Access to Treatment and Support for Children affected by HIV/Aids

The article will give a closer look on, what the injustice of different access opportunities means for the affected children. It compares the data of UNAIDS and the National Aids Council of Zambia with impressions from the HIV/AIDS-Work of Kindernothilfe partners in Zambia, where examples from local and family level collected by a questionnaire, give a clearer picture and an outlook for the real situation on the ground.

Ending Aids: Zambia as a Positive Example

Zambia is a country with a high political priority to fight HIV/AIDS. The Government of Zambia affirmed its commitment to reach Universal Access of HIV-prevention, treatment and mitigation services for Zambians affected by HIV/Aids. From the 23.5 million people living with HIV in Sub-Saharan Africa in 2011, 970’000 live in Zambia (UNAIDS 2013: p.7). Currently the national response against the epidemic is guided by the 2011-2015 National Aids Strategic Framework (NASF) which also adopted a human rights approach (National Aids Council 2012: p.9 and 43). Critical is still the enormous donor dependence (National Aids Council 2012: p.44). Even when Zambia has massively increased its domestic investments in the health budget by 45% or 5 million US-$ in 2012 (UNAIDS 2012: p.21) Zambia’s health budget is still below the Abuja Commitment of 15% (National Aids Council 2012: p.43).

The starting point of improving access was to integrate the HIV/Aids response in health care to get HIV/Aids services in all public health facilities (National Aids Council 2012: p.12).

Towards Zero New Infections

Today fewer people are becoming newly infected with HIV, millions are receiving HIV-treatment, fewer babies become infected with HIV and African Governments are investing more than ever in the Aids-response. One key sign of the turnaround is the steady decline in new HIV-infections each year, which are now below one third below the peak of 1998 due to successful prevention approaches. (UNAIDS 2013: p.28f).

In Zambia the rate of new infections has declined by 58% (UNAIDS 2012: p.12-14). Prevention is the important tool to reduce new infections. Since the early days of the epidemic, countries have implemented Aids-education and awareness campaigns, as well as condom distribution programmes.

Towards Treatment for All

In 2011 there were 33% fewer AIDS-related deaths in Africa than in 2005. In Zambia the total number of Aids-related deaths went down by 56% in the same time period. From 70’685 to 31’282 persons in total numbers (UNAIDS 2013: p.8).

Today more than seven million people across Africa have access to lifesaving antiretroviral therapy (ART). The therapy costs decreased from more than 10’000 US-$ to around 100 US-$ per year and person. The total number of people receiving treatment grew in the time from 2005 till 2012 by 805%. So more and more people live longer, healthier and can live their life more productive. (UNAIDS 2013: p.28f). Zambia is one of the five countries in the Region with more than 80% HIV-treatment Coverage (UNAIDS 2012: p.17).

Less HIV-infections among Children

Also the Global Plan towards the elimination of new HIV-infections among children by 2015 and keeping their mothers alive was very successful. Only from 2009 till 2011 the new infections among children decreased by 24%. (UNAIDS 2013: p.15). Zambia is one of the six African countries, where the number of newly infected children decreased highest by 59% from 21’000 to 9.500 (UNAIDS 2012: p.27 and 31). Zambia was one of the 22 countries focussing on this issue.

The UNAIDS target is reducing the new Infections among children by 90% till 2015 in comparison to 2009. In the preliminary results of 2012, Zambia is with 85% (UNAIDS 2012: p.30) one of the 17 countries where more than 75% of pregnant women receive antiretroviral treatment (UNAIDS 2013: p. 28f). The percentage of children contracting HIV born to mothers infected with HIV decreased from a peak of 7.72% in 1997 to 1.99% in the Year 2011. National coverage of this prevention is with 80% approaching universal access levels (National Aids Council 2012: p.1). This led with 1.51% in 1997 and 0.33% in 2011 to a reduction of about 78.1% of the death rate among children due to HIV/AIDS.

Prevention is the key to reduce new infections. Also access to education by building new schools, putting HIV-prevention in the curricula and the training of teachers was helping reducing new infections. It was researched, that HIV-prevalence had reduced among young people who had spent more years in school (National Aids Council 2012: p.26)

The Problem of Accessing Antiretroviral Therapy for Children

The Minister of Health made clear, that the national targets for Zambia shouldn`t be below the Global Targets of the 2011-2015 HIV-Interventions Strategic Plan. All targets should deliver the service to all (National Aids Council 2012: PII).

Already the growing number of orphan and vulnerable children affected by HIV/Aids is an example to make it obvious, how difficult it is, to fulfil their human rights to have access to adequate food, shelter basic education and health services. With around 92% in comparison to the non-orphaned children, there is no increase in improved school attendance since years (National Aids Council 2012: p. 48).

