Newsletter GRANDIR | La lettre d’information sur le VIH pédiatrique en Afrique

In 2005, the WHO estimated that between 700.000 and 1 million children under 5, died each year of pneumonia. Most of them lived in developing countries. HIV infection greatly increases the probability of contracting pneumococcal disease. The association of HIV infection with sickle-cell anaemia also appears to further increase the risk of severe pneumococcal infection. Growing resistance of pneumococcus to the most commonly prescribed antibiotics underscores the urgency of vaccines being made available against pneumococcal disease.

At the beginning of 2007, the pneumococcal 7-valent vaccine called PCV7, had already been approved for use in over 70 countries. It protects against 7 strains of pneumococcus. The strains targeted by this vaccine, which was initially developed in industrialized countries, are not always those most common in developing countries. It is nonetheless effective and will be replaced in the future by more appropriate vaccines. This vaccine prevents not only pneumonia but also other kinds of serious pneumococcal infections. Generally, 3 doses are administered throughout the course of the first year of life. The 23-valent vaccine, which is prepared differently, is not suitable for children under 2 years old.

The WHO advocates including this vaccine in programs on immunization. Now that the pneumococcal vaccines have proven their safety and their effectiveness in children infected by HIV, the WHO recommends that countries with a high HIV prevalence consider it a priority to start implementing the pneumococcal 7-valent vaccine.

At the end of 2005, UNICEF launched its "Unite for children, Unite against AIDS" campaign to mobilize action concerning HIV prevention, care, treatment and support of children as well as young people living with HIV in resource-limited countries. UNICEF set 4 ambitious goals to accomplish by 2010: 1. Access to PMTCT for 80% of pregnant women living with HIV. 2. Treat 80% of children living with HIV (cotrimoxazole or ART). 3. Reduce the overall number of children living with HIV by 25%. 4. Support and protect 80% of children affected by HIV.

More than a year after its inception, UNICEF has published a stocktaking report. The results are mixed:

• Coverage of PMTCT remains low: in 2006, 10% of pregnant women living in sub-Saharan Africa were HIV+, and less than 10% of them had access to antiretroviral prophylaxis to reduce the transmission of HIV to their child (an increase from 3 per cent in 2003).


• Ante-natal follow-up is still very limited, which translates into many mother/child couples not receiving regular follow up after birth: only 4% of children born to mothers living with HIV in poor countries received cotrimoxazole as prophylaxis.


• Most children living with HIV are not provided timely HIV diagnosis and few children receive the antiretroviral therapies that they need. In resource-limited countries only 10% of children living with HIV who need to be on ART have access to it.

However, there are also promising developments:

• The importance of social assistance provided by NGOs to orphans has now been acknowledged: a study conducted in 28 African countries showed that community-based organisations (CBOs) and international NGOs provided social assistance to close to 5 million orphans and vulnerable children (OVC): schooling, nutritional support, economic support, psycho-social follow-up, access to healthcare. As more programs supporting OVCs are set up, it only proves the point that better integration of the NGOs and the CBOs in national plan of actions (NPA) on OVCs is critical.


• Some countries have scaled up access to PMTCT and pediatric HIV care: In Rwanda, where a national pediatric AIDS conference is held every year, making it possible for health workers and community members to be mobilized, 20% of HIV+ children were on ART already by the end of 2005 and 36% of pregnant mothers living with HIV had access to ARVs in prophylaxis to reduce the risk of transmission from mother to child.

These efforts must be continued. However, the commitments of funds from international donors remain insufficient: UNICEF reminds us that for the period 2006-2010, 30 billion US dollars are necessary to accomplish the 4 goals of the campaign.

Congratulations to Dr. Alexia FILA, from CTA in Pointe Noire, Congo, who sent us this answer which seems to us to be the most appropriate solution to Trésor’s problem, published in Growing Up Info 12. We asked Julien Makaya, clinical psychologist at the NGO Serment Merveil to give his point of view to further complete Dr. Fila’s answer.

Alexia Fila recommends that the social worker makes a home visit to evaluate Trésor’s social and family situation. She also proposed additional consultations: that Trésor also sees a doctor for a clinical check-up after having interrupted his treatment, and so that Trésor and his aunt receive therapeutic education. She suggested that he temporarily lives somewhere else and also participates in support groups for teenagers. The goal of these measures is for the teenager to regain his self-confidence and help him deal with his positive status.

Julien Makaya sees important elements in this answer but doesn’t think that Trésor’s situation necessarily justifies getting more people involved. Involving more people in a situation where a person is already in distress can sometimes actually backfire and cause more harm.

Trésor confided his problems and his suicidal thoughts to the social worker, so it is probably better, at least for the time being, that she remains his main confidante. She should show him that she is available to listen to his problems. He can express his feelings, and release accumulated psychological tension. Their session should be a moment of understanding, empathy, comfort and support through which she helps Trésor imagine alternative solutions and approaches to his problems.

After a long exchange she should set up a series of sessions in the immediate future and the two of them should create an outline for resolving a number of issues. These issues will become clearer after the following take place:

• A home visit to meet Trésor’s aunt, evaluate the situation and take into consideration the solutions that she suggests. This visit will be an opportunity for Trésor’s aunt to learn about how HIV is transmitted, the consequences of stopping treatment and, especially, the psychological consequences of stigma and discrimination which are similar to Trésor’s current experiences.

This visit will be followed by:

• A family mediation session with Trésor and his aunt to help bring them closer together


• The suggestion of placing Trésor temporarily in a foster care center or a foster family either while waiting for the mediation session to take place or depending on its outcome.


• Suggesting that he starts immediately on ARV therapy explaining the health consequences of cessation of treatment.


• Suggesting that Trésor takes part in support groups for teenagers living with HIV to access peer psychological support, socialization by joining a new group of teenagers in similar situations. This participation in support groups would help Trésor learn to deal with his HIV status and cope with the challenges of stigma and discrimination.

If the social worker feels that it is necessary, and if it’s possible, she can seek the services of a psychologist if she feels she needs advice in counselling Trésor, or she can bring Trésor to the psychologist for consultation. She can also consult Trésor’s medical doctor to keep updated on his clinical situation and reinforce the therapeutic conselling that she has started provided him.

Your turn to play!

In each of the 12 issues, Growing Up Info presented an exercise in the form of a case study, multiple choice quiz or crossword puzzle.

This time it’s your turn to come up with an exercise that will appear in issue number 14 of Growing Up Info. It can be a case study, of course, but also an exercise in another form. If you include a photograph in your case study please make sure that the people in the picture have given their permission for it to appear in Growing Up Info.

The person who presents the most original exercise will win a reference book on HIV/AIDS!

Send your complete suggestions to: grandir@sidaction.org