Many children under 15 in Zimbabwe discover their HIV status only when they fall critically ill later in life. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 17 2015 (IPS)

Fifty-one-year-old Mateline Msipa is living with HIV. Her 17-year-old daughter, born after Msipa was diagnosed with the virus, may also have it, but she has never been tested.

“My daughter is not aware of my HIV status and with the stigma associated with the disease, it is hard for me to now open up to her about my status,” Msipa told IPS.“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents." -- 13-year-old Tracey Chihumwe

Msipa’s daughter says she has never attempted to undergo an HIV test despite Zimbabwe’s revised testing guidelines allowing children of her age to get one without parental consent.

“I have no reason to get tested for HIV because I have never engaged in sexual intercourse before,” the 17-year-old told IPS.

Figures show that thousands of children in Zimbabwe are infected with HIV – presenting a major battlefield for government efforts to defeat the spread of HIV /AIDS nationwide.

The U.N. agency UNAIDS estimates that nearly 200,000 children from birth to age 14 have the virus but are not in treatment because they have not been properly tested. It is a trend that researchers term “suboptimal” counseling and testing in that southern African country.

“Children often get tested for HIV [only] when they fall critically ill, which usually doesn’t save them from dying,” Letwin Zindove, an independent health expert who works as an HIV/AIDS counselor here, told IPS.

The new estimate threatens to dash the southern African nation’s effort to meet a U.N. goal of reversing the incidence of infection in the population by 2015.

Older children – between six and 15 – who might have acquired HIV at birth are especially vulnerable to a major outbreak of full-blown AIDS. A study last year by the London School of Hygiene and Tropical Medicine found this group received inadequate access to provider-initiated HIV testing and counselling by primary care-givers.

Lack of clear national standards for HIV/AIDS testing leads to confusion and missed diagnoses in some cases. Credit: Jeffrey Moyo/ IPS

The study found health-care workers were reluctant to offer testing which could expose the child to abuse if he or she tested positive. On top of this, long waiting periods for appointments also hindered routine testing and counseling.

Last year, Zimbabwe launched its revised national guidelines for HIV testing and counselling with special emphasis on couples, children and adolescents as it stepped up efforts to halt the spread of the virus ahead of the 2015 deadline of the U.N. Millennium Development Goals (MDGs).

Under these guidelines, a child aged 16 years or older is eligible to give full consent for HIV testing and counselling.

However, the study found that many healthcare workers don’t fully understand the new guidelines.

“They expressed confusion about the age at which a child could choose to test him/herself, what type of caregivers qualified as legal guardians, and whether guardians had to undergo testing themselves first,” it said.

The appearance of a slow-progressing HIV disease among children has also contributed to dangerous delays in testing. New research has found that a substantial number of HIV-infected children survive to older adulthood. Delaying testing and diagnosis until symptoms appear results in a high risk of chronic complications such as stunting and organ damage.

Under the U.N.’s MDG Target 6A, countries should have halted new infections and begun to reverse the spread of HIV/AIDS by 2015.

Zimbabwe’s numbers of HIV incidence may be high (14.7 percent of adults) but the numbers are higher yet in South Africa (17.8 percent), Botswana (23 percent), Lesotho (23.6 percent), and Swaziland 25.9 percent.

Countries with low numbers are Mali, Guinea, Burkina Faso, Benin, Sudan, Senegal, Niger, Mauritania and Somalia – ranging from 1.0 percent to 0.7 percent.

While most countries are achieving a measure of success towards the U.N. goal, two have been a major health care disappointment.

Uganda, once hailed as a Cinderella success story, and Chad have seen a rise in infections. It is a disappointing turnaround from the 1990s when an aggressive public awareness campaign that urged medical treatment and monogamous sexual relationships led to a precipitous drop in infection rates in Uganda.

In 2012, H.I.V. infection rates in Uganda were seen to have increased to 7.3 percent from 6.4 percent in 2005. Over roughly the same period, the United States, through its AIDS prevention strategy known as Pepfar, or the President’s Emergency Plan for AIDS Relief, spent 1.7 billion dollars in Uganda to fight AIDS.

Activists say children are not immune to the deep-rooted stigma surrounding HIV/AIDS here — another barrier to testing.

“Zimbabweans are one huge community, closely-knit, and once a child is tested for HIV, it becomes difficult for it to remain confidential, resulting in any child tested becoming exposed to stigma,” Sifiso Mhofu, an affiliate of the Zimbabwe National Network of People living with HIV, told IPS.

This problem is very real for orphans like 13-year-old Tracey Chihumwe (not her real name) from Mabvuku, a high-density suburb of Harare, the Zimbabwean capital.

“Talk of rejection, talk of stigma and discrimination about HIV-positive people here has rendered me confused on whether or not I should get tested for HIV/AIDS, although I don’t know what killed my parents,” Chihumwe told IPS.

