"Dilemma"

Back in February, during the period when one of the girls, Joyce, was sick and blacking out, an issue was raised which, thinking about it now I’m sure I must have thought about before, but it did not preoccupy my like it has been doing these past days.

Joyce was taken to hospital by the school nurse accompanied by the 2 Swedish ladies Günilla & Gün-Britt who were here at the time (both nurses incidentally). From what they told me afterwards, more or less the first question the nurse asked of Joyce was whether she had been tested for HIV/AIDS if so what the result was. The school nurse replied yes, and that the result was negative.

Now I know this not to be true. Not the result I hasten to add, but rather that Joyce has not been tested. Indeed, none of the children at the school have been tested. And therein lies the beginning of the dilemma. As none of the children have been tested, we do not know whether any are infected, nor do we know in which phase of the infection they are (question, can you name them? All the children here can).

Although there have been great strides in recent years to combat the virus through educational programmes and increased access to generic antiretroviral drugs - In Kenya, for example, HIV infection rates have fallen from 15% in 2001 to 6% at the end of 2006, one in seven children across the African continent still die before the age of five (World Bank Development Indicators).

St. Anna is a school for children & orphans. Most of the orphans are HIV/AIDS orphans i.e. one or both of their parents have died of HIV/AIDS. The hypothesis that some of the 200+ children at the school are infected must therefore be fairly solid. Even simply taking the national infection rates, statistically somewhere between 6% - 15% percent of the children could be infected. Indeed, the average age of our children today is 8, which would place them right at the peak of 2001.

The real dilemma the school leaders are facing however is this. The policy has been not to test the children to avoid stigmatizing those who tested positive. We all know how cruel children can be and there is a real risk of that the children shunned/ostracised by their classmates. The consequences for the running of the school could be severe. However on the flip side, if we tested the children we would have the information to act and to prescribe treatment. The antiretroviral drugs today can allow a person to live a ‘normal’ life for potentially many years (plus socio-economic factors), and the ever continuing progress against the disease can only give further hope for the future.

But the longer we leave it to understand the children’s’ true situation, and the further along the timeline from seroconversion to onset of HIV/AIDS-related illness the child is, the harder it will be to intervene effectively. As with so many illnesses, early diagnosis is everything.

What should we do? I have my position and have made it clear… but it is not shared by all at the school.