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'Invisible Population' Still Lacks Access to HIV/AIDS Care

Robert Wayne | Crosswalk.com Contributing Writer | Monday, November 30, 2009

'Invisible Population' Still Lacks Access to HIV/AIDS Care

December 1, 2009

World AIDS Day 2009 comes with rising hope in the fight against HIV/AIDS, but the battle is far from over among the "invisible population." 

This demographic - children born with HIV - represents those who acquire the disease through no fault of their own, yet is often overlooked in AIDS education and resource allocation. The latest United Nations study reports that the number of new HIV infections has decreased 17 percent worldwide over the past eight years, but that figure may be misleading. About 2 million children under the age of 15 live with HIV, about 90 percent of whom acquired the virus from their mother.

In regions of sub-Saharan Africa, the killer remains very much on the loose. Especially in rural areas, HIV-infected mothers often pass the disease to their babies. Only one in three HIV-positive pregnant women receives treatment from Preventing Mother-to-Child Transmission (PMTCT) programs. 

"Most people think of HIV as primarily a sexually-transmitted disease, which it is. But there is a whole invisible population of babies being born with it because the moms have it," said Kristie Urich, coordinator of the World Vision U.S. World AIDS Day task force. "Moms don't intend to pass it to their children. It just happens." 

Many HIV-positive mothers are not being adequately educated about the dangers or else they lack the resources to thwart the disease. Their babies can acquire the virus in utero, during the birth process or through breast feeding, Urich said. 

In many regions, such as sub-Saharan Africa, cultural barriers and stigma stand between women, their children, and access to life-saving AIDS resources. 

"It's an issue of access and women's rights. It's a global issue, not just a cultural issue," said Bwalya Melu, who has worked with World Vision for nearly 20 years. 

"According to the U.N., the rates of infection are going down, which is good. But in what category?" he said. "Those not infected are mostly men. Last year's report was that a lot of women, and those under age 16, were not getting access (to AIDS education and necessary anti-viral drugs)." 

The disease can strike whole families in some places, as in Princess Kasune Zulu's case. The native Zambian lost her younger sister in 1986 to AIDS. 

"She did not make it to her second birthday because she was born with HIV, so this is very personal to me," said Zulu, who speaks on behalf of World Vision as an AIDS activist in Chicago. 

The disease took another toll Zulu's mother died of AIDS in 1993 and her father died from the disease four months later. Then, in 1997 she tested HIV-positive. Her husband at the time - the couple no longer are together - had been married twice before, and both of his former wives died of AIDS. 

Zulu was not expected to live past six months, but continues to fight the disease more than a decade later. Her book on the subject, "Why We Are Princess," is due out in December. 

"Every day 740 children die because of AIDS, one every two minutes, and without treatment more than half will die before their second birthday," Zulu said. "So this (PMTCT) is critical, because the transfer of the virus is preventable. With proper care and treatment they don't have to be born with HIV and develop AIDS." 

"It costs less than $4 to prevent mother-to-child transmission," Zulu said. "This should not still be happening in 2010." 

World Vision is coordinating efforts to increase awareness of Preventing Mother-to-Child Transmission (PMTCT) programs while also encouraging Americans to call their congressmen to advocate that promised government funding actually happens. 

"The global AIDS bill last year was re-approved to $37 billion, but it hasn't been fully funded," Urich said. "On paper it's supposed to happen, but a lot of things get cut in the legislative process." 

World Vision also intends to work toward funneling funds toward Zambia, which is one of the African nations where PMTCT needs the most support. The goal is to make prevention efforts more of a priority. 

A new child and maternal health study by World Vision shows that, despite the proven low cost and effectiveness of preventive health efforts, many of the world's poorest countries with a high incidence of HIV still fail to emphasize these resources with adequate funding in national health budgets. This includes basic prenatal and postnatal care for pregnant women, which is essential in order to test mothers for HIV and begin antiretroviral therapy cuts the risk of mother-to-child transmission to virtually zero. Even before these interventions, prevention often must start with community-level education to fight the stigma of HIV and help women understand the importance of prenatal care. 

World Vision is not the only agency serving as an advocate for the education of pregnant mothers. 

Bob Carter and his wife, Hope, have served as medical missionaries in Kenya and Zambia since 1985. The couple, stationed in a rural setting about an hour west of Nairobi, Kenya, work with Serving in Mission's Hope for AIDS program. 

Carter has seen multiple tragedies caused by AIDS. One encounter in Nairobi's notorious Kibera slum: 

"She was a 34-year-old HIV widow with four children ages 15, 12, 8 and 3 months. When her husband had died six years previously, his family had chased her away and she had returned to her own family. When she was diagnosed with HIV a year later, her own family drove her out. Eventually, the woman met a man who befriended her and helped pay for her living and medical expenses. She became dependent on his assistance. She also became pregnant. And that was the last she saw of him." 

"Unfortunately, this poor widow is not alone," Carter said. "There are thousands more like her just in Kibera.  What answer do the people of Jesus Christ have for her, and for the thousands of others like her?"

But there is hope. 

Carter pointed to a health statistic called "Life Expectancy at Birth." In 1960 the life expectancy in Kenya was 43 years.  It increased gradually and continually over the next 30 years until it reached 58 years in 1990.  Then the effect of AIDS began to be felt.  An increase in deaths at younger ages, particularly infants, resulted in a dramatically reduced life expectancy, which declined to 48 years by 2005.

At this point, PMTCT efforts had started to be introduced widely across Kenya, particularly in government facilities but also many if not most church-run health institutions. By 2009 the lost years have been regained and the life expectancy is now back up to 58 years. 

"This is best explained by a substantial reduction in the number of babies being born with HIV and a corresponding drop in infant mortality," Carter said. "This is a real sign of hope -- a sign that PMTCT, at least, is working."