Focus on primary schools coping with HIV-positive pupils
Sunday 15 August 2004
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KENYA: Focus on primary schools coping with HIV-positive pupils

[This report does not necessarily reflect the views of the United Nations]

©  World Vision/Jane Nandawula

School children like these have been hit hard by HIV/AIDS in Kenya.

NAIROBI, 16 February (PLUSNEWS) - Mary Waweru, a kindergarten teacher in Nairobi's sprawling Kawangware slums, has noticed that some of her pupils are increasingly absent from school due to ill health. Some of the young children have already been orphaned, being supported by charity organisations.

Waweru has begun to suspect that these frequently absent pupils could be suffering from AIDS, which she thinks may have been passed on to them by their parents before they were born.
Such children are usually very thin, and subject to skin rashes, frequent fevers and endless coughs, she explains.

Her 46 pupils, Waweru says, include 12 orphans who are under the care of local charities. "It is hard to tell if a child has HIV unless you see the obvious signs," she told PlusNews recently. "You can only start suspecting if the child is constantly ill."

Waweru recalled one serious case of a seven-year-old girl, who had left the kindergarten this year to join primary school. "I don't know if she is still alive," Waweru said. "She was always ill and slow in class. But as a teacher, you try not to frustrate the child. You try to give the child as much love as you can," she added.

Waweru had had a similar case five years ago, but it was not until the boy died last year while in his fourth class in primary school, followed months later by his mother, that Waweru came to realise that the child had been suffering from AIDS-related illnesses. "I remember the child was very weak and not performing very well. He kept forgetting things he had learned. I felt sorry for the child," Waweru recalls. "I only came to learn later on that he had died from HIV/AIDS," she added.

Waweru could not tell how many of her pupils were infected with HIV, nor did she have any concrete information regarding the health status of their parents. But it was no longer surprising to her that a growing number of her pupils could be HIV positive, going by the number of parents dying in the neighbourhood. "You know, unless a parent tells you what is happening, you can't know," she said.

Some pupils have parents who are too ill to provide for them, and lack adequate food and clothing as a result. "Some of these children do not get proper food from home, because their parents are ill and poor. If they can be helped, such children should given food too," Waweru said. And because they lived in rented homes, many were left homeless once their parents died, she added.

"There is a big problem out there. Children are being left without anyone to look after them. Some of the children here have no food at home. You wonder who will take care of all these children."

At Ndararua primary school, located in Riruta Satellite, another densely populated slum in Nairobi, an increasing number of children are suspected to be suffering from AIDS. Teachers at the school, which has about 1,500 pupils, say suspected HIV/AIDS cases are more common among children of the earlier classes, but know of only two recent deaths associated with the disease.

In November last year, a sixth grade pupil died, following a long bout of AIDS-related illnesses. The pupil's mother and two younger siblings had died earlier. The father was now seriously ill in hospital, Florence Ndung'u, a senior teacher at the school, told PlusNews recently. Another of the school's pupils had died in 2002, also from AIDS-related illnesses, she said.


The school had no official records showing the number of HIV-positive pupils, Ndung'u said. It relied solely on records of absenteeism and the deteriorating physical appearance of a child. "We can only look at the features. We keep records of how many times a child goes to hospital," she noted. "I hear of many cases of children infected with HIV. You look at their features," she said. "We don't even know some of the parents. Parents are dying very frequently."

Officially, the school has about 51 orphans, but the number is believed to be far higher, owing to the lack of detailed information on the family status of its pupils. There are also cases of pupils who are not listed as orphans, because they are being cared for by members of their extended families. Whether the pupils were infected or orphaned, Ndung'u explained, their fellow pupils, who could only watch them suffer, were also severely affected.

The situation in Ndararua is similar to that in other primary schools, where a growing number of orphans and children in early classes bear visible signs of HIV infection.

Nationally, official figures indicate that Kenya has an average HIV-infection prevalence rate of 15 percent, with about 700 people dying from AIDS daily. These figures indicate a possible higher infection rate among children, especially in many rural areas, where, in some cases, prevalence relating to pregnant women can be as high as 30 percent.


Although HIV/AIDS is a major public health issue in Kenya, its specific impact on infected school children did not receive media attention until a children's home caring for HIV-infected orphans sued the government, because its children had been rejected by various public schools by virtue of their condition.

Catholic Father Angelo D'Agostino, who runs the Nairobi-based Nyumbani children's home, said it was spending about US $14,000 yearly on maintaining its 41 children attending a private school, who continued to do so even after the government had introduced free primary school education January 2003.

The high-profile case, which Nyumbani won, highlighted the daily discrimination being suffered by many of the country's HIV-infected orphans. "It [the case] will help to break down the barrier of discrimination and stigma. The kids [now] go to public schools. It will be tough, but it has to be done," Tony Banks, a Nyumbani official, told PlusNews.

However, according to Chris Ouma, an HIV/AIDS project officer with the UN Children's Fund, the problem of admitting children infected with the HIV virus to Kenyan schools was largely attributable to parents bringing pressure to bear on schools to reject such children - as opposed to government policy.

"This is not a government problem. As partners, we are sure the government recognises the rights of these children," he said. "What we need is education programmes to sensitise parents that the kