Tag Archives: adolescents

What’s happening to Kenya’s first generation born HIV-positive?

Globally, there is a general lack of awareness of the health and social challenges that face the first generation of children born HIV positive; in fact, this has not been an issue of special focus. Yet the population of that group of people is not only increasing in numbers, it is also growing older. According to UNAIDS, of an estimated 390,000 children born with HIV in 2010 globally, 90 percent of them were born in 22 countries, of which 21 are in sub-Saharan Africa, the odd one out being India[1].

There is a lot of hope that with increasing access to improved PMTCT services especially the availability of the more effective antiretroviral regimen for pregnant women and their newborn babies, fewer children will be born HIV positive. Where highly active antiretroviral therapy (HAART) has been employed, the rate has reduced to below 5 percent. As a result, in 2011 UNAIDS and PEPFAR jointly launched the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive. The plan has a main focus on the 22 countries (see above).

Source: UNAIDS and PEPFAR bring together Health Ministers and partners to advance progress in ending new HIV infections in children

For many years there was a strongly held assumption that survival from birth to adolescence with HIV was so unlikely without treatment as to be negligible, and that HIV in late childhood was very unusual. The accepted view was that the majority would die before the age of five. However, there is now accumulating evidence that children born with HIV do survive into teens and adults. In Kenya, the oldest of these children are now approaching 30[2]. In Uganda it is estimated that as many as 150,000 children are already living with HIV right from childhood. In 2006, the oldest surviving of young people born with HIV in Uganda turned 23 years old, thanks to antiretroviral therapy[3]. That same year, The Aids Support Organization (Taso) had registered 4,696 ten to nineteen-year-olds living with HIV since infancy, while another 1100 young people were receiving care at the Mildmay Centre and Mulago Hospital.

A recent article by Amelia Hill[4] entitled Teenagers born with HIV tell of life under society’s radar, HIV-positive youngsters who were infected before or at birth reveal their secret lives, highlights some of the challenges faced by youngsters in the United Kingdom who were born HIV positive. These challenges include:

  • Coping with the discovery that they are HIV positive: Usually the doctors and the parents would have withheld the information until such time as it is considered “safe” to divulge the status to the child. One 18 year old describes how at nine years old a careless receptionist at his local hospital blurted his status, and his reaction to the shocking revelation: “I remember standing there, with my mother’s hand around mine, as these feelings of complete confusion and fear washed over me. I suddenly realised that the pills my mum had been giving me every day – that I had thought were sweeties – were medicine, after that day at the hospital, I would lock myself in the bathroom when my mum took them out of the cupboard. Or I’d pretend to swallow them, and then throw them away. I know I’m killing myself,” he says truthfully, but with studied nonchalance. Inconsistency in the taking of medicines has important implication to development of resistance to specific drugs by the virus.
  •  Fear of stigma: HIV-positive youngsters have expressed worry over being branded by the stigma that is attached to HIV in society. “Society forces me to live two lives, one of which – the one where I’m honest about my status – I have to keep completely secret from the other one. It’s partly because I have to live this life of shame and secrecy that I find it so hard to take my meds….I’m angry about the stigma in society that makes me have to lie about my status“. Some adolescents have admitted having considered killing themselves.

Two studies, one in Zimbabwe and the other in Uganda have specifically highlighted some of the issues facing adolescents and young adults who were born HIV positive in those countries. In Zimbabwe, a clinical study[5] has suggested that as many as one in four children may survive into adolescence without diagnosis or treatment. Of the children under HIV care in Zimbabwe during 2008, 42% were aged 10-19 years. This study has bust the long held assumptions that HIV in late childhood is very unusual, and that survival from birth to adolescence with HIV was so unlikely without treatment as to be negligible. Among the problems most commonly faced by adolescents were psychosocial issues and poor drug adherence (which is critical in keeping the ever-changing AIDS virus at bay).

The Population Council in Uganda[6]  has addressed reproductive health needs of adolescents born with HIV. It involved a sample of 732 adolescents aged 10-19 years. The study shows that these adolescents are most likely to be orphaned, hardly any of the teens and young adults born with HIV have both their parents alive, As such they are subject to the challenges that face orphans generally. They were also found to be at risk of entry into casual relationship, using no protection, and with persons whose HIV status they do not know. Most of them conceal their status to their partners. The study reports that as many as 61 percent of the sexually active adolescents surveyed said they did not use any protective method during their first time sex, and do not know the status of their current partner.

There are lots of similarities between the findings in the two Africa-based studies and the issues raised by their counterparts in the UK report. What these limited studies clearly reveal is the inadequacy of our knowledge regarding the social, psychosocial and health challenges faced by adolescents and youths born HIV positive and their guardians.

[1] UNAIDS and PEPFAR bring together Health Ministers and partners to advance progress in ending new HIV infections in children http://www.unaids.org/en/resources/presscentre/featurestories/2012/may/20120523whagp/

 [5] Rashida Ferrand,a Sara Lowe,b Barbra Whande,b et al., Survey of children accessing HIV services in a high prevalence setting: time for adolescents to count?Bull World Health Organ. 2010 June 1; 88(6): 428–434. Published online 2009 December 16. doi:  10.2471/BLT.09.066126

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A commentary on Unsafe Abortion in Africa

Unsafe abortion remains a major contributor to the unacceptably high levels of maternal morbidity and mortality rates that prevail in Africa. It also continues to be one of the formidable challenges to the achievement of Millennium Development Goal 5 of improving maternal health by 2015. This is despite the many meetings and conferences that have addressed the issue over the last four decades, one of the earliest being the IPPF Regional Conference on Family Welfare and Development in Africa, Ibadan, Nigeria, August/September, 1976, where I was privileged to present a paper entitled Abortion in Africa[1]. Perhaps the most recent meeting is the Ipas[2] sponsored conference in Ghana (November 8-11, 2010), entitled “Keeping Our Promise: Addressing Unsafe Abortion in Africa”.

The persistence of unsafe abortion in Africa is, ultimately, perpetuated by two key factors: (a) the restrictive laws against termination of pregnancy; and (b) the limited or lack of access to adequate abortion services. Criminalisation of abortion in majority of African countries is something inherited from the colonial laws, despite the fact that the law has since decriminalised the procedure in the colonial “mother countries” (United Kingdom 1967; France 1975; Italy 1978; Spain 1985; Belgium 1990). On the other hand, it can be observed that passing of laws for or against abortion has little effect on the numbers of abortions that take place; in fact, the only difference is that the patterns of morbidity and mortality associated with abortion change. Stringent laws against abortion will not deter women in need from going through with an abortion, the only thing such laws achieve is to push many of them to undergo unsafe procedures with consequent high rates of morbidity and mortality. The procedure of medical termination of pregnancy is simple, short and safe when undertaken in the open, by trained persons; however, carried out in secrecy, usually by unskilled operators, it is expensive, unsafe and life threatening.

Obviously, like many other freedoms- legalisation of abortion may be abused, when abortion becomes a primary method of birth control, as happened in the former USSR. Increased access to contraception since the collapse of the Soviet Union, has led to a reduction in the numbers of abortions in Russia. However, it should be realised that induced abortion may still be the only means of birth control for many women in some parts of Africa, i.e. women who have very limited access to contraception, including adolescents and youths who are denied not only the services but also information on sexuality, on moralistic grounds. For such women, the desire to do away with an unwanted pregnancy can be so intense that they will avail themselves of this last resort despite the law, or the attendant risk to their lives. Sadly, many of these women live in countries where penal codes do sanction abortion under certain conditions but they are unaware of this provision; or, for various reasons, they cannot access safe abortion services in their countries.

Evidence from the Demographic and Health Surveys, over the last three decades, shows that women (and men) in most parts of Africa have increasingly taken to contraceptive practice. For anyone who chooses to practice contraception the hope is that it would not fail her or him. The shock of the discovery that this is not so, though infrequent, can drive the hapless individual seeking termination of the pregnancy. For most people it follows logic that if contraception is acceptable, then consideration for abortion should follow where there is failure- this is why in many countries medical termination of pregnancy is an accepted second line of defence against unwanted pregnancy.

Finally, in addressing the issue of unsafe abortion particular focus is needed on ensuring equity in access to health care, especially for the poor and marginalised communities, who are the main victims of quacks in backstreet clinics. Despite the absence of supportive data at this moment, it is highly possible that in many African countries, considerably more induced abortions occur among the wealthier and more mature women than among the poor young single women, that are often reported from public institutions. It is the latter that sustain Africa’s high abortion-related maternal mortality rates, and who will make it impossible to attain national and international goals, if they are left ‘out of the loop’.

Related Link

On The Abortion Question

[1] Mati JKG. Abortion in Africa. In Family Welfare and Development  in Africa. Proceedings of IPPF Regional Conference, Ibadan, Nigeria, August/September,1976.

[2] http://www.ipas.org/Library/News/News_Items/Keeping_Our_Promise_Addressing_Unsafe_Abortion_in_Africa.aspx Conference co-sponsored by FEMNET, Ghana Ministry of Health, IPPF Africa Regional Office, Marie Stopes International and the United Nations Economic Commission for Africa. A BBC interview on this conference is available on http://www.bbc.co.uk/worldservice/africa/2010/11/101109_ghana_abortion_conference.shtml

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