The Zimbabwean government is now struggling to ensure to that 85 percent of the population – including children and adolescents – knows their HIV status by the end of this year, in a desperate bid to meet the MDGs deadline in December.

But this will not be an easy task.

“Despite revised guidelines of HIV testing for children, pockets of resistance to get children tested for the virus exist from children themselves, parents and guardians as well,” a top government official, who requested to remain anonymous for professional reasons, told IPS.

Edited by Lisa Vives and Kitty Stapp

Soon parents in rural Kenya will be able to receive the HIV tests results of their infants as soon as the relevant blood tests have been done. Credit: Isaiah Esipisu/IPS

By Isaiah Esipisu
NAIROBI, Feb 20 2012 (IPS)

Jesse Mtembe, a nursing officer at the Akithenesit Health Centre in Teso North, in Kenya’s Western Province, cannot wait for his centre to be connected to a new software system for diagnosing HIV in infants that is being developed in the country’s leading private university.

Soon Mtembe’s patients will be able to receive the HIV tests results of their infants as soon as the relevant blood tests have been conducted at one of the country’s central laboratories some 200 kilometres away. Currently parents in rural health centres wait up to 18 weeks for the blood test results.

Since 2011, students at Kenya’s Strathmore University have been developing and refining software of infant HIV diagnosis. The software has been implemented in 75 health centres in the remotest parts of the country as part of first phase trials.

The software seems simple enough. Once blood samples arrive at one of the country’s four central Kenya Medical Research Institute (KEMRI) Centre for Disease Control and Prevention (CDC) laboratories all samples are logged into the system. Once this is done, the software automatically generates a short message service (SMS) to the rural health centre the sample was sent from to confirm receipt.

Once diagnosis has been completed, the system generates another SMS to confirm this, and if the result is negative, the results are also given. Results are received in rural areas on SMS printers and parents are notified by the clinic that their results are ready.

“On the SMS printers that we have already installed in rural clinics, we only send negative results in real time. This is because as a policy, all positive results on the polymerase chain reaction (PCR) equipment have to be re-run for confirmation in order to avoid false positives that might be due to contamination,” said Oscar Mulondanome a lab technologist at the Alupe Centre, one of the country’s testing laboratories.

Unlike other HIV testing methods such as rapid tests, where a patient receives the results after a few minutes, testing for the virus in infants requires the PCR technique, which is used to amplify the genetic make-up (or DNA) of a single or a few HIV viruses.

In Kenya, early diagnosis in infants is conducted with the support of the National Aids and STIs Control Programme and the United States Army Medical Research Unit. The project is being funded by the Clinton Health Access Initiative.

“The database application has allowed real time analysis of data generated for active interventions and has a wide geographical coverage,” Silvia Kadima, a research scientist at the KEMRI HIV laboratory, told IPS.

“We are projecting that by April this year, the software tool will be customised to Kenya’s local needs, and that is when it will be officially launched and rolled out by the government,” said Kadima.

She said that 50 more facilities would be connected for further trial phases before the product is officially rolled later this year. Kenya has a total of 904 listed public health centres all over the country.

The system is a welcome relief to far-flung places like the Akithenesit Health Centre.

“Given the location of our health centre in a remote area, we have to rely on lifts offered by officers from the nearby military camp to transport the samples to (the Alupe Hopsital in Busia) some 200 kilometres away, where there is an infant HIV testing centre,” Mtembe said.

It is a journey that takes a minimum of 10 hours because of the poor state of the road.

“After a few months, we then go through the same route to collect the results. And if they are not ready, then we have to organise another trip on another day,” said Mtembe, who is also head of the centre, which only has three nurses.

However, in Kitui County in Eastern Province, residents say they are already experiencing the impact of the system.

“For my first two babies, I received their HIV test results 18 weeks after the blood sample had been collected, and this was given during the routine postnatal clinic visits. But for my third born, I received an SMS on my phone five days after the sample collection, asking me to collect the results,” said Elizabeth Mwende a resident of Mutomo village in Kitui.

The 17-week difference in receiving an infant’s HIV results is key to effective treatment.

“Diagnosis of infants within six weeks of birth allows timely initiation of anti-retroviral therapy (ART) of children below two-years-old and can save lives. Without ART, up to 50 percent of children who acquired the virus from their mothers, would usually die before the age of two,” said Dr. Lucy Matu of the Elizabeth Glaser Pediatric AIDS Foundation.

“Early infant diagnosis allows for early and timely intervention. If a kid from an HIV-positive mother turns out to be negative, then proper preventive measures will be put in place to ensure that they do not acquire the virus at all,” added the Prevention of Mother-to-Child Transmission adviser at the foundation.

(END/2012)