Wednesday, July 30, 2008

HIV/AIDS & African Children

Only a very few countries have as devastating HIV infection rate as South Africa. According to AVERT, an international AIDS charity, 1000 people in South Africa die daily of AIDS-related illnesses. The South African government, with all its potential for democratic leadership, has taken on a counter-intuitive, regressive approach to the HIV/AIDS pandemic. President Thabo Mbeki and his Minister of Health, Manto Tshabalala-Msimang, have questioned the science of HIV and inimated that western nations promotion of antiretroviral treatment reflects western, white hegemony and ongoing oppression of black Africans. In spite of international and national outcries, they instead have encouraged citizens to focus on nutrition, herbal treatments, and even traditional healers (Sangomas). The activist group, Treatment Action Campaign (TAC), begun in 1998 to protest government inaction, brought homocide charges against Manto Tshabalala-Msimang in 2003, attiributing the infection rate of 600 a day to her neglect. The TAC was founded by nobel prize nominee, Zackie Achmat, who protested the government's neglect by stopping taking his ARV medication because only the affluent could afford to get adequate treatment in South Africa. In 2003, the ANC government soften towards antiretrovirals: "The government’s change in attitude towards ARVs was partly a result of a court battle in which GlaxoSmithKline and other pharmaceutical companies agreed to allow low-cost generic versions of their drugs to be produced in South Africa. This made South Africa one of the first African countries to produce its own AIDS drugs" (AVERT).

The results of the South African Department of Health Study (2007) of pregnant women who visited antenatal clinic estimated that 29.1% of pregnant women were HIV+ in 2006. The estimated prevalence in Johannesburg's province of Gauteng was 30.1%. There is some evidence to suggest that the infection rate is flattening out at this level. An earlier household survey in 2005 suggested that 10.8% of South Africans were HIV+ and for those between ages 15-49, the prevalence rate was estimated at 16.2%. However, these estimates are based on adjusted results on the 55% of the people surveyed; the remainder refused to be tested. The AIDS epidemic has had its worst impact on South Africa's poor (black) population (13.3%) and barely affected its white citizens (0.6%). The death rate between 1997-2005 increased 87% overall, but those who suffered the worst increases were adults 29-49 (169%) and children 0-9 (91%). The average estimated life expectancy of South Africans is 54 years.

Women in sub-Saharan Africa are particularly vulnerable to both the virus and discrimination in African patriarchal culture. In spite of major preventative education efforts by the government and NGOs, condom use is widely rejected by men, such that sex workers have two rates: one for unprotected and the other protected sex. The unprotected sex option is more expensive, but also opted for more often by the men who use their services. While female sex workers are often blamed for the spread of the virus, it is their customers who demand unprotected sex, and then infect their wives when they are home. Wives who take the risk to get tested and are found to be positive, are typically severly beaten by their husbands (blamed for getting sick, when it was their spouse who infected them), expelled from their homes, and ostracized from their communities. With the risks to women surrounding the discovery of infection, denial has been the coping method of choice, so that women may have one or more children before one of them becomes sick; not even in acute sickness do the women (and men) get tested, until they end up admitted to a hospital or visit a local clinic for help. This was the case for the mother with TB and HIV whom I visited early in my stay; she was not tested until she got very sick and went to the hospital and had by then infected her two youngest children.

At least 25% of children born to an untreated HIV+ mother will contract the virus, either in utero, during delivery, or through breast milk. This is called 'vertical transmission' in the pediatric AIDS literature. The benefit of proactive HIV testing for sexually active or pregnant women is that their children's chances of contracting the virus drop to about 8%. All the HIV+ children served by Cotlands (both the orphanage and the outreach program) contracted the virus through vertical transmission. The Home-based care tries to address the problem of denial and further vertical transmission by requiring that mothers be tested for HIV before their children can be admited to the program. Breaking through denial is the first step of treatment. Therefore, all the mothers of Home-based care clients are HIV+ themselves, and can qualify for ARVs along with their children. Apparently, there are a number of mothers and grandmothers who still consult traditional healers in addition to using ARVs. This can lead to complications, such as when a child with diarrhea is given enimas. The photo above is of two HIV+ children under a year old in the care of their grandmother.

One of the many tragic consequences of the AIDS pandemic in developing countries, like South Africa, is the impact the disease has on the country's economic development. "Between 1990 and 2003 – a period during which HIV prevalence in South Africa increased dramatically – the country fell by 35 places in the Human Development Index, a global directory that ranks countries by how developed they are" (AVERT). When the greatest infection rates are in the employable age group, a family can become destitute when the visus strikes. More and more households are headed by the pre-and-post-employable, that is by children and grandmothers. The photo is of a grandmother who cares for two grandchildren; the laundry is piled neatly on the bed in her one-room shack. She is also sick from undiagnosed AIDS.

A recent study, Exporing the Role of Family Caregivers and Home-based Care Programs in Meeting the Needs of People Living with AIDS, researched two Home-based Care (HBC) programs from four of South Africa's provinces and found that "most of the study's households do not have a working member" and that the bulk of their income was from pensions and/or social grants. One of the mothers I have met through Cotlands HBC married a man from Nigeria about four years ago for money, and they have stayed married although he is not involved in the care of their son, who is HIV+ and paralyzed from the waist down. Because she is married the mother and son do not qualify for grant support from the government, even though she has effectivelybeen a single mother. On the other hand, her older child does qualify because she has a different father. The mother is too ill now to work.

1 comment:

Linda Lee said...

Hi Susan,
I put a link to your blog from my're doing great work!
I hope you don't mind that I shared the link, I think the more people that know of the issues, the better.
keep writing, and be sure to check out my blog!