Identifying and testing children living with HIV

Providing treatment for children with HIV/AIDS essentially involves three stages: finding a child, testing a child and treating a child. Most children living with HIV become infected through mother-to-child transmission, and these children need to be tested as soon as possible after birth to find out if they are HIV positive. If a child living with HIV is only clinically identified once they are ill, it may be too late for antiretroviral treatment to be effective.

In developed countries, children can be tested soon after birth (sometimes within 48 hours) using polymerase chain reaction (PCR) tests and other specialist techniques. Where this technology is available, the longest a mother will have to wait for an accurate result is usually around six weeks.

In resource-poor countries, where PCR testing is generally unaffordable or unavailable, a mother may have to wait up to 18 months after giving birth before antibody tests (which are used in adults, and are more commonly available) can be used to accurately diagnose her child. During this time the antenatal clinic, where the mother was probably diagnosed, is likely to lose contact with her.

In some resource-poor countries, ‘dried blood spot’ testing has been introduced in recent years. This is where a small sample of blood is taken from a child, dropped onto paper, and sent to a laboratory where it can be tested. Since these samples do not need to be refrigerated and are easy to transport, they can potentially be sent miles away to places where PCR is available. This means that even children living in resource-poor areas can be tested relatively quickly. However, dried blood spot testing can be expensive and it can take a long time for test results to return. There's also evidence that when the drug nevirapine is used to prevent mother-to-child transmission of HIV, dried blood spot testing doesn't always detect HIV in the first few days of the child's life.

Anthony

I am a 42 year old Italian guy from Staten Island NY. I have been living with this disease for 10 years going on 11. I was diagnosed in 1996 and from 1996-2000 I was in so much denial I ran the streets as I had before smoking crack and just wanting to get high and higher, because I thought if I was going to die , I was going to die happy and high.

So I thought. After 4 years I saw I was still here and healthy , so to speak. I decided to get help for my addiction and get educated about HIV/AIDS. I am happy and yes even proud to say that I have been clean from the drug of my choice for 6 going on 7 years and have been an HIV/AIDS Outreach Worker, Educator and Test Counselor for the same number of years and still am. I have also been a member of many groups within the government of New York: HIV/AIDS Planning Council, Advisory Group to the Planning Council, HIV/AIDS Advocate, Human and Civil Rights Advocate. I have found my passion and knowing now that it is not a death sentence, just a change of life, I can go out and spread the word that, "WE CAN LIVE" and live a very happy, productive life.

I have been addicted to crack for 12 years and lost everything: my job, my partner after 8 years, my home but mostly myself. I am back now with alot of thanks to many, but mostly to myself because it was me who willing and chose to get the truth and I did. I will persevere in this fight to educate and fight for the rights of HIV/AIDS people and all people who are treated unjustly........ I have never been more content and happy than now.

Anthony J Raiola

Russell

Hi my name is Russell a white 20 year old male. What am about to write is a true story about me finding out that I have HIV (Some events have been left out and some names changed), and the truth of what am going though now and back when I found out…

So lets travel back a two weeks ago, I woke up like every other day, the date Sunday the 31st of Aug 2008, it’s the day that will go down in history for being the start of the worst week in my life, but at the same time a new scary beginning. A beginning that I had of read about when I was 16 years old, A STI that around 1100 people in Western Australia live with every day, that we know of. This is how I became that 1101 person.

Here I am getting up out of bed and getting ready for my day the sun was shining the cats where trying to get outside like they do every morning, the time was around 9am. Today was abit different and for me it felt different maybe cos I knew i was about to get tested for HIV, and all the other STI’s who knew all I knew is I had this wierd feeling that something was not right. My closes mate at the time Smith said “I am sure it will be ok.” Just the day before. Smith and I where great close friends some thought that we where an item but we weren’t. Smith and I went back just a few months but for some reason unknown to us we felt like we knew each other for a life time.

