Keren Dunaway was five years old when her parents used drawings to explain to her that they both had HIV, the virus that causes Aids-and so did she. Now the 12-year-old is one of the most prominent Aids activists in Latin America and a rarity in a region where few children are willing to break the silence and tell their classmates they have HIV for fear of rejection.
"The boys and girls who live with HIV are here and we are growing up with many goals," Keren said at the opening of the recent international Aids conference where she shared the stage with Mexican president Felipe Calderon and UN Secretary-General Ban Ki-moon. "We want to be artists, teachers, doctors-and even get married and have kids. But achieving these goals will only be possible when we receive the attention we need, when we are guaranteed the medicines that we need, when we are accepted in schools."
Taking several deep breaths to overcome stage jitters, Keren delivered what was clearly the star speech of the conference's inauguration. The audience repeatedly interrupted her brief, but moving words with loud applause and whistles, and followed her discourse with a standing ovation that lasted well after she left the stage. In an interview with The Associated Press days before the conference, Keren talked matter-of-factly about the virus she has had since birth, flashing a dimpled smile and exposing a row of braces. "It is like a little ball that has little dots, and is inside me, sort of swimming inside me," she said, curling her fist as she recalled what her parents explained to her with drawings long ago.
Keren's openness about her HIV status comes as the virus' victims grow increasingly younger. According to the 2008 UN Aids report people of ages 15-24 accounted for 45 percent of those infected with the virus in 2007 worldwide. Each year, around 370,000 children aged under 15 become infected with HIV. Almost all of these infections occur in developing countries, and more than 90 percent are the result of motherto- child transmission during pregnancy, labour and delivery, or breast-feeding.
Without interventions, there is a 20-45 percent chance that a baby born to an HIV-infected mother will become infected. In Malawi the national HIV and Aids policy provides for medication to be provided to pregnant mothers who are found to be HIV-positive to prevent mother-to-child transmission (PMTCT). The most effective way to prevent mother-to-child transmission of HIV involves a long course of antiretroviral drugs and avoidance of breast-feeding, which reduces the risk to below 2 percent.
Since 1999, it has been known that much simpler, inexpensive courses of drugs can also cut mother-to-child transmission rates by at least a half. The most basic of these comprises just two doses of a drug called nevirapine-one given to the mother during labour and another given to her baby soon after birth. These short-course treatments, combined with safer infant feeding, have the potential to save many tens of thousands of children from HIV infection each year. Recognising this potential, UN member-states set targets for preventing mother-to-child transmission in 2001, as part of a landmark agreement called the UNGASS declaration. In this document the world's leaders made the following pledge: "By 2005, reduce the proportion of infants infected with HIV by 20 percent, and by 50 percent by 2010, by ensuring that 80 percent of pregnant women accessing antenatal care have information, counselling and other HIV prevention services available to them." Because HIV can be transmitted through breast milk, a mother's method of infant feeding has a strong influence on the likelihood that her baby will become infected.
The only certain way to avoid transmission is to abstain from breast-feeding and provide replacement foods instead. But even where this is feasible, it is likely to increase the risk to the baby from other illnesses such as malnutrition and diarrhoea. Therefore, many impoverished mothers are best advised to breastfeed even if they are HIV-positive. The case in Malawi is the samethe national nutrition policy stresses the need for exclusive breast-feeding. Principal secretary for nutrition and HIV and Aids Dr. Mary Shawa said by putting in place such policies the Malawi government recognised the critical role breast-feeding plays in child survival development. "As the government and also department responsible for nutrition we recognise the role that breast-feeding plays in child survival growth and development hence we have introduced these policies in order to promote adequate nutrition and health for children," said Shawa.
In Malawi about 40,000 babies are infected annually by their mothers. However, those who attend prenatal facilities in hospitals undergo testing and are given the necessary precautions to avoid transmission of HIV. This includes medication throughout the pregnancy and that prescribed after the child is born.
Medical Aid Society of Malawi, marketing manager Andrew Ngomwa emphasised that medication for HIV-positive patients is provided at no cost or a very minimal cost. "Every individual as long as they are a member of MASM has access to HIV management medication. All it requires is for one to step forward and say 'I am positive' to his doctor," said Ngomwa. Depending on the hospital and the medical scheme MASM members pay no shortfall for antiretrovial services if they go to government and mission hospitals, but there is a shortfall in all private hospitals which could be in the ranges of 10 percent for members on the VIP scheme and 20 percent for members on the Executive scheme.