Teen Horrors: HIV stigma among Malawi’s young

 

Lilongwe ‑  Teen Club, a youth organisation based in the northern Malawi district of Rumphi, was formed last year to deal with continued stigma and discrimination of people living with HIV.

Sixteen-year-old Chikumbutso Phiri is a member of the organisation. She says stigma and discrimination by family members and the community remain a big challenge for people affected and infected with HIV and AIDS. She recalls a situation where one of the youth lost both parents to the virus and attracted stigma from her wards that did not miss any opportunity to remind him that his parents had died of AIDS.

“We ganged up and approached the family to discuss with them how their behaviours would impact on the young child,” she says adding that after several discussions with the family the situation had since changed.

Chikumbutso also narrated a case in which a member of the club reported that his relative, who had been diagnosed positive at birth and was on antiretrovirals (ARVs), was facing stigma and discrimination at school after fellow students realised that their friend was on the life-prolonging drugs.

“We learnt that the child was born positive and was on drugs,” said Chikumbutso, who bemoaned lack of proper communication and information to tell the child of his predicament.

“We were told that the relative was given ARVs under the pretext that he was taking asthma dosages but when his schoolmates realised that he was taking ARVs, they begun making fun of him together with his family,” said the Teen Club member.

Teen Club is now trying to find ways of approaching the school authorities and the parents to mitigate the situation. United Nations Population Fund (UNFPA) HIV Prevention Officer, Humphreys Shumba, says situations where parents hide their HIV status are on the increase.

“Unfortunately, this only serves to take away the self-esteem of would otherwise be intelligent pupils and students,” Shumba says.

Meanwhile, Shumba says hiding information from children living with HIV into adulthood poses big challenges to HIV programmes because a significant number of HIV positive children are surviving and ageing into adulthood and sexual activity without knowing their status.

He explains that while HIV prevalence is much lower in the 0-14 than in the 15-49-year-old age group, it nevertheless results in a significant influx of HIV positive adolescents into the adult population. 

The prevalence of HIV among 10 to 14-year-old children in Malawi is roughly two percent, according to the 2013 Spectrum AIM, an estimate also reflected in 2010’s Malawi Demographic and Health Survey of HIV prevalence among those who never had sex.

Shumba warns that studies have shown that at two percent HIV prevalence rate, there are approximately 10 000 HIV-positive 14-year-olds out of a total 440 000 children in this age group, who will enter the 15+ adult population by the end of the year.

“This influx of HIV positive adolescents can be expected to hold steady for the next few years, as HIV infants and children from cohorts born in the era before prevention-of-mother-to-child transmission (PMTCT) programs were put in place, age into adulthood, he says quoting one of the studies conducted in the country.

However, a study titled “Modes of Transmission Analysis and HIV Prevention Response” shows that the number of transmissions at six weeks has declined sharply since the inception of the national PMTCT program in 2002, and was estimated to be around nine percent in 2012, with a further decline expected to be below 5 percent by 2015.

“Thus, the cohort of HIV-positive adolescent (0 to 14-year-olds) can be expected to decline significantly in their numbers in the medium-term, starting when the cohort born at inception of the PMTCT programme enters adulthood,” says Shumba adding that the situation will, however, reach a steady state if current patterns of breastfeeding, during which a significant fraction of transmissions occur, continue in Malawi.

Current patterns show that close to 50 percent of women who breastfeed, do so at 12 months after birth, according to health survey.

This mode of vertical transmission, however, can also be limited when ART is provided to all breastfeeding HIV-positive mothers, as is the case with the adapted Option B plus, World Health Organisation (WHO) programme currently underway in Malawi.

The transmission analysis and HIV prevention response study reveals that eventually adolescent HIV-positive cases do not hold a significant transmission risk to their partners, as most of them should be stable ART partners, which should drastically reduce their potential in terms of the onward transmission of HIV.

Receiving ART seems the best explanation for survival.  However, programmatic data, interpreted together with insights from Spectrum AIM 2013 projection for Malawi, suggest a more complex situation where approximately 40 000 (approximately 20 percent) out of 180 000 HIV positive children aged 0-14 received ART in 2012.

Further, a significant proportion of past vertical transmission of HIV occurred during breastfeeding, and these children have a much better survival outcomes compared to children infected perinatal, as survival prospects with HIV increases with age at infection.

Hence, a significant proportion of 0-14 HIV-positive children may have survived to the point of adulthood without receiving ART. The study summarises that over the next few years a steady stream of HIV-positive adolescents will age into the adult population.

“It should not be assumed that their survival to this stage of life must have been due to ART. A significant proportion of those infected relatively late in their live during breastfeeding, may have survived without ART”.

October 2013
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