Inter Press Service - December 1, 2006
Joyce Mulama

Which citizens is a government most accountable to? Those who voted it into power? Or is it more the people who're too young to cast ballots -- too short, even, to reach the table in a voting booth: the children?

If it's the latter, then how has Kenya's government conducted itself towards the nation's children in the matter of HIV/AIDS? Those who pause to take stock of this, Friday, in commemoration of World AIDS Day (for which the theme this year is "Accountability") will find themselves confronted with a situation which often seems to contain more problems than solutions.

"The country and the world at large have shown commitment to fighting the disease, but children have received a raw deal," said Michael Angaga, national co-ordinator of the Network of African People Living With HIV/AIDS, of the 150,000 children who are infected with HIV -- this according to official figures. While 50,000 of these children are in urgent need of treatment, only 7,000 are receiving anti-retroviral drugs (ARVs).

"The government did not come up with a specific treatment plan for children. It was blanket treatment that has worked to the disadvantage of HIV-positive children," Angaga told IPS.

Patrick Odawo, anti-retroviral programme officer at the National AIDS/STD Control Programme (NASCOP), a government body, notes that paediatric HIV/AIDS treatment in Kenya only started two years ago. (STD stands for "sexually transmitted disease".)

In part, this reflects the challenges that confront initiatives to care for HIV-positive children around the world -- notably concerning diagnosis.

Most of the children in Kenya living with the virus are said to have been infected via mother-to-child transmission. However, diagnosis of the virus in children aged less than 18 months is problematic because infants who contract HIV from their mothers may also have absorbed antibodies to the virus from maternal blood. The presence of these antibodies is typically used to diagnose HIV; but as there is no way of knowing whether antibodies in a new born's blood sample have been created by the mother or the child, it is difficult to discern whether the child itself is infected.

In these cases, the polymerase chain reaction (PCR) technique is required. PCR allows for the replication of DNA; as a result, it can amplify HIV DNA that may be present in a blood sample, and make it possible to detect the virus.

There are currently just five laboratories in Kenya capable of carrying out PCR. But, while the technology required for PCR is admittedly expensive -- costing over 45,000 dollars -- a question that begs asking is why government found it possible to spend millions of dollars on buying luxury cars for high-ranking officials rather than invest in wider availability of PCR.

A report issued earlier this year by Transparency International, the anti-graft watchdog, and the Kenya National Commission on Human Rights indicated that the administration of Mwai Kibaki spent about 12 million dollars in 2003 and 2004 to purchase vehicles for ministers, their deputies and permanent secretaries (a directive was later issued for some of the cars to be returned). This would have purchased about 266 PCR machines.

Until recently, blood samples from babies in several government hospitals in Kenya's capital, Nairobi, had to be transported more than 450 kilometres to a laboratory in Kisumu, which is funded by the Centers for Disease Control and Protection in the United States, and the Clinton Foundation -- established by former American president Bill Clinton. (While another PCR facility has now been established in the capital to carry out tests on babies' blood, it is said to have a smaller capacity than the Kisumu laboratory.)

There have been claims that the Kisumu centre is overwhelmed by the volume of tests that it has to conduct -- from western Kenya, as well as the Nairobi region -- leading to delays in issuing results.

"The test should take two weeks. If the mothers come and find that the tests (results) are not there they do not come again, because it is expensive paying transport two or three times," said Van Winghem Joelle, project coordinator at Mbagathi District Hospital in Nairobi for Doctors Without Borders (M decins Sans Fronti res, MSF). MSF is a global aid agency.

Together with the Ministry of Health, MSF runs an HIV/AIDS clinic at Mbagathi where about 950 children have enrolled since 2003, some 450 of whom are on ARV treatment.

Paediatric AIDS care has also been hamstrung by a lack of fixed dose combinations of ARVs, where two or three drugs are combined in single formulation. This has made adherence to treatment regimens on the part of caregivers problematic, and opened the door to development of drug-resistant strains of HIV.

Most of the drugs require cold storage; however, several parts of Kenya lack the electricity needed to run refrigerators -- which many people are too poor to buy. According to government figures, about 56 percent of Kenyans live on less than a dollar a day.

In addition, Kenya is short of sites offering ARVs for children. While there are 261 such sites for adults, only 144 exist for children. But, "We are looking at increasing the number of sites, and also hoping that next year we will be able to have more than double the number of children on ARV treatment," said NASCOP's Odawo.

Government is also at pains to point out that a treatment plan for children is now in place. This five-year programme (2006-2010) stipulates, amongst other goals, the strengthening of PCR access to ensure that this method of diagnosis is available even at the lowest level of health care -- the dispensary level.

"If we are able to diagnose at six weeks, we will be able to capture more children and put them on ARVs, thus saving lives," noted Odawo.

It further states that children aged less than 15 whose parents are HIV-positive should be tested as a matter of course. However, this measure has been heavily criticised by AIDS activists, who see it as a violation of rights.

"It is the height of discrimination," said Angaga. "Why should one test children of HIV-positive parents only? We know that there are children who are exposed to HIV through other modes. We also know that there are parents who may not have taken tests," he added.

"If we want to do prevention, let us test every child. (For) those found to be positive, let us put supportive systems in place."

Measures to ensure that children do not contract HIV to begin with include encouraging pregnant women to take AIDS tests so that they can try to avoid passing the virus on to their unborn children.

"It is risky when the mother is pregnant and she does not know her status. In the case that she is positive, both she and her baby suffer," said Esther Mureithi, a nurse at New Life Home Trust, adding that this also led mothers to abandon their HIV-positive children.

The home, with branches in several parts of Kenya, is a charitable organisation that cares for abandoned babies, most of whom are infected with the AIDS virus.

In all, some two million of the East African country's approximately 30 million citizens have contracted HIV.

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