OUAGADOUGOU, 18 August 2009 (IRIN) - Health authorities estimate that less than 25 percent of HIV-infected children in Burkina Faso who require treatment are taking life-saving drugs while thousands of at-risk children are undiagnosed because their families refuse to have them tested.

The Joint UN Programme on HIV/AIDS estimated that as of 2006 10,000 children were infected with HIV in Burkina Faso, with 4,600 needing antiretroviral (ARV) treatment.

Only 46 percent of HIV patients in Burkina Faso who required treatment as of June 2009 – 23,000 people – are taking ARV drugs, according to the government’s national HIV and sexually transmitted diseases council.

“We know the numbers [requiring treatment] are higher because of children who are born to HIV-positive mothers,” said the council’s director of health services, Joseph André Bidiga. “We do not offer prevention of mother-to-child transmission [PMTCT] services in all our health centres.” He said more than 20 percent of the country’s health facilities do not offer this service.

Multiple studies have shown that ARV treatment combined with abstaining from breastfeeding can cut the risk of mother-to-child HIV transmission to less than 5 percent. But in 2007 only 33 percent of HIV-positive pregnant women worldwide took ARVs, according to World Health Organization (WHO).

WHO estimates that more than 400,000 children worldwide were newly infected in 2007, mostly through their mothers.

Fleeing HIV tests

The HIV council’s Bidiga told IRIN parental refusal to test children masks child HIV infections. By law children under 18 require parental permission for HIV tests in Burkina Faso.

Some parents cannot fathom their babies could be infected, said paediatrician Alice Zoungrana with Charles de Gaulle paediatrics hospital in the capital Ouagadougou. “We are in 2009 and it is sad, but many families…still think [HIV] is a purely sexual disease that does not affect children,” the doctor told IRIN.

She added that while 75 percent of families grant permission for their children to be tested at the hospital, authorization is given only reluctantly. “It takes time because [families] refuse and accept to test only when their children fall ill a second time. It is during the second hospitalization that they accept.”

''We are in 2009 and it is sad, but many families…still think [HIV] is a purely sexual disease that does not affect children''
It is not uncommon to see parents leaving the hospital with their children in the middle of the night to avoid the test, Zoungrana told IRIN. “These adults have not been tested themselves and do not want to know their children’s status.”

A nurse who works east of Ouagadougou and is infected with HIV told IRIN: “I had my suspicions when my son had swelling on his body and was constantly sick, but I never imagined he could have had AIDS.”

She said both she and her eight-year-old son now take ARVs.

National HIV council health director Bidiga told IRIN adults are the gatekeepers to HIV testing. “We target adults for [HIV] awareness and outreach, but we are not reaching the numbers we would like. For adults who are not tested, their children are worse off because it is the adults who bring the children in for testing.”

Message blocked

Paediatrician Zoungrana said messages about HIV are not getting through. “We have to revisit messages we are sending out to the population so they accept that HIV infections are possible in both adults and infants.”

Women are less resistant than men to having their children tested, said Jacques Sanogo, director of the NGO “Espoir” – hope in French – in Burkina Faso’s second-largest city Bobo-Dioulasso. “Often mothers test their children without letting their families know.”

A 45-year-old widow, infected with HIV by her late husband, told IRIN she was able to get tested only after his death in 2001. “Both he and his family refused that I and my children get tested after I accidentally discovered his ARVs in the house.” In 2002 she learned she was infected with HIV while her three children were not.

To overcome reticence about HIV tests, community health workers visit families to talk about preventing mother-to-child transmission and the importance of HIV testing, NGO director Sanogo told IRIN.

Paediatrician Zoungrana said the confidentiality of house visits by trusted community members boosts acceptance of the message. “These community approaches work best because they are closest to the population and messages get across better.”

An estimated 2.7 percent of Burkina Faso’s population – 150,000 people – were infected with HIV as of 2006, according to the government.

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