Paediatric care still facing major drawbacks

Kenya's antiretroviral programme has grown by leaps and bounds since a presidential declaration made the drugs available free of charge in 2006, but infected children are still not accessing medication as easily as adults.

"We have 160,000 people on antiretroviral drugs across the country, but only 12,000 of these are children, and most of these are over the age of five years," said Dr Robert Ayisi, head of prevention of mother-to-child HIV transmission at the National AIDS and other Sexually Transmitted Infections Control Programme (NASCOP).

According to UNAIDS, an estimated 150,000 Kenyan children under the age of 15 years are infected with the HI virus. "What we need to know is why this is, so that we can begin to address the issues," Ayisi told a meeting held by the Population Council, a research group focusing on gender and reproductive health.

During the meeting on 29 August, the Population Council's Horizons Programme, which is supported by the United States International Agency for International Development, released the preliminary findings of their ongoing research.

"Barriers [to paediatric HIV testing and care in Kenya] come in the form of caregiver barriers and service delivery barriers, which combine to prevent children from being tested or receiving treatment when they are HIV-positive," said Dr Karusa Kiragu, a Horizons programme associate.

Poverty among caregivers was a major constraint, with many of them too poor to travel to clinics with their children. An estimated 56 percent of Kenyans live on less than one dollar per day.

"People are very poor ... some of them walk all the way, and they have to sit and queue for a long time," a health manager at western Kenya's Kendu Bay, one of the study sites, told researchers. "They walk back home, several kilometres away, tired, hungry and pathetic; even children ... I wish we could offer them a small meal while they wait - that would really help them come."

Other barriers to children being tested and obtaining treatment included lack of awareness, stigma and denial. "Shame and blame is very common among caregivers of HIV-positive children, and the public is also harsh," Kiragu said. "We found that 31 percent of people surveyed thought parents of HIV-positive parents should be ashamed of themselves."

Among service providers, major barriers indicated by the study were distance from patients, lack of skills among health workers, lack of child-friendly facilities and staff shortages.

"Fifty-eight percent of nurses feel confident in disclosing the HIV status of a child to his or her parent. This needs to change through training," Kiragu said.

Although the government ran a media campaign to inform the public about HIV prevention and treatment, Kiragu pointed out that most study respondents said their main source of information about paediatric HIV was their health worker.

"Most of us are not counsellors. We are expected to be aware, but we do not have the relevant information," a health worker in Embu, central Kenya, told researchers.

Ayisi said, "We are aware of the gaps in information of paediatric HIV, and NASCOP and the Clinton Foundation will soon launch a media campaign on paediatric HIV. The political will exists to improve paediatric care and, step by step, we will address all the barriers to accessing it."

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