by Patty Hewson | Wynnewood, United States
Goal: To increase knowledge of the mechanisms of treatment within HIV orphaned children in Cameroon.
Arts and Crafts
Topical Flouride Application
With the availability of highly active anti-retroviral therapy (HAART), HIV has become a manageable disease in Cameroon. In spite of this availability, the process of accessing health care, diagnosing, and treating HIV positive persons within Cameroon remains formidable. With an HIV prevalence rate of 5.1% in the adult population, Cameroon has one of the highest rates within Western Africa. The maternal to child (MTC) transmission rate remains high at 6%, leading to 7,300 newly infected infants born in 2010. There are currently 304,000 children orphaned by HIV within the country.* As of 2005, the government of Cameroon has made HAART available at no cost to infected children as well as adults. However, many problems remain in the acquisition of the medication and the proper management of the disease. Factors that underlie this include a lack of education, financial resources, and a road infrastructure to travel for treatment. Children between the ages of 0 and 14 years represent the populations least likely to receive treatment. Of all children eligible for HAART in Cameroon only 13% are currently receiving treatment.* In spite of the World Health Organization’s (WHO)’s goal of beginning therapy with CD4 counts lower than 350, many adults and children do not begin therapy until an opportunistic infection occurs and CD4 counts are by that time much lower than the recommended 350.** Some of the barriers that exist in utilizing HAART in Foumban, Cameroon include: 1. Lack of knowledge about the disease, limited awareness that medications are available, and lack of awareness of how the medications work to decrease viral load and increase immune function. 2. Heavy stigma attached to the disease and reluctance to admit that the disease is present within a family. Therefore children who are HIV infected are not informed of their diagnosis and the reason they are taking the HAART medications, or instructed in preventing spread of the disease to others. 3. Lack of financial resources to access medical care as there is no health insurance or provision of free medical care in Foumban, Cameroon. 4. Diagnosis late in the course of the disease once a person has manifested signs of illness. 5. Lack of financial resources available to cover the cost of transportation to medical facilities and to pick up the monthly allotment of medication. 6. Lack of confidentiality. HIV medications are dispensed in one room within the government hospital that is known to be the “HIV Room. “ Patient’s names are recorded in a book, which is visible to others. The only parameter used to determine if a medication regimen is working is a monthly weight check done on the scale in this room. 7. Difficulty in obtaining the lab work necessary to begin or change the HAART regimen. Prior to 2011, it was impossible to obtain a CD4 count within Foumban, a town of 110,000 as the CD4 machine was in disrepair. Given that a CD4 count or symptoms of AIDS are required prior to the initiation of HAART, doctors were forced to wait until children became ill prior to distributing medications. Although CD4 counts are presently available at a cost of $10 each, patients remain unaware of their importance and how they serve as a marker of disease progression. Furthermore, as of 2012, it is still necessary to travel 7 hours to the capital city of Yaoundé and to pay $70 in order to obtain a viral load, that is necessary prior to qualifying for second line HIV medications. Families providing support for children orphaned by HIV do not have the financial resources, knowledge or sophistication needed to carry out these recommendations unassisted. 8. The use of traditional medicines employed in the treatment of HIV by witch doctors and other non-medical providers. In addition the tendency to revert back to traditional medicine verses maintaining the use of HAART once a patient begins to improve on the HAART regimen. 9. Frequent hospitalization and medical treatment of children who begin therapy only when CD4 counts are already low, have interrupted HAART therapy, or have developed a resistance to the first line of medications available. -------------- * National AIDS Control Committee Central Technical Group, (2010). The Impact of HIV and AIDS in Cameroon Through 2020 ** World Health Organization, (2010). Antiretroviral Therapy for HIV Infection in Infants and Children:Towards Universal Access Recommendations for a Public Health Approach