In 2011 90% of the adults 15 years and older received antiretroviral therapy (ART). But only 28.1% of the children under 14 years received ART (National Aids Council 2012: p.3). This extreme injustice is a Child and Human Rights Issue. Tremendous effort is needed before 2015 to reach access for all and to stop child rights violations.

The number of health facilities providing HIV/Aids services was impressingly increased from 420 in 2005 up to 1’784 in 2010. But HIV-Testing for children isn`t included (National Aids Council 2012: p.13-14). That is the reason, why Kindernothilfe and its partners want to put the focus on improving access for children.

Advocacy of Kindernothilfe and its Partners in Zambia

The interaction between Kindernothilfe and its partners in Zambia on this issue started with a questionnaire about the access situation to treatment and support in Zambia. With Africa Directions, BIC-Choma Children Development Project, Women for Change and Jesus Cares Ministries four partner organisations of Kindernothilfe took part intensively by giving an overview about the situation in different regions for children and their families and giving an outlook for opportunities by working out recommendations.

Testing, Counselling and Treatment of Children

The health centres are still up to 25 km walking distance in remote areas. The facilities are overcrowded and drug shortages happen often. But all organisations named first, that even when the Health Facility-Coverage increased tremendously missing counselling and testing facilities for children are one of the biggest gaps to improve the treatment situation for children.

And when there is the opportunity to test children it is not used, because nobody knows about it or it is closed because of missing health workers. And often the facilities are not child friendly. Children have to wait for hours; they wait between hundreds of adults and the health personnel is not trained to talk to children.

Often children can`t be tested because both parents must permit the health personnel to test the child. And often both parents are not available or not interested to test the child. Because of the missing tests and sensitization for the issue by their parents and the health institutions, very few children can be put on antiretroviral treatment programmes.

HIV-Prevention

The focus on Preventing Mother-to-Child-Transmission with reaching nearly access for all is a key for reducing new infections among children countrywide. Flexibilities with giving pregnant women after testing and counselling their antiretrovirals even for birth at home with control visits afterwards made it possible for most of the pregnant women to be put immediately on treatment

A big improvement is the taking up of HIV/Aids-prevention in the school curricula. Especially reproductive health and life skill lessons make prevention work by creating awareness and coming to a responsible behavioral change.

But often especially the most vulnerable children and orphans miss HIV-prevention in school, because they have to work or to take care for ill family members. Much more girls than boys are at risk to get infected and need protection.

The five main recommendations for next steps to improve the Situation of Children as Results of the Experiences are:

1. More domestic and international health financing to reach universal coverage with the focus on building more child counselling and testing facilities and to have a better payment, that health workers keep on their work and to get more funds for child formula for the antiretroviral treatment.
2. Sensitizing the parents affected by HIV/Aids by media campaigns and in self-help-groups for child rights to make have a better use of child test and treatment opportunities or to protect the children better not to be infected.
3. More social protection and support for the most vulnerable groups most at risk like young girls and orphans.
4. Improving the just introduced HIV-prevention in school curricula by training teachers and peer groups and giving more space in schools for the issue.
5. Giving critical enablers like local leaders an important role in the HIV-prevention by sensitizing and informing them about their responsibility and to become a role model in HIV-protection and to advocate to support access for treatment for all. This would also reduce stigma and discrimination for people affected by HIV/Aids.

 Kindernothilfe and its partners invite other interested actor in this field and will continue to work on this issue by information exchange and advocacy; work for children affected by HIV/Aids to get the same chances to get support and into antiretroviral treatment programmes.

*Frank Mischo is Political Scientist and works in the Department for Awareness Raising in the German Kindernothilfe. He is responsible for the HIV/Aids-Project and Lobby work in Kindernothilfe and additional he is in the Council of the Action against Aids – Alliance, Germany, Speaker of the Lobby-Working Group and Member of the Children and Aids Working Group of the Action against Aids-Alliance, Germany.
Contact: frank.mischo@knh.de, www.kindernothilfe.org

References

• UNAIDS 2013: Special Report for the Summit of the African Union, May 2013
• UNAIDS 2012: Global Report - World Aids Day Report, December, 1^st 2012
• UNICEF 2012 Children and Aids. New York. The Forth stocktaking report is a review of progress on how AIDS affects children and young people. Unite for Children, Unite against AIDS, which was launched in October 2005 by the Joint United Nations Programme on HIV/AIDS (UNAIDS), UNICEF and other partners, was a call to action around the impact of HIV and AIDS on children.
• National Aids Council – Republic of Zambia 2012: Zambia Country Report – Monitoring the Declaration of Commitment on HIV and Aids and the Universal Access – Biennial Report. Submitted to the United Nations General Assembly Special Session on HIV and Aids, March 2012