MY CHILD IS HIV+. HOW SHOULD I CARE FOR IT.

Three years ago and on one Sunday morning, I received an unusual call from my neighbour. That day his sensitivity was unlike a lamppost. He asked me if I would be generous enough to be having his cousin’s kid everyday after school until the child’s parents get it in the evening upon their retirement from work. I was puzzled and I asked him why would he require same of me when everything he said seemed likely on his part? The child was his nephew, he had children who attended the same school as did the child and even a housekeeper who waited on them and besides, though I didn’t say this aloud, he was kind of a weird neighbour. Then he had shaken his head, and told me this amazing revelation.

He confided to me that when the cousin (who had just been transferred to Yaoundé and who had moved to the same quarter as we) asked him if their child could have the same housekeeper who got my neighbour’s children from school, also get his child to their house in order to stay together with it’s cousins till he and his wife returned from work, he couldn’t see why he could’ve refused them the favour but mindful of something he would tell me presently, he has thought otherwise. He said his last child of three children has HIV+ and he was finding it difficult to protect the others form being transmitted the virus from their half sister. How else more could he promote the plausible likelihood of putting his cousin’s child in harm’s way.

I listened with sheer interest as he led me though his ordeal at home and the aftermath this event could produce irrespective of either way it turned out. However, it turned out that I asked him to tell his cousin the truth and also reminded him of the doctor’s guideline as provided by the World Health Organization which same (most part copied verbatim) I am herewith going to share with my readers. Some reader may be reading this who may be HIV-infected and pregnant presently, or yet, may be gearing towards marriage or are going to face the unfortunate discovery even whilst in marriage. The following will posit for them inter alia, what they must know regarding how HIV is transmitted to the child and how it can be prevented, why they should acknowledge that the child is HIV-infected in order to access appropriate services, and many more.

The number of children under 15 who have lived or are living with HIV since the start of the global epidemic in the late 1970's is more than 5 million. 4 million of them have already died. Nearly 600 000 children globally were infected with HIV in 1999, mostly through their mothers before or during birth or through breast feeding (vertical transmission). In Cameroon presently, statistics show that the global data of 1999 has been overwhelmed.

HIV infection can be transmitted to:

1. the unborn child (in utero infection),
2. neonates during labour and delivery (intrapartum infection),
3. neonates, when exposed to infected maternal birth fluids,
4. infants after birth and also through breast milk (post partum infection) (30 percent risk of transmission).

Other sources of HIV transmission to infants and children include:

• transfusion with HIV-contaminated blood or blood products,
• use of non-sterile equipment in health care facilities,
• use of non-sterile equipment by traditional healers (surgeries, male and female
• circumcisions, scarification),
• sexual abuse,
• injecting drugs,
• sexual initiation practices involving sex workers,
• child prostitution.

Common symptoms of HIV infection in children HIV-infected children have an increased frequency of common childhood infections such as ear infections and neumonia. In developing countries such as Cameroon, diseases such as chronic gastroenteritis and tuberculosis are also frequent. In HIV-infected infants, the symptoms common to many treatable conditions, such as recurrent fever, diarrhoea and generalized dermatitis, tend to be more persistent and severe. Moreover, HIV-infected infants do not respond as well to treatment and are likely to suffer life-threatening complications. Enlarged lymph nodes and an enlarged liver are common in children infected with HIV. Opportunistic infections occur as the immune system becomes more affected, and most of these children have some type of neurological involvement, such as developmental delay or infection in the brain.

The course of HIV in infants/children are such that the majority of infected infants develop disease during the first year of life and have a high mortality rate. With recent research and new antiretroviral therapies (ARVs), there has been significant improvement to child mortality in countries where this treatment is available and accessible. The diagnosis of paediatric AIDS is difficult. In addition, in developing countries, diagnostic procedures might not be available or routinely used. Different countries might show slightly different patterns of the opportunistic infections that are common in HIV-infected children.

The signs and symptoms most commonly found in HIV-infected children include:

• Weight loss
• Chronic diarrhoea
• Failure to thrive
• Oral thrush (This often recurs after treatment and can be the first indication of HIV
• infection.)
• Fever

Making a diagnosis of AIDS in children when HIV testing is not available is not complicated. In infected women, the maternal HIV antibody is passively transmitted across the placenta to the fetus during pregnancy This antibody can persist in the infant for as long as 18 months. Consequently, during this period, the detection of HIV antibody in infants does not necessarily mean that an infant is infected. Therefore, a case definition for AIDS is made in the presence of at least 2 major, and 2minor signs.

Major signs:

• weight loss or abnormally slow growth
• chronic diarrhoea for more than 1 month
• prolonged fever for more than 1 month

Minor Signs:

• generalized lymph node enlargement
• fungal infections of mouth and/or throat
• recurrent common infections (eg. ear, throat)
• persistent cough
• generalized rash

Please note: Confirmed HIV infection in the mother counts as a minor criterion.