I headed out to go to RPH (Royal Perth Hospital) arund 10am I had my appointment at 11am, To get to the city I have to catch the 421 bus and the Striling Train into the city, all the way I was thinking to myself that all I have to do is turn away and go back home and no one would be the wiser. However I had to do it. I had not had a blood test for close to a year and something in me said that I needed to find out if I had anything. All the way sitting on the bus and train I was trying to take my mind off the feeling that I am about to have a test that could change my life. To take my mind off it I started listening to my iPod and one song kept playing and playing. For some reason all I wanted to do was listen to this one song that reminded me of living in foster care and growing up in over 30 different foster homes, going to 20 plus schools, being belted, raped and neally killed. The song Secrets by Anastacia hearing the kids at the start and end of the song made me feel safe while the words stuck out in my mind like my life in a song. Never being able to be a child always having to think fast on my feet, not worrying what some one would say or do to me as long as they did not do it to my sisters or older brother.

Before long I am there waiting in the waiting room to see the Doctor, he was the doctor that three days from now would ring me up and tell me to come in. He asked me when was the last time I had a HIV test I said around a year or maybe more. He looked at his records and it showed that I have not been tested since late 2006, He said that they will do a full STI test which ment anal, mouth, and cock swaps to test for any other STI’s and a blood test to see if I had HIV.

I went from the doctors office into the nurses room standing beside me a young 20 something year old lady who was about to take my blood, I said to her “I might scream, I hate needles.” She replied “Oh there is nothing to be worried about, ill be soft.” Yeah I heard that from many people in the past from other Doctors to the first guy I had sex with.

Before long it was all over and was told that I should be notifided by Wednesday. The day continues on, heading home all I can think about is that what if the test comes back POZ what will I do then, What will my life be like? Will I crash, will I be able to carry on? Oh and the big question was will I still have the strength to keep working on my own business, or will I give up and get a 9 to 5 job?

Tuesday was not that easy I stayed in bed slept for most of the day, I rang Smith at around 10am and just talked he kept saying it will be ok. Being the friend that he is. But deep down I knew something was going to come up and eat me alive.

Wednesday morning comes, I get a phone call around 9am from the Doctor asking me “Hi Russell I need to see you. Can you come in as soon as possible thanks.” I left for RPH straight way did not know what I was going to be told. At first I was thinking HIV then maybe some other STI I was so confussed I just did not know what to do. I got there around 10:30am and went straight in, it was like they where waiting for me ready to take my soul and toss it out the 4th story. I went into his office and I sat down, then I hear “Russell am sorry to say but the test for HIV is positive.” I frooze for a few seconds and just looked amazed. What felt like a life time of silance was around 30 seconds. I said “I was thinking it might come back that way.” I cant believe that I said that really the first words out of my mouth was I thought it might come back that way. What a dick nob.

We talked for about 30min about the T count and how they have to do more testing. That day was going to be a hard one, for what I thought was going to be a 20 min visit soon turned out to being a full day there from 10:30am till 5pm when I was able to get up and go home. It was like a bad dream getting tossed from department to department, getting 9 tubes of blood out and being told that it is a very very rare thing for them to be wrong about this. Still they tested it and the wait was on till Friday when I would finialy find out if I was the next person in WA for that matter in the World to have HIV.

While waiting for the test I had to get back to work working on organzising the Mr. G competitions (This name has been changed in this story to protect the competition.) I had to organize the Melbourne, and Sydney rounds that where coming up search for the hottest male in Australia. The Melbourne rounds that are coming up in a few weeks was my most concerend about event. I took my worry about my health and placed my worry on my business. I need this to be the hottest competition in Australia, I want to show people that not all guys are alike. We're not the way the media likes to show us.

So I kept going working as hard as I have every worked in my life. I called my mate Smith and told him that I was HIV poz and he just froozed hung up the phone and did not return any of my calls, sadly to this day I have no idea what he is doing or if he is ok.

Friday come so fast went in to the doctors and the Dcotor called me in, sat me down and said “Yeah the test come back poz.” I left there feeling down, sad and all alone, who do I tell, who can I tell, who can I trust?

Sitting down writing this is the hardest thing I have had to do today. Realizing that I have HIV well that has not hit me just yet. I told a true friend of mine just two days ago he went to have sex and unlike normal where he would just have bareback sex, he told me he put on that condom and is now going to get himself and his partner tested. He went on to say He would not be able to be me, in the way that I am staying strong and following my future, there is NO WAY that am going to let this little bug kill me. I want to help inform people young and old that its better to have safe sex and get tested every 3 months, other wise they risk ending up like me HIV POZ!!!

