Grandir

Experiences: words to break the secret

Participants were struck by several particularly moving stories. Kerrel MacKay, a 20 year old Jamaican whose father had AIDS described how hard it was for her to care for her dying father without being able to talk to anyone about this secret illness.

Jeanne Gapiya-Nyonzima, President of ANSS, a care and support organization for PWHAs in Burundi, has been speaking publicly for over 10 years about being HIV+. But it was during this conference that she chose to speak about a particularly painful moment in her life "(In 1988) I became pregnant with my second child. The doctor who I saw at the time knew that my first child was infected. Thinking that he was doing right, or not really knowing what to do, he decided that I should abort. However the pregnancy was already quite advanced so I ended up having a hysterectomy which was psychologically devastating. For years I felt as if I had literally been mutilated. Now, thanks to scientific progress and technology it is possible for HIV+ women to have children and to protect them against HIV infection. Unfortunately I will not be able to benefit from these advances because I will never be able to give life"

In the fight against AIDS words can be healing and help to lift taboos and secrets. In a conference forum but also between parents and children, as the orphan members of the Ivorian organization Nzrama reminded us during the conference's closing session.

To find out more Testimonials can be
viewed on line
http://colloque.colloque-enfance-sida.org/
colloque/multimedia/
videos/var/lang/EN/rub/1008.html

DBS PCR: an invaluable tool in early and accessible diagnosis

During the conference "Childhood and AIDS", the importance of early HIV diagnosis in children was often mentioned. Mortality linked to HIV is very high during the first 2 years of life. Common HIV tests (detection of HIV antibodies) are not adapted to the situation of the infant who carries his/her mother's antibodies sometimes up until the age of 18 months. CD4 count may have useful diagnostic value for children in this age group, but PCR tests which detect HIV-DNA or HIV-RNA remain the only way to confirm infection in young children (not before 6 weeks especially in children who have received ARVs in the context of PMTCT).

PCR remains expensive and requires specialized reference laboratories equipped with specific personnel and technology, so it is generally inaccessible to patients who live far from large African capital cities. The technique of using dried blood spots (DBS) on filter paper is changing this situation. It makes it possible for the use of PCR to become more widespread, as it requires equipping a limited number of reference laboratories and training a smaller number of laboratory technicians.

Simple and risk-free technique: 5 drops of blood taken from the child's heel are placed on filter paper. This is taken to the reference lab. Government subsidized programs are starting up for example in Rwanda, Uganda and Ivory Coast, enabling better national coverage.

Limits: The filter paper must be kept dry and protected (plastic bag or cellophane) so as to prevent them from touching each other during transport. A transport system needs to be set up to take specimens to the laboratory. Partnerships with postal companies should be considered. Blood sampling is simplified at the local level, but it requires the lab to take on a few additional steps/tasks. Remember that if the HIV exposed child is symptomatic, PCR will only confirm the decision to start ART; and if the child is asymptomatic, two negative results repeated at a two month interval don't exclude the possibility of the child becoming infected later on through breastfeeding, if breastfeeding does continue (repeat PCR two months after weaning). Finally, spreading PCR on the national level is worthwhile only if test results are given quickly.

To find out more
PCR (Polymerase Chain Reaction) is a gene amplification technique (molecular biology)

Further news on DBS on "Women, Children and HIV" website http://womenchildrenhiv.org/
wchiv?page=ch-15793374

ICAP's and ANECCA's training modules on early diagnosis are available on line at www.columbia-icap.org/ethiopia/pdf/
infant_diagnosis_lecture.ppt www.anecca.org/index.php?option=com_downloads&Itemid=
51&func=fileinfo&parent=
category&filecatid=3

ANECCA's algorithms for early diagnosis of pediatric HIV are available at www.anecca.org/index.php?option=com_downloads&Itemid=
51&func=fileinfo&parent=
category&filecatid=17

An article in Transversal on alternative techniques for biological tests (in French only) www.sidaction.org/actualite/
transversal/recherche20/file

Answer to last month's case

We gave you an exercise concerning ARV dosages. Here are the correct answers:
Yacouba - Triple therapy AZT + 3TC + NVP
Dosages AZT 9ml, twice a day -- 3TC 4ml, twice a day -- NVP D1-D14: 4ml, once a day / D15-D30: 6ml (or 7ml), twice a day
Quantities to be given for the first month of therapy AZT 6 bottles/100ml -- 3TC 3 bottles/100ml -- NVP 3 bottles/100ml Isabelle - Triple therapy d4T + 3TC + LPV/r (or EFV but monitor transaminases)
Dosages d4T 20ml, twice a day -- 3TC 1/2 scored tablet, twice a day -- LPV/r 2,5ml, twice a day -- or EFV 1 tab@200 mg + 2 tabs@50mg to be administered in a single dose in the evening
Quantities to be given for the first month of therapy d4T 6 bottles/200 ml -- 3TC 30 pills@150mg -- LPV/r 3 bottles/60ml -- or EFV 30 caps@200mg & 60 caps@50mg

A new case study on HIV disclosure

On June 14, Growing Up and Serment Merveil (Congolese NGO) conducted a satellite workshop on disclosing an HIV diagnosis. The following case came up for discussion.

Cecilia is 8 years old and lives with her maternal grandmother and 3 brothers, the youngest of whom is HIV+. Her mother died two years ago and her sick father has returned to the village where he was born. Cecilia, who tested positive after her mother's death, is not aware of her HIV status. She is seen by a hospital doctor on a regular basis but is not on ART. Her CD4 count is still high. Her little brother is treated at the same hospital and he is on ART. Lately, Cecilia has been asking a lot of questions to the hospital staff, "Why do I have to come and see the doctor? Why does the doctor give medicine to my brother and not to me? How come my other two brothers do not come see the doctor here?" How would you react if you were faced with these questions?

To find out more
The terms of the exercise and the full-fledged and detailed answers are available at
www.sidaction.org//pro/
international/grandir/outils/


























Please send your answers to grandir@sidaction.org
and win book on HIV/AIDS!