Global Health and HIV and AIDS

Every year on December 1, the world commemorates the “World Aids day” and each year has its theme. This is one of the important days on the fight against the pandemic. The other is the May, 18^th when the world unites against in candle light memorial vigil. These day have made distinctive impact in the fight against the disease for more than two decades. World aids has been there since 1988 and the candle light memorial since 1983. This today’s commemoration marks 21^st anniversary since it was first designated. Interestingly, for the first time in the history of candle light memorial in 2008, the day was inaugurated by the Malawian President Dr. Mutharika in Africa. I am saying for the first because the day has always been inaugurated in the US.  Perhaps this indicates how the problem of HIV and AIDS has become more global. This calls for the need to collaborate globally and engage each other, if we are to fight the disease.

For the 2008 candle light memorial vigil I was excited to have been invited to participate in the event that was held was in the Lilongwe Capital City’s soccer arena Civil ‘Civo’ Stadium. Soccer here has been used due to the diversity in the audience intended. You would agree with me that most African nations and indeed Europe they call the sport football, which is a different issue altogether in the US. So to avoid such misunderstanding better choose a term to be appreciated by many. Well, back to the issue, I was excited because my participation, rather our participation I was not invited as an individual. The invitation was extended to Baylor College of Medicine’s Children Foundation – Malawi (BCF – M). The foundation has runs the only specialized pediatric HIV and AIDS care services in Malawi and serves largely the central region. It has some presence in Zomba and Blantyre in the south and Mzuzu in the northern region respectively. The services range from the provision of antiretroviral therapy, nutritional support to psychosocial support to the population it serves. The psychosocial support, by June, 2009 it had registered about 150 children to its membership club called Teen Club.

This does not any way mean that the foundation is only serving 150 children. Since its official inception in 2006 it has ever enrolled about 4000 patients under its care. The ages range from less than 6 months old to more 18 years.  So being the largest facility providing care to this age group, the organizers of the event felt obliged to include us in the program. Therefore, we had to join the big walk at 6:00am from the Nico Center, popularly know as “Pa Hyper” after one of the building’s biggest client. The children came and participated in the march to the stadium, hoping that someone will also tackle the challenges that children with HIV and AIDS encounter in a day to day life. On personal note though, I was shocked on behalf of the children whom I had accompanied that there was nothing near addressing the plight of the children. To say the least I was shocked to the extent that if I did not accompany these children I would have walked out the stadium way before the candle was lit by the country’s president.

Having about 91, 000 children who are eligible for ART and about 250,000 children orphaned due to deaths of parents due to HIV and AIDS related sickness bother me most. Furthermore, those at policy making level, makes me wonder if they have ever sat down and start think if it is prudent to think that there are no children who are HIV positive after having found out that the virus has been with the human population for more than half a century. Consider this; what could have happened to a mother was HIV positive say between 1985 to about early 2000 in Africa, when services like pMTCT where not known let alone available to many such people. For sure children being born to such mothers were at more risk to contracting the virus during birth as there was not prevention in place to protect such. So does it make sense for people to continue giving less regard to children who might have been in such a situation? For obvious reasons, no. This where is anger and frustration may be coming from. For some of us and me in particular who really are passionate about helping the children have there voices heard are hardly given an opportunity to meet people like the Global Health Council president, the GHC is one of the greatest stakeholder in the organization of candle light memorial vigil. I don’t even know if the organizers had even thought of a post event analysis to think what went well and what was left out. If they did nothing was heard. Or I did not hear anything to that effect.

It is rather disturbing to realize that of 33.2million people living with HIV and AIDS out of which 22.4million are in the Sub-Saharan Africa as per UNAIDS and other bodies in the frontline fighting against the disease estimates, about 2.5million are children.  They get infected before reaching 25 years and are killed by AIDS before they are 35 years. Ironically, this hardest hit region enjoys some relative peace, of course with exception with countries like Democratic Republic of Congo. May be were not doing enough, or our interventions are not good enough to fight HIV and AIDS.

I had an opportunity of attending a Grand Round at the New Jersey Medical School marking the world AIDS day. The speaker was Dr. Roy M. Gulick, Professor of Medicine, Chief-Division of Infectious Diseases, Weill Medical College of Cornell University, New York. Some of the statistics that came out  were relatively new to me but informative. These are since the time AIDS was first diagnosed in 1981, there has been 70million people to have ever lived with the virus. Half of them are living, the converse is true. And the whole of North America (US and Canada) has 1.4million people living with HIV and AIDS, with US having about 1.2million. More than 50,000 (56,000) new cases of HIV infections are reported every year in the U.S. Now when we look at the disparities, perhaps or perhaps not we need to focus some energy in the Sub-Saharan Africa.

However, it is only good to say that there are some people who are working day and night to make sure that HIV and AIDS is dealt with. This is either through conducting the vaccine trial. One of such is the Thailand vaccine trial that has managed to let scientist that if we all put efforts we will conquer AIDS. As one of the investigators, “though the trial showed 31% effectiveness in preventing HIV, but it should be said that it is still significant.” There are also other organizations like Clinton HIV and AIDS Initiative (CHAI), Baylor International Pediatric HIV and AIDS Initiative (BIPAI), Partners In Health (PIH) and PEPFAR a United States government initiative that are doing an incredible job in the fight against HIV and AIDS. For instance, BIPAI has made itself a champion in pediatric HIV across the Sub-Saharan Africa. It has a network of clinics in Botswana, Lesotho, Swaziland, Malawi, Uganda, and Tanzania and partnered with others in South Africa, Mozambique and Libya. The other good thing is that they have tried to build capacity on local staff on HIV management through the national foundations.

Also another way of fighting against AIDS is to appreciate the role that young people can do. For instance, if one follows this link will understand the sentiment being made by young leaders across the globe (http://www.worldaidscampaign.org/). However, there are even a lot of young people especially the adolescents who seem to have no voice, like the ones I have lighted above. These children face stigma and discrimination to some degree in different situations. This can be at home or any other social gathering. There are a lot of unheard stories across the globe about HIV and AIDS.

It is no secret on my part that I have a passion about serving the underserved especially children living with HIV. Until three months ago I was available for children in Malawi to offer my support psychosocially. The support transcended across my professional attachment with Baylor. I just had to be by them every third Saturday of the month. Having them address me with not so good a diminutive of my name as ARichaR, (as a form of respect I guess) it really made feel good.

As we commemorate the “World AIDS Day” under the theme, “Universal access and Human rights” we should be mindful of the both the strides made in the last quarter century and the challenges that are so enormous.

*I dedicate this piece to the two children who died in 2008. These are YM who died a day after I had promised to give him a camera in January. And BP an energetic 15year old boy who died on the Christmas Eve (24^th December). May the souls of the two children continue to rest in peace.