Isha

During my pregnancy I found out I was HIV+ and it was a day just before Christmas. I went to my doctor for a check up knowing that I had done an HIV test. I didnt expect the results that day but even though the doctor told me he had my results I was not bothered at all because in my mind I was sure I was negative. The doctor went to take my results as my fiance and I were sitting down waiting. He came back and I could see my fiance panicking as he is the one more emotional than I. the doctor set down as he opened my file and read the results to us. You are HIV+, he said. I didnt say anything in shock as my mind just stopped working at all. My God, I said. My doctor continued to speak and giving us advice and telling my fiance to go test as well. He told me about my CD4 count and viral load of which I didnt even hear what he was saying at the time.

My doctor gave a prescription of is called TRIOMUNE 30, it was a very good medicine he said as it was just introduced and was a combination of the HIV meds. As I said it was just a day before Christmas and you can just imagine the mood everyone is in. I was going driving home that day as I like spending my holidays with my family. I am a kind of person that when I find out about something disturbing I switch off and not even feel hurt over it but when it hits me it really does. I got home and we were all happy to be together as we are a only girls at home (5 girls) and my mother is a single parent which I met only in 2004 Dec, 22 yrs at the time. When I first saw my mother she was really struggling and poor with 3kids as my old sister and I were brought up by my dad. Saying anything to my mother would destroy her as she has a soft heart and all of them basically at home are very fragile compared to me.

I didnt want to spoil the holidays for them really and I was the bread winner at home and still am as I said when I found my mom she was really struggling. The night before Christmas I watched all of them busy up and down preparing for Christmas. Cooking, baking and all that and remember that I was still pregnant at the time therefore they just told me to sit there and relax because we were up and down after my doctors appointment buying everything needed. I remember sitting in the lounge alone whist they were playing gospel music so loud. At home we are all Christians and God comes first. As they were busy in the kitchen I just sat there and listened to the music playing, oh God tears started falling from my eyes as I really thought of this deeply this time, what it meant for my unborn baby, what it meant for my future. I cried, really cried because since I had been told the news I had not responded anyhow. Unfortunately my mom saw me and she asked what is wrong now baby. I couldnt say anything but cry. My sisters came as well and my big sister who understood me better than all of them came as well. She said to them no ma dont worry I know she is only crying because she is in worship because of the songs that they were playing. I couldnt stop crying really and my mom started crying as well, it started to be a very sad moment for us now. Just imagine if they cry only because they saw me cry how much more if they had known what was going within me.

I started taking meds to prevent my baby from getting infected and now she is a beautiful 3mnths old and I am so crazy about her. Eventually my fiance went for a test this year as well and he was HIV+ as I knew already because I knew he gave me that disease as I was a very careful in my past relationships. The good thing is that both our CD4 counts are still fine. Mine is 451 and his 351 but my worry is that I was recently tested for TB and it was positive and now I am on treatment and my fiance is. They gave pills for my baby as well to prevent me from giving it to her. My big worry is that I am a smoker and its very hard for me to stop as I am used into and I tried stopping but I always fail. My fiance smokes as well and this is not good for both of us mostly I with TB I know. My life is just a mess at he moment and with every puff I take I think of my baby and I value her and I grew without my mother and I worry that by smoking I am taking the opportunity of leaving a longer life with my kid. She is my princess and I do everything for her hence I got to stop smoking.

Besides all this I know God is my strength I am not only strong because I can do it but because God gives me strength and He sustains me. He is looking after my baby and he is a God of possibilities and He surpasses all circumstance.

To you all out there please take care of yourselves and know that Greater is God than any disease out there, be strong all the time and know that even the person next door might be living with HIV but you dont know as she doesnt know about you, therefore dont feel sorry for yourself. Live your life and be strong. Be healthy.