Having said that, my neighbour was advised not to be stereotype against his own child with HIV-related illness but rather be also very supportive while not forgetting to protect the other family members and friends. Most HIV-related illness is caused by common infections which can be prevented or treated at home or in a health centre. However, the illnesses often last longer in HIV infected children, and are slower to respond to standard treatments. The standard treatments are nevertheless the most appropriate treatments. The following general recommendations should be used in the management of HIV infected infants/children especially for mothers and other care-givers.

They must maintain good nutritional status in weight loss and failure to thrive; in most countries of the developing world, HIV-infected mothers are still breast-feeding their infants. However, with the knowledge that HIV can be passed through breast milk ( approximately 30% risk), this practice might be changing. In some countries, substitutes for breast milk may be recommended for infants of HIV-infected mothers.

However there needs to be a safe and adequate supply of affordable breast milk substitutes, access to a clean water supply and adequate means to boil water and to sterilize equipment. In some communities, where supplies and equipment are limited or unavailable, the risk of babies dying if not breastfed will be greater than the risk of passing on HIV. In countries where ARV is available, breast milk substitutes will probably be recommended.

Regular growth monitoring (preferably every month) is an appropriate way to monitor nutritional status. If growth falters, additional investigations should be done to determine the cause.

Ask your physician early to provide vigorous therapy for common paediatric infections as early as possible.

All infants with HIV antibodies should be treated vigorously for common paediatric infections such as measles and otitis media. Because the immune systems of children with HIV infection are often impaired, these diseases may be more persistent and severe, and the children may respond poorly to therapy and develop severe complications.

Consequently, the mothers of all HIV-positive infants should be encouraged to take their infants for examination and treatment as soon as possible whenever symptoms of common paediatric infections develop.

Emphasize early diagnosis and treatment of suspected TB for all family. TB is one of the most common and deadly opportunistic infections and the HIV positive child is very susceptible to contracting this disease. Every effort should be made to ensure that TB prevention and treatment is available to family members.

Immunize according to standard schedules. All infants and children should be immunized according to standard schedules. The only exception is that infants with clinical symptoms of HIV infection should not be given tuberculosis vaccine (BCG). It is important that correct sterilization procedures for immunization equipment be strictly followed.

Ensure the child has good quality of life. Most infants of HIV infected mothers are not infected with HIV. In addition, many of those who are infected will have months of asymptomatic life. Some will live for years without developing symptoms. Every effort should be made by members of the child's family and by the health care professional to help the HIV-infected child to lead as normal a life as possible.

The HIV-infected child with an opportunistic infection should have the following basic nursing care:

Infection control: Maintain good hygiene. Always wash hands before and after care. Make sure linen nappies and other supplies are well washed with soap and water. Burn rubbish or dispose of in containers. Avoid contact with blood and other body fluids and wash hands immediately after handling soiled articles.

Skin problems: Wash open sores with soap and water, and keep the area dry. Salty water can be used for cleansing. Use medical treatment, such as prescribed ointment or salve, where available. Local remedies, oils, and calamine lotion might also be helpful.

Sore mouth and throat: Rinse the child's mouth with warm water at least three times daily. Give soft foods that are not too spicy.

Fevers and pain: Rinse body in cool water with a clean cloth or wipe skin with wet cloths. Encourage the child to drink more fluids (water, tea, broth, or juice) than usual. Remove thick clothing or too many blankets. Use antipyretics and analgesics such as aspirin, paracetamol, acetaminophen, etc.

Cough: Lift the child's head and upper body on pillows to facilitate breathing, or assist the child to sit up. Place the child where she/he can get fresh air. Vapourisers, humidifiers can provide symptomatic relief.

Diarrhoea: Treat diarrhoea immediately to avoid dehydration, using either oral rehydration salts (ORS), or intravenous therapy in severe cases of dehydration. Ensure that the child drinks more than usual, and continues to take easily digestible nourishment. Cleanse the anus and buttocks after each bowel movement with warm soap and water and keep the skin dry and clean. Antibiotics used for other infections can worsen the diarrhoea. Remember to wear gloves or other protective covering when handling faecally contaminated material.

Local Remedies: There are often local remedies that alleviate fevers, pains, coughs, and cleanse sores and abscesses. These local remedies can be very helpful in relieving many of the symptoms associated with opportunistic infections. In many countries, traditional healers and women's associations or home care programs compile information on local remedies which alleviate symptoms and discomfort.

To conclude:

The ability of a family to care for a child with HIV-infection or related illness is affected by their socio-economic status and their knowledge and attitudes about HIV infection. The following questions will help the person concerned to determine what care can be expected from family members and what care must be obtained from other sources.

• What does the family know about HIV infection? Do they know how HIV is transmitted and how to prevent transmission?
• Can the family acknowledge that the child is HIV-infected, in order to access
• appropriate services?
• What is the parents' state of health, including their emotional condition? Are they
• physically able to care for the child?
• Which individuals can offer support to this family? What is their state of health?
• Are they able and willing to help care for the child?
• What is the social service system like to support this family?
• What is the family's economic situation?
• What is the condition of their living space?
• What does the child eat? Is there a food shortage?
• Is clean drinking water freely available?

Most part copied verbatim from

Barbara Stilwell's "Fact Sheets on HIV/AIDS for nurses and midwives"
WHO