Great strides have been made in the dissemination of HIV drugs in the region of the world most seriously affected by AIDS. But this success concerns only a part of the population: the adult one. In Sub-Saharan Africa, after twenty years of efforts to stem the epidemic, the number of children infected with the virus remains unacceptable: 130 thousand a yearoften left without drugs or forced to treatment on and off, due to logistical problems and the prejudice that still affects the disease.
The numbers of shame. The complaint comes from an article published in the New York Times, which tells stories of mothers and children desperate for testing and treatment in a rural area of Kenya. The testimonies follow the same picture of UNAIDS, the United Nations HIV program: 76% of HIV-positive adults in sub-Saharan Africa today receive targeted drugs, but only half of the children can count on the same life-saving treatment.
Indeed, in 2021, 99,000 children died of AIDS in this region of the continent, and AIDS is the leading cause of death for adolescents in 12 states under the Sahara. An estimated 2.4 million children and teenagers in the area have contracted the HIV virus, but only half of the cases are diagnosed.
How it should be (and how it goes instead). Preventing the transmission of the virus between mother and child during pregnancy, childbirth and breastfeeding would theoretically be quite simple, if only all pregnant women were tested for HIV and, if positive, started antiretroviral therapy immediately . This is what is required by local guidelines, which try to find the cases that initially escaped with a second test carried out during labor and which – in case of positivity – indicate to administer drugs to newborns for the first six weeks of life.
In 90% of cases, this protocol is sufficient to prevent the infection from passing. But between theory and practice there is the chronic lack of tests and drugs, clinics closed due to covid and lack of staff, crumbling infrastructure, insufficient government funds and skipped checks for other health emergencies.
Bottom of the list. “Children with HIV are harder to find than adults, we have fewer tools to test and treat them, and they depend on their caregivers for access to health care,” said Anurita Bains, director of UNICEF’s AIDS program.
“Because they don’t spread HIV, they’ve ended up at the bottom of the priority list. Almost forgotten.” A problem only postponed, because these children (in the luckiest cases) will grow up.
Too late. In many cases, the diagnosis of HIV in children comes late, after the children have full-blown symptoms – such as repeated infections caused by the virus. This is because doctors don’t necessarily think of a contagion for a 4.5-year-old child with recurrent pneumonia or because, even if there is a suspicion, tests are lacking. Routine six-week-old newborn screenings include testing for HIV only in babies with a known family history of HIV, but not in all babies.
Still a taboo. In cases where pediatric medicines are available, and are free of charge, cultural factors hinder treatment. In many contexts, the HIV diagnosis weighs on women like a sentence to marginalization, because if HIV positive they are often accused of infidelity to their partner. To be able to reach the hospitals and subject themselves and their children to the necessary treatment without acting covertly, mothers must be able to communicate the diagnosis to their husbands, with the risk of repercussions.
Accounts at the end of the month. Poverty complicates things. Even women who have jobs often earn the equivalent of a few dollars a month. And if the drugs available for free have run out, all that remains is to divide the few that can be bought among all the children, giving each one the same insufficient dose.
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For whom the bell tolls