs every year to meet this target.

“If we prevent HIV infection in children then we do not have to take care of them when they are infected,” said Dr Phillipa Musoke, chairperson of the health department’s paediatric committee.

PMTCT programmes were first piloted in 2000 in the capital, Kampala, and in the northern districts of Arua and Gulu, but the services are now available at most county-level and district health centres in 76 of the country’s 83 districts.

Even in northern Uganda, where conflict has severely affected health services, an estimated 70 percent of women have access to PMTCT services. The ministry of health intends to scale up services to all county-level health centres by 2010.

Although most pregnant HIV-positive women in Uganda now have access to PMTCT services, between 60 percent and 70 percent of pregnant women still give birth at home, making it impossible to administer the ARV drugs that can prevent transmission to the mother and her new infant.

Dr Dennis Tindyebwa, technical director of the Elizabeth Glaser Paediatric AIDS Foundation, noted that 98 percent of pregnant women in Uganda agreed to HIV testing and counselling, but only 67 percent returned for their results; of those who tested HIV-positive, very few came to health facilities to have their babies.

“For some women it is the distance to the health centre, or the poor quality of services and personnel, as well as lack of infrastructure,” he said. “But there is also low male involvement in PMTCT, as the men deny their spouses the opportunity to participate in the programme.”

Studies have also shown that knowledge of the availability of services and correct infant feeding options after birth was still low. “Many women did not know that giving food or a drink to the breastfeeding baby of an HIV-positive mother was not allowed,” said Dr Deogratius Mugisa at the ministry of health in central Uganda’s Kayunga district.

“Cultural beliefs, social stigma, ignorance and economic status influenced the mother’s attitudes and preference for the different [feeding] alternatives.”

Uganda’s HIV prevalence declined from over 20 percent in the 1990s to about six percent in 2000, but has recently crept up again slightly. Dr David Apuuli Kihumuro, head of the Uganda AIDS Commission, pointed out that controlling infection levels among adults would mean fewer paediatric infections.

“If the mothers do not get infected, then the children will not,” he said. “I am convinced that in this country we can reduce new infections; political will must be re-energised.”

“We were born in an AIDS-free generation,” he added. “We have a moral obligation to ensure that our children and grandchildren are born, and remain free from, HIV/AIDS.”