Drug users and sex work

Although injecting drug users constitute a risk group in themselves, there is also an overlap between drug addiction and those involved in sex work. Individuals who fall into both categories are therefore particularly vulnerable to HIV and are perhaps doubly stigmatised. The link between substance abuse and sex work is hard to pinpoint though there are a variety of factors that are common to both including homelessness, unstable family lives, socio-economic deprivation, disrupted schooling, local authority care and co

One study of UK cities found 63% of people who sold sex outdoors did so mainly to pay for drugs. Heroin was the most commonly used drug, with 78% having used it, and just under half the sample had injected drugs in the previous month.³⁰ UNAIDS believes that the spread of HIV in several North African and Middle Eastern countries is being facilitated by a combination of injecting drug use and sex work with one third of IDUs having paid for or sold sex. In Syria 53% of drug users have sold sex, with 40% of these saying they had never used condoms.³¹ One study of Sichuan province, China, reported similar rates, around 56%, of female IDUs who sell sex.³²

IDUs who are sex workers put themselves at risk and also facilitate the transmission of HIV between population groups. Looking at the spread of HIV among the two risk groups in Jakarta, Indonesia, the Commission on AIDS in Asia found that infection levels began to increase within commercial sex networks only after the epidemic among injecting drug users had reached significant levels.³³Sexual risk behaviour related to drug use should not just be considered within the bounds of sex work. While the impact of drugs on sexual behaviour may vary by drug, length of use, sexual identity, and other factors, there are a number of effects related to drug use that could influence unsafe sexual behaviour. HIV transmission may be facilitated among drug users and their sexual partners if the user is sexually stimulated or disinhibited by drugs.

nfidence and esteem issues

Injecting drugs and marginalisation

People who inject drugs are perhaps the most marginalised group at risk of HIV infection. According to nongovernmental sources reporting to UNAIDS, only 16% of countries have laws or regulations protecting drug users from discrimination, compared with 21% and 26% of countries providing protection for sex workers and men who have sex with men, respectively

Injecting drugs for purposes not prescribed by a doctor is illegal worldwide, and the criminalisation of drug use and possession can hinder attempts to engage IDUs with available HIV services. There have been documented incidences of Ukrainian police arresting and beating IDUs near needle exchanges for possessing used and sterile syringes.²⁰ Police in Thailand have reportedly acted similarly despite possession of syringes being legal in the country.²¹ It is estimated that 40% of countries have laws that interfere with their ability to reach injecting drug users.²²

IDUs who find themselves on the wrong side of the law and in confrontation with the police may be mistrustful of the authorities in general and hesitate to seek treatment or take advantage of prevention initiatives in the first place. Following a major drug operation by Vancouver police in the Downtown Eastside district, in which there were reported cases of unnecessary force and illegal search and seizure, the number of sterile syringes provided nightly by a local needle exchange program dropped by a third.

Why are drugs injected?

There are several possible reasons as to why drugs are injected rather than taken in other forms. The UNDP HIV and Development Programme suggests these include the availability of drugs that can be injected, linked to production locations and trafficking routes; that it is a cheaper and more rapidly acting method; the sharing of knowledge about such techniques that comes from migrating drug users; and so none of the drug becomes lost in smoke, especially when drug control efforts reduce its availability.⁷

The UNDP estimates that the most common change in drug consumption patterns is the move from the smoking of opium to the injecting of heroin and other drugs as a result of law enforcement.⁸ Populations in developing nations have become more exposed to new methods of drug taking, including injecting, as refinement of drugs into injectable forms has been forced from more developed nations and closer to production areas.

In Pakistan, for example, the last 10 to 15 years has seen a shift from the inhalation and smoking of heroin, to the injecting of heroin and synthetic drugs. Injectors of heroin are an ever growing proportion of total heroin users rising from less than 2 percent in 1993 to 15 percent in 2000 to more than a quarter in 2007. This is largely attributed to aggessive drug control measures that have reduced supply, boosted the cost, and made injecting a more economically viable method of consumption.⁹

One HIV-positive IDU in Pakistan described the scarcity and growing cost of heroin as the primary reason for switching from inhaling to injecting:

Why do people take drugs?

People take drugs, both legal and illegal, for a variety of reasons that will differ from person to person and from drug to drug. Individuals may enjoy the sense of detachment or euphoria that drugs create, their relaxing or energy-inducing properties, the heightened alertness or sensitivity they produce, and their medicinal qualities. Peer pressure or habit may be other reasons, and if they are chemically dependent, addicts will feel they cannot operate without them. These reasons will depend on an individual’s own background and socio-economic circumstances.

Drugs can be taken in a variety of ways including drinking, smoking, snorting and rubbing, but it is the injection of drugs that creates the biggest risk of HIV transmission.