A Question of Life or Death - Human Rights Watch

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There also needs to be a special effort to improve food security of people living with HIV, and their communities. Kenya’s fight against HIV is largely donor-funded: the United States alone contributed about US$368 million in 2007, more than the government’s own allocation of funds for HIV programs. Donors should support measures to increase treatment access for children in Kenya. When doing so, they should seek to strengthen the health system as a whole, in order to achieve lasting improvements. Key Recommendations • Develop child-focused health policies, in order to make child testing and treatment easily available at local-level health facilities, with staff trained in pediatric HIV and child psychology. Publicize information about available pediatric HIV services. • Strengthen the role of community health workers, social workers, and counselors who often help children get tested and treated. Ease regulations requiring parental consent for tests. Develop a policy on disclosure of HIVstatus to children. • Take measures to improve food security in vulnerable communities, as lack of food constitutes a major treatment access barrier. • Strengthen existing child protection mechanisms with a view to improving protection against abuse and neglect, in particular of orphans. Ensure that cases of disinheritance, child neglect, and abuse are investigated and prosecuted in accordance with international legal standards. • Take measures to fight stigma and discrimination, for example through the creation of HIV support groups and through an awareness-raising campaign about the rights of people living with HIV. Detailed recommendations are given at the end of this report. A Question of Life or Death 6
II. Methodology Field research for this report was carried out in July and August 2007 and August 2008 in Western province (Kakamega district), Nyanza province (Siaya and Bondo districts and Kisumu), Rift Valley province (Uasin Gishu district and Eldoret), Coast province (Mombasa), and Nairobi, including Kibera and Mathare slums. We conducted 68 interviews with children, parents, and guardians. Twenty-five interviews were with children, of whom 18 were confirmed to be HIV-positive; 6 others were orphans whose status was not known, and 1 was an orphan who had tested HIV-negative. Of the children interviewed, 16 were girls and 9 were boys. Our interviews also included conversations with 29 HIV-positive mothers, 2 HIV-positive fathers, and 12 guardians of children living with HIV. Adults were in a better position to explain to us the obstacles to testing and treatment both for very small children and in some cases (for the reasons described below), for older children. In situations where children were too ill to be interviewed, we refrained from the interview. For those children who were not aware that they are HIV-positive, we limited our questions to issues that did not touch on the child’s HIV status. In addition, we carried out over 80 interviews with social workers, community health workers, counselors, nurses, clinical officers, doctors, administrative medical staff, and nongovernmental organizations (NGOs) working on health or child rights. 1 In the Kenyan government, we interviewed representatives of the Ministry of Health, the Ministry for Gender and Children Affairs, and the Ministry of State for Special Programs. We also interviewed academic experts and staff of international donors, UNICEF, and humanitarian agencies. 1 We use the term community health worker broadly to mean all persons working in the community, with or without payment, as part of health facilities, agencies, or NGOs with health programs. This includes social workers, outreach workers, counselors, adherence counselors, and others whose main role is to provide information about health issues and accompany patients in the process of seeking health care. 7 Human Rights watch December 2008
Page 1 and 2: A Question of Life or Death Treatme
Page 3 and 4: December 2008 1-56432-412-5 A Quest
Page 5 and 6: Map of Kenya 1 Human Rights watch D
Page 7 and 8: care of other relatives, but can su
Page 9: It is indicative of the current lac
Page 13 and 14: statistics by the UN classify child
Page 15 and 16: Treatment of HIV and of opportunist
Page 17 and 18: The case of Kenya Kenya has a gener
Page 19 and 20: AIDS, Tuberculosis and Malaria prio
Page 21 and 22: Following political conflict and po
Page 23 and 24: (EU). 61 There are also two importa
Page 25 and 26: stigmatized. Such beliefs are still
Page 27 and 28: Many patients distrust antiretrovir
Page 29 and 30: A community health worker in Mathar
Page 31 and 32: discriminatory experiences to relat
Page 33 and 34: According to a nurse at an HIV/AIDS
Page 35 and 36: decided to go to Nairobi with the c
Page 37 and 38: often by themselves, and it has bec
Page 39 and 40: know why. I’m afraid that he will
Page 41 and 42: [Carolyn’s] mum died when she was
Page 43 and 44: Both my parents died. I had two ste
Page 45 and 46: een told about their HIV status. Fo
Page 47 and 48: the very least, a child above 10 sh
Page 49 and 50: een raped by police. 169 Sexual exp
Page 51 and 52: We think that children are dying of
Page 53 and 54: way that she could adhere to our pr
Page 55 and 56: Sometimes caregivers start children
Page 57 and 58: Sometimes at the clinic, the treatm
Page 59 and 60: At this writing, health facilities
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mother, who already has an older ch
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are even more vulnerable to these s
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concern when the Kenyan government
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Despite this gap, change is finally
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Up until 2006, the large majority o
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Young people under 18 who are marri
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make cotrimoxazole widely available
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The need to make ART for children a
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normal for patients with life-threa
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treatment. For example, we were int
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access to health care. Both the gui
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VII. Legal Framework National and i
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The child’s right to the highest
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Every child shall have a right to h
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International law requires states t
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In Kenyan national law, under The C
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VIII. Detailed Recommendations To t
Page 95 and 96:
To the Kenya Food Security Steering
Page 97 and 98:
To UNAIDS, the World Health Organiz
Page 99:
shared with us their analysis and a
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A Question of Life or Death - Human Rights Watch

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