Children neglected in HIV war as firms keep off unprofitable market

They are innocent, angelic, and sometimes believed to be nigh on perfect. When a child is born, everything about the world is a new experience.

They don’t have the slightest idea of how smooth or rough their journey living on earth will be. They cannot control that.

Everything they do is pegged on who takes care of them, mostly, their parents. The bumpy ride sets in when the little angel is, unfortunately, infected with a virus that compromises their immunity –the Human Immunodeficiency Virus (HIV), one that causes AIDS.

Antiretroviral Therapy

That means that their life will be dependent on Antiretroviral Therapy (ART) to help in suppressing the viral load.
But, there are missing links, children are dying young and they need not to.

Scientists now say that there is a gap in the pharmaceuticals industry since drugs for children living with HIV are not as profitable as that of adults. Last year, UNAIDS reported that about 53 per cent of children were on HIV treatment. That implies that about 850, 000 children globally who are infected with HIV, live without taking necessary treatment –Kenyan children are part of this statistic.

The latest report by the Joint United Nations Programme on HIV/Aids (UNaids) 2020 states there are about 6,800 new HIV infections in children in Kenya compared to 5,700 in Uganda and 8,600 in Tanzania.

Only 58 per cent of children who are HIV positive are on treatment compared to 78 per cent of adults.

 “The paediatrics ARV market is particularly vulnerable and complex because children are few (hence a small and shrinking market) and they require different dosages and dosage formulations as they gain weight,” says Dr Irene Mukui, HIV Access and Medical Leader at Drugs for Neglected Diseases Initiative (DNDi).

“Paediatric HIV treatment is more expensive than that for adults – per child,” she adds.

Prevention

Pauline Marango, a clinical officer, has been working in the HIV unit at the Malava Sub County hospital for close to six years now. And, she says, children with infected mothers can be prevented from getting HIV if the necessary steps are taken as early as the mother learns that she has conceived. The prevention will see to it that there are fewer cases of infections in children.

“We encourage mothers to go to the clinic as early as possible, immediately one realises that they are pregnant and on the first visit, a HIV test must be done,” says Pauline.

“When we realise the mother is positive, we treat the unborn child as exposed so that we can start intervening as early as possible for them not to be infected with the virus,” she adds.

Even with the intervention, some babies end up getting the virus but as Pauline says, with the right treatment, they can live long.
Dr Mukui says that only half of the children living with HIV have access to Antiretroviral Therapy globally. Most of them do not even celebrate their second birthday because of the gap in treatment for children living with HIV.

In a village, where access to hospitals may not be very easy, children living with HIV are hit the most. It is even worse when they are orphaned and their caregiver may not be willing to help.

“The children may not know what is going on, but the adults who take care of them who are still clouded with the myths about HIV, sometimes stop getting drugs for them, that means that they are likely to get very sick from opportunistic diseases,” says Pauline.

The children are most affected with tuberculosis, malnutrition, recurrent pneumonias, scabies associated with HIV and stunted growth.
“Children living with their grandmothers are doing really well in terms of getting drugs consistently, the issue only comes when the grandmother is very old and cannot take in some instructions or even make it to the clinic when they are required,” explains Pauline.

The caregivers who may be willing to play by the book may still have a problem with drug storage. “We have to improvise and give a short medication, say for two weeks,” says Pauline.

A drug like lopinavir/ritonavir syrup, commonly known as kaletra needs refrigeration, and not everyone can afford that.

Storage

“We ask the caregivers to store it in a container with ash and sand near a traditional water pot so that it can have the feel of refrigeration and the child will be given drugs for only two weeks so that they can come back for a new dose,” explains Pauline.

Other than the refrigeration and explaining it to a caregiver who sometimes may not get the concept well, the drug also has side effects,
“The drug may be very bitter for the children yet it is the best drug for viral suppression,” she says.

Even when Kenya has had the HIV epidemic for almost 36 years since the first case was reported, stigma persists.

“Once a child is diagnosed to be HIV positive, regardless of the age, we as health care workers ensure that the child receives ART but we live in a society where stigma is still real,” says Pauline.

Pauline says that for mothers who opt to give birth at home, they risk their babies’ lives since they miss out on the necessary antenatal clinics that could help them make decisions before it is too late. “Those that avoid clinics and give birth at home may not have the knowledge they need,” she explains.

And, since the children below nine years—which is considered the youngest group— will one day grow up, disclosure by the caregivers as early as they start being curious is something that needs to be done. “We avoid accidental disclosure because it leads to children refusing to take drugs because they are usually in denial,” says Pauline.