FOCUSING ON PAEDIATRIC HIV IN SUPPORT OF DAY OF THE AFRICAN CHILD
……HIV testing and enrolling HIV positive children to ART is a priority for a safe generation
Last week the world celebrated Day of the African child. Like every year on 16 June, the African Union and its Member States observe the Day of the African Child (DAC) as a commemoration of the 16th June 1976 student uprising in Soweto, South Africa, where students who marched in protest against apartheid-inspired education, were brutally murdered.
Eswatini also joined the rest of the world in celebrating the day at Magubheleni under the theme; “Eswatini fit for Every Child: Known and Protected”. This is an annual event where partners celebrate the children of Africa and address issues which call for serious introspection and commitment towards addressing the numerous challenges children face in Africa.
Day Of the African Child is all about knowing and understanding that children are the future generation and they deserve to be protected from any form of harm. This is not only physical harm but psychological and emotional harm. Health issues also are expected to be a priority in a child’s upbringing. This is why it is imperative that children are tested for HIV so that every parent or guardian can raise them knowing how to better care for them. Introducing your child early to ART will do them more good because as a parent you are able to structure their diet, and ensure they consume the right kind of food. Children like that grow up understanding their health status which fosters early acceptance of who they are and boost their confidence.
In Eswatini we are lucky to have a foundation dedicated to children issues on HIV and that is the Elizabeth Glazier Paediatric AIDS Foundation (EGPAF). The foundation’s work is to increase community engagement on access to prevention of mother-to-child HIV transmission (PMTCT), early infant HIV diagnosis, and voluntary medical male circumcision services. Many a times people often ask, how else can a child get HIV besides being born with it. We are fortunate as a country that the Ministry of Health is proactive in ensuring that no child is born with HIV as we move to end AIDS by 2022. This has been done through early initiation of antiretroviral therapy to expectant mothers, living with HIV, in the early stages of pregnancy. Today let us answer some of your questions around HIV in children.
What causes HIV in children?
A child can be born with HIV or contract it soon after birth. HIV transmission in children can happen:
- during gestation (passing through the placenta)
- during delivery (through the transfer of blood or other fluids)
- while breastfeeding
Of course, not everyone with HIV will transmit it during pregnancy, especially if they’re following antiretroviral therapy. Worldwide, the rate of transmitting HIV during pregnancy falls to below 5 percent with intervention, according to the World Health Organization (WHO)Trusted Source. Without intervention, the rate of transmitting HIV during pregnancy is about 15 to 45 percent.
HIV transmission in teenagers and young people
Secondary transmission, or horizontal transmission, involves contact with semen, vaginal fluid, or blood containing HIV. Sexual transmission is the most common way teens contract HIV. Transmission can occur during vaginal, oral, or anal sex without a condom or other barrier method. Adolescents may not always know they have HIV. Using protection like correct condom use can reduce the risk of contracting or transmitting a sexually transmitted infection (STI), including HIV.
HIV can also be transmitted through sharing needles, syringes, and similar items. While extremely rare, it is possible to contract HIV in healthcare settings through contact with blood containing the virus. However, HIV doesn’t spread through insect bites, saliva, sweat, tears and hugs. And you certainly can’t get it from sharing towels or bedding, drinking glasses or eating utensils and toilet seats or swimming pools.
HIV symptoms in children and teens
An infant may not have any obvious symptoms at first. However, as the immune system weakens, you may start to notice:
- lack of energy
- delayed growth and development
- persistent fever, sweating
- frequent diarrhea
- enlarged lymph nodes
- repeated or prolonged infections that don’t respond well to treatment
- weight loss
- failure to thrive
Symptoms vary from child to child and with age. Children and teens may have:
- skin rash
- oral thrush
- frequent vaginal yeast infections
- enlarged liver or spleen
- lung infections
- kidney problems
- memory and concentration problems
- benign or malignant tumors
HIV TREATMENT FOR CHILDREN
Today many children and adults with HIV live long and healthy lives. The main treatment for children is the same as adults and that is AntiRetroviral Therapy (ART). Antiretroviral therapy and medications help prevent HIV progression and transmission.
Treatment for children requires a few special considerations. Age, growth, and stage of development all matter and have to be reassessed as the child progresses through puberty and into adulthood. Other factors to take into account include:
- severity of the HIV infection
- the risk of progression
- previous and current HIV-related illnesses
- short- and long-term toxicities
- side effects
- drug interactions
A 2014 systematic review found that starting antiretroviral therapy soon after birth increases an infant’s life span, decreases serious illness, and decreases the chances of HIV progressing to AIDS. Antiretroviral therapy involves a combination of at least three different antiretroviral drugs. When choosing which drugs to use, healthcare providers consider the possibility of drug resistance, which will affect future treatment options. Medications may have to be adjusted from time to time.
One key element for successful antiretroviral therapy is adherence to the treatment regimen. According to the World Health Organization, it takes adherence of more than 95 percent for sustained suppression of the virus. Adherence means taking the medications exactly as prescribed. This may be difficult for children, especially if they have trouble swallowing pills or want to avoid unpleasant side effects. To remedy this, some medications are available in liquids or syrups to make it easier for young children to take.
Parents and caregivers also need to work closely with healthcare providers. In some cases, family counselling may be beneficial for everyone involved. Adolescents living with HIV may also need:
- mental health counselling and support groups
- reproductive health counselling, including contraception, healthy sex habits, and pregnancy
- testing for STIs
- substance use screening
- support for a smooth transition into adult healthcare
Research into paediatric HIV is ongoing and treatment guidelines may be frequently updated. Be sure to keep your child’s healthcare provider informed of new or changing symptoms, as well as medication side effects. Never hesitate to ask questions about your child’s health and treatment. Happy youth month!