Listening to HIV+ Kids in Zimbabwe

Mankaza, 15, tried to get away inconspicuously from the other girls at her boarding school in southern Zimbabwe. But before she could leave the hall some of her classmates started jeering and soon all joined in, "Where are you going Mankaza? Mankaza's going to juice up, Mankaza's going to juice up!" Juicing-up in Zimbabwe refers to topping up airtime on mobile phones with recharge cards. But the kids are not referring to airtime. The kids at Mankaza's school know that she is HIV+ and twice a day, at 7am and 7pm she has to take her ARVs.

"I don't want to go back, I don't want to spend the next minute in that school," says Mankaza to MSF Pediatrics Counselor Christopher Dube at the HIV Counseling Center of Tsholotsho, a rural town in southwestern Zimbabwe.

MSF helps care for over 7,000 HIV positive kids in Zimbabwe. Over 60% of those are already on ARV treatment. In Tsholotsho, an MSF-Spain's project site, Christopher has 340 HIV children that need counseling.

The worst problem, he explains, is the stigma. "They are just ostracized. They are labeled. They carry that with them wherever they go," says Christopher, who has been a Counselor with MSF for four years. "They have to fight their war, but before they fight and win their war they have to understand themselves first."

The stigma and discrimination against HIV+ people in Zimbabwe is pervasive. Christopher explains that many of the HIV positive parents don't disclose to anybody their status, not even to their own children. And then when they find out the children are positive as well they try to hide it from them. Sometimes, Christopher says, the children find out they have the virus by overhearing a whispered conversation. They perceive that it is something to be ashamed of. Almost no HIV child in Zimbabwe discloses their status to their friends at school or to their teachers and even among their own family only a select few will know.

"I thought they would start laughing at me," says Tanatswa, 15, on the reason why he hasn't told any of his friends at school; he also has not told any of his teachers. Milantre, 15, agrees, saying in a soft voice, "People will go around gossiping about you. You won't feel good when people talk about you."

In a country that has been scourged with HIV since the 80s and now has an estimated 2 million HIV infected people, one would think that there would not be so much discrimination, especially towards HIV vertically infected kids. Yet despite years of counseling, the children still find it hard to disclose.

"We want them to be able to say, yes, I am taking the tablets, right, so what?" says Christopher the MSF Counselor but admits that this has not been achieved yet.

In Bulawayo (Zimbabwe's second largest city) MSF helps treat and counsel at Mpilo Hospital the largest number of HIV children in any MSF program around the world. Mpilo has registered 3,165 HIV+ children and MSF has helped to start up close to 2,000 of those on ARVs.

MSF provides Mpilo Hospital with its only two Pediatric Counselors. "It was easy when we started; the number was easily manageable," says Mtandazo Ncube, who started working as an MSF Pediatric Counselor in Mpilo Hospital five years ago. "Then we could do proper counseling."

But since then the number of HIV children included in the program has increased tremendously, while the number of counselors has remained the same. The MSF Counselors now group the children into cohorts, according to the day they begin ARV treatment. Each cohort can have between 15 to 25 children. The counselors may see over 140 children in one day.

And the numbers keep on growing. Every week approximately 40 new children get started on ARVs in Bulawayo. The MSF Project in Bulawayo hopes that soon they will be able to decentralize HIV+ children from Mpilo Hospital to smaller clinics around the city. This will take the load off the main hospital in terms of giving out the monthly ARV medication. MSF has already hired one more HIV Counselor and hopes to hire more in the future.

"There is a gap in Zimbabwe," point out Mtandazo, "when it comes to addressing the psycho-social needs of children." There are no psycho-social supports groups formed just for children and hardly any specialized counselors.

Both Tsholotsho and Bulawayo project plan to have an HIV Kids day once a month in the future. "We have to get them together," says Tsholotsho's MSF Counselor Christopher, "they will understand and say, oh, there are so many of my kind – I'm not alone." He says the worst is when "they are just there suffering silently."

Doris, 9, holding a small white poodle-shaped bag her mother sent her from South Africa where she works, says some of the other children at the home she stays in know that she is HIV+. "They do like me because they know what I feel and they don't want me to feel sad because they really love me and they don't want to make me cry if they don't play with me," she says, adding shyly, "They are still good friends and I want them to be alive even if I’m not alive." She said that when she started on ARVs and was counseled she felt she understood things better: "I was not afraid anymore because it is something (HIV) that can just happen, it just does and I can not make it not happen again."

In the majority of children's cases, getting them on treatment in time means that they will be able to lead a life free of illness and co-infections. Children take much better to the ARVs and are far more resilient in the end than adults. Since it has only been in the last decade that children were started on ARVs, nobody knows yet how long they will be able to live on them. The oldest in Bulawayo is now 25 years old.

Nozipho, who at 15 has been on treatment longer and had a harder time accepting it, says: "Sometimes it is hard, sometimes it is not." And after a thoughtful moment, looking at her other HIV companions who had come to the hospital for their treatment, she said to them, "I think we are very brave. We can change the world, together."