THOUSANDS of HIV-positive children are suffering and dying unnecessarily because of late diagnosis, a Zimbabwe-based expert on HIV/AIDS said, calling for universal testing of children entering health facilities in high prevalence countries.
HIV/AIDS was the leading cause of hospitalisation and in-hospital death among teenagers in the two public hospitals in the Zimbabwean capital Harare, according to 2010 research by Rashida Ferrand of the London School of Hygiene and Tropical Medicine, a specialist in paediatric HIV/AIDS.
Africa has more than three million children living with HIV/AIDS, 1.7 million of them adolescents aged between 10 and 18, according to the United Nations. The majority do not know they are infected.
Ferrand often manages distressing cases, such as that of a 15-year-old orphan with cryptococcal meningitis, which causes swelling of the brain. “His eyes are protruding from the pressure that’s built up in his head. It’s as serious as that,” she said in a telephone interview.
The boy was brought to casualty but his grandfather would not give permission for him to undergo the recommended medical procedures. He was discharged, against the doctor’s advice.
“They have taken the child back home. It’s highly likely that this child will die,” said Ferrand.
In 2012, 110,000 adolescents aged 10 to 19 died from AIDS-related illnesses, 97,000 of whom lived in sub-Saharan Africa.
Human rights abuse
Denying a child the right to life-saving medical care is a human rights abuse, Ferrand said.
“If this was in the UK, we could bring in social services, we could bring in child protection services, and force the guardian to bring this child for treatment,” she said. “It’s a very difficult and potentially very complex thing to bring up because you cannot approach a community and accuse them of neglect.”
Africa is struggling to cope with an epidemic of orphanhood, alongside that of HIV/AIDS, with 15 million children having lost a parent to HIV/AIDS, according to the United Nations.
Extended families often do not have the money or the time to care for sick children whom they have inherited from relatives.
In another case, a stepfather sent an HIV positive11-year-old girl, who needs medical care, to live in a rural area because he felt he could not support her. After her mother died, he married another woman with whom he has three healthy children.
“These are things that are very uncomfortable for communities to address. Nobody wants to say that ‘I discriminate against this child because he or she is not my real child,’” said Ferrand.
Vital to test
Up to 80 percent of older children living with HIV are undiagnosed, Ferrand found in her research in Zimbabwe.
“Testing being missed is a huge issue in this age group. The vast majority of older children get tested when they present with an AIDS defining illness,” she said. “By which time, they are already very immune suppressed.”
While half of HIV positive children die before the age of two without treatment, one-third live to the age of 16.
“The paediatric epidemic is ageing,” Ferrand said, citing recent gains in reducing mother-to-child transmission.
These older children are filling up the beds in the hospitals where she works.
In her 2010 research, she found that 46 percent of adolescents admitted to hospital were HIV positive, most having acquired the infection at birth. Of these, almost 70 percent had opportunistic infections, like pneumonia and tuberculosis.
Consent a problem
Ferrand is calling for routine testing of children in all healthcare facilities to ensure that more children receive anti-retroviral therapy (ART) and treatment for complications, like stunting and lung disease, before it is too late.
Only 34 percent of eligible children under 15 are receiving ART – half the percentage of adults.
“In high prevalence settings, such as Zimbabwe, I think it would be cost effective to test any child entering a health facility regardless of age,” she said. “We need to develop a coherent model of testing for older children to mop up those who miss HIV testing in childhood.”
The 15-year-old boy with cryptococcal meningitis had been visiting clinics for more than three years, complaining of headaches while also not growing well. He was never offered an HIV test.
Even with recent progress, only 40 percent of infants born to women living with HIV were tested within the recommended two months of birth in 2012.
In her research in Zimbabwe, Ferrand found that 76 percent of children attending a health clinic were offered an HIV test. Only 30 percent ended up taking the test because the majority could not obtain consent.
In many countries, the parent or guardian has to give consent for a child under 18 to be tested. This can prove impossible when the parents are working in another country, as is common in southern Africa.