[Audio: Human Rights Watch's Juliane Kippenberg explains why children are not getting life-saving access to treatment for HIV/AIDS in Kenya.]
(Nairobi, December 16, 2008) - About 40,000 children in Kenya are likely to die in the next 24 months if they do not receive antiretroviral treatment (ART), Human Rights Watch said in a report released today. Anti-retroviral drugs are free in Kenya, but are not reaching two-thirds of the children who urgently need them.
In the 100-page report, "A Question of Life or Death: Treatment Access for Children Living with HIV in Kenya," Human Rights Watch documents how the government's HIV treatment program has failed to get lifesaving drugs to the majority of children who need them. If untreated, half of all children born with HIV will die before their second birthdays. Yet, many local health facilities do not ensure that children have access to HIV tests and rarely offer antiretroviral treatment for children. Medical staff are often not trained to deal with HIV in children, and there are too few community health workers to help children gain access to testing and treatment.
"The Kenyan government has focused on getting treatment to adults but has neglected children living with HIV," said Juliane Kippenberg, senior researcher on Africa in the Children's Rights Division of Human Rights Watch. "The recent expansion of infant testing is a step in the right direction if carried out properly, but the government needs to do much more to help children overcome treatment access barriers."
There are at least 60,000 children in need to anti-retroviral treatment in Kenya. The number could be considerably higher if one takes into account recent government guidelines that require all HIV-positive infants to get treatment. At present, only 20,000 children - a third or less - of the children are getting treatment, compared to about 54 percent of the estimated 392,000 adults in need of treatment.
Nearly 90 percent of HIV-positive children worldwide live in sub-Saharan Africa. More than half of the global number of people in need of treatment live in Eastern and Southern Africa, and the region has the highest number worldwide of child deaths due to HIV. Kenya is representative of many of the challenges Eastern and Southern Africa face in fighting the epidemic.
Human Rights Watch appealed both to the Kenyan government to strengthen health and child-protection systems to get children the treatment they need, and to international donors to support these measures and to help strengthen Kenya's health system as a whole.
HIV-positive mothers and children often experience discrimination, violence, and property loss, making it harder for the women and their children to seek care. Children, especially those orphaned by AIDS, are sometimes neglected, abused, or sent from one relative to another. The result often is that they don't get treatment. Economic barriers to treatment are also considerable.
"Families often cannot afford transportation to health clinics or simply enough food for the medicines to work properly," Kippenberg said. "As a result, children do not get the medicine they need, or they are forced to stop their treatment."
Post-election violence in early 2008 also disrupted some children's treatment. While most patients were back on treatment within a few weeks, some children stopped taking the drugs due to lack of food or supply failures, and died as a result. Access to HIV services remains precarious for displaced children living in transit camps.
Human Rights Watch called upon the government to address barriers to HIV treatment for children by strengthening legal protections, health policies, food security, and community mobilization. In particular, the government of Kenya should:
- Develop child-focused health policies and services, including pediatric treatment at local-level health facilities;
- Expand the role of community health workers, who often help children get access to care;
- Strengthen child-protection services, for AIDS orphans in particular;
- Carry out campaigns to reduce the stigma of HIV; and
- Improve food security.
Selected accounts (names changed to protect privacy)
"Today, my daughter is ... staying in the village with my grandmother... but she is not on ART. The grandmother is old and can't take proper care of her. The hospital is too far away and there is no money for transport. The nearest hospital is in Migori District in Nyanza province. But the grandmother's village is Awendo village in Kisumu district. The grandmother has asked me to come to get the girl because she has a wound on her leg that is not getting better. But I can't take care of her now. I don't have a place to live myself."
- The mother of a 9-year-old, HIV-positive girl in Mombasa who is not getting treatment
"My daughter was very sick, I had to go out and get drugs for her. She was very down. She went without drugs for around one month because I couldn't get food to eat. I would often return home at night with nothing to eat, and I couldn't give my daughter the pills because she was too hungry. This was after the [post-election] violence...."
- A mother in the Mathare slum in Nairobi who could not give her daughter ART because she had no food
"He improved greatly. He went to primary school class four. Then, during the Easter break in April, his paternal family [in Kisumu] wanted him to visit. They mishandled him. He did not take his drugs there. He came back alone, on a vehicle, very weak and sick. They did not escort him and did not take him to the hospital. It was as if they did not want him anymore and sent him back. When he came back, we took him to Bondo Hospital. He died the same night."
- The maternal aunt of an HIV-positive boy who died in May at the age of 8, and had received his tuberculosis medicines and antiretroviral drugs inconsistently
"Both my parents died. I had two stepmothers who were married to my father. I lived with them. Sometimes they gave me food, sometimes not. My older sister ran away.... I was sometimes sick. They put me outside the house during the day and left for work. I would stay like that until they come back. I just laid down, people used to pass. One day, a stranger lady came and found me sleeping outside. She took me with her to her home. I stayed with her for some time, but then she became mean to me. She cooked my food separately from hers and she prepared it badly. I was sick then, and she did nothing about it."
- Christine, a 15-year-old, HIV-positive girl, who sought help from a complete stranger when her stepmothers mistreated her