The prevalence of HIV among adults aged 15 to 65 in Uganda is 6.2%.
PIC: Nalongo Nakato with her three year old daughter. (Credit: Elvis Basudde)
MITYANA - Mityana district health officer, Dr. Fred Lwassampijja, has raised concern over the increasing number of children with unsuppressed viral load.
Out of 500 children in the district, 40% are unsuppressed. “This is indeed, deplorable,” he regrets.
The global targets by UNAIDS is to realise 90% undetectable viral load (VL) among those who have been started on antiretroviral treatment (ART) to control the epidemic by 2020 so that it can be eliminated by 2030.
Viral load is the term used to describe the amount of HIV in your body. When the viral load is high, it means you have a lot of HIV in your body and the greater your risk of becoming weak and ill as a result of the accumulated virus in the body.
Low VL (below 1000 copies/ml) shows that the ARVs are working well. High or unsuppressed VL (above 1000 copies/ml) shows that the ARVs are NOT working well, meaning a patient is not taking their ARVs properly (poor adherence).
Undetectable viral load means that treatment has worked and HIV has stopped making more copies of itself in one’s body.
However, this is not the case with children (aged 0-15) living with HIV in rural areas.
“It is regrettable that children are not suppressing their viral load due to poor adherence.
"There are many factors that contribute to children living with HIV not suppressing viral load, and the “key drivers” are the parents who abandon their children leaving the responsibilities of child care to the grand parents who are in most cases aged, sickly, financially constrained and sometimes drunkards,” says Lwasampijja.
Other glaring issues children are grappling with under the care takers include poverty, poor feeding, unhealthy living conditions, long distance to the health facility, stigma and discrimination, drug stockouts, unfriendly youth corners at the facility, neglect and abuse by adults.
Poverty is another outstanding factor. Majority of these care takers live below poverty line and cannot afford necessities. Sometimes children miss appointments because they do not have transport to the health facility.
Samari Nakawuuiki who is in charge of maternal child health at Kyantungo health centre IV, says the long distances from their areas to the health facility are a big hindrance.
“Sometimes they may not have money to collect the medicines. And for the school going children, it becomes a nightmare to leave school and walk a long distance to pick medicine. So they tend end up failing to adhere to treatment,” says Nakawuuki
Jingo Ahmed, also a health worker in the ART department at Kyantungo health centre IV, says some guardians do not care much to come and get the children’s medicine.
Instead, they send the children alone unaccompanied and some of them may not reach the facility.
Those who are able to reach the facility may find that the drugs are out of stock or they may be discouraged by the big number of clients they find at the facility.
Most of these facilities also lack friendly youth corners where these children could get drugs.
As she shades tears while narrating her ordeal, Nalongo Nakato, a resident of Mutete says she delivered twins but one of them died.
What hurts her most is the fact that the father of her remaining child has abandoned them for another woman.
Nalongo is HIV positive and her three-year-old daughter is positive as well.
She says they both swallow their ARVs well but sometimes she would forget as she is overwhelmed with the burden of looking for food.
“I get my medicine from Kyantungo Health Centre IV, six kilometres away from where I stay.
"Many times I miss out on going for refill and any medical investigations because I lack transport to the facility,” she says.
“My daughter and I are on our own with God as our keeper. I have forgotten all about the father of my daughter because he doesn’t add any value to our existence. He last cared for this girl when she was two weeks old,” she added.
The 57-year-old Lydia Mbabazi takes care of a seven-year-old grandson whom he says his mother dumpedat her homewhen the boy was barely four months old.
The boy’s father is there but helpless as his work is just to drink alcohol.
The boy falls sick often due to opportunistic diseases because he is not taking his medication regularly.
Mbabazi sometimes fails to pick his medicine from the health facility five kilometres away because she doesn’t have enough money for transport.
As a result, the boy sometimes misses out on his medication. The boy does not go to school.
Mbabazi says the boy was born with HIV but due to poor health care, the boy looks sickly all the time.
The feeding is also a challenge. Mbabazi has a small garden where the family of five grows food but due to drought, the harvest is not always good.
A survey conducted in Mityana by The National Forum of People Living with HIV&AIDS Networks in Uganda (NAFOPHANU), an umbrella organisation of networks of people living with HIV in Uganda, documented these as some of the salient challenges associated with children living with HIV.
“These challenges are characteristic all over rural areas with children living with HIV being taken care of by elderly people.
They greatly affect these children’s education as well as adherence to treatment and access to treatment,” says Dorothy Nassolo, the NAFOPHANU communications and public relations officer.
“The plight of children being taken care of by their elderly and sickly great parents needs to be addressed urgently.
Those in school suffer stigma, poor feeding at home, and therefore, poor adherence to treatment because living under such conditions makes it difficult to supress the viral load,” she says.
Adding that, “If they are having unsuppressed viral load, it is dangerous as it results in having the virus which is resistant to drugs. Such a virus can continue multiplying until the line of medicine is changed.
There is need to strengthen the social protection policy and also reduce on the dependence levels," she says.
The study was carried out in collaboration with Aidsfonds, through “Towards an AIDS Free Generation in Uganda” (TAFU) programme.
Interventions are aimed at reducing the number of HIV infections among children and increase the number of children living with HIV enrolled and retained on treatment.
The prevalence of HIV among adults aged 15 to 65 in Uganda is 6.2%. This corresponds to approximately 1.2 million people aged 15 to 65 living with HIV in Uganda.
The prevalence of HIV among children aged 0-14 is 0.5%which corresponds to approximately 96,000 children living with HIV (the 2017 statistical abstract from Uganda Bureau of Statistics).
In Mityana alone, the prevalence is about 2% but more in girls, about 1.2% and the boys about 0.8%.
And for the adult population in Mityana the prevalence is 7.4%. The 500 children in Mityana district are among the 96,000 children, under the age of 14, who are living with HIV in Uganda.
Nakawuki says as a mitigating factor, they try to health educate them, to monitor these elderly caretakers by making physical visits to their homes.
The elderly have also been empowered to at least be able to produce food for themselves or by keeping animals.
And for those in the habit of drinking alcohol and getting drunk are advised to stop it.