Reversing the spread of dreaded HIV possible

The Acquired Immunodeficiency Syndrome (AIDS) epidemic is now in its fourth decade after the initial description of Human Immunodeficiency Virus (HIV), in 1983. At the beginning of the epidemic, HIV was invariably fatal. With the availability of antiretroviral therapy (ART), it has now become a chronic treatable condition in children, as well as in adults.

Grim statistics

Though concerted efforts have resulted in reduction in new cases there are currently about 36 million people estimated to be living with HIV worldwide. An estimated 78 million people have become infected with HIV and 35 million people have died of Aids-related illnesses since the start of the epidemic.

Approximately 19.5 million people were accessing antiretroviral therapy by 2016. These global efforts have meant that the number of people receiving HIV treatment has increased dramatically in recent years, particularly in resource-poor countries.

This has resulted in more HIV infected people with increased exposure to unborn children. A great stride has also been made in the area of prevention of mother to child transmission of HIV with significant reduction in new paediatric cases.

HIV infection, especially in children, is a family disease with social, economic and medical aspects that make it one of the most challenging diseases in the current times. The virus can be very well controlled with good quality of life, but so far there has not been a cure and life-long treatment is required.

The most significant shortcoming in the response to paediatric HIV remains the limited prevention of mother-to-child transmission, allowing a large number of children to be born with HIV in the first place, in spite of it being largely preventable. In the developed countries, mother-to-child transmission has been virtually eliminated, but in resource-limited settings.

By law, children around the world are protected from preventable disease and death. In Kenya, every child is guaranteed the right to health by virtue of international treaties and the constitution. The law is clear, but the implementation remains a challenge and HIV/Aids continues to kill children.

The Kenya Demographic Health Survey (KDHS), carried out in 2008/2009 estimated that 1.49 million Kenyan adult and children were infected with HIV out of which 110,000 were children aged 0-14 years. HIV/Aids present the greatest challenge to the development of any country and has puts immense pressure in the workplaces. The bulk of the infection is in the productive age-group (25-49years).

This has resulted in Kenya instituting polices that would help organizations handle HIV/Aids infected persons with more respect and reduced stigmatization and victimization. A person can still continue working even when diagnosed with HIV without fear of being laid out on the basis of their HIV status.

About 15 women die every day due to pregnancy related complications in Kenya and 20 per cent of all deaths among mothers in the country are HIV/ Aids related. In 2003, there were 650,000 Aids orphans in Kenya. In 2008, the Government began providing free antiretroviral drugs (ARVs) to HIV-positive people who need them, and medical care is now free for children under five.

Testing is critical

There has been a gradual increase in HIV testing facilities in Kenya. In 2000, there were just 3 voluntary counseling and testing (VCT) sites but this had increased to more than 4000 by 2010. In 2008, about 860,000 people were being tested annually for HIV and in 2013 had increased to 6.4 million. From 2009 to 2013, the percentage of pregnant women tested for HIV increased from 68 per cent to 92 per cent.

Kenya has made big steps towards creation of “Aids free generation”. In partnership with USaid, the Government of Kenya has enabled the country to combat the HIV/Aids epidemic. Kenyans have increased access to HIV/Aids prevention, treatment and care services, more people are on anti-retroviral therapy and more Kenyans are being tested for HIV.

Kenya is among nations in which significant progress has been made, both in preventing mother-to-child transmission and in testing and treating infants and other children. By 2011, 69 per cent of the pregnant women with HIV received ARV drugs to prevent mother-to-child transmission.

This is an excellent illustration of how international law, national policy, and public health programs can mutually reinforce the realization of the right to health.

Dr Gitakah, Consultant Paediatrician at Aga Khan University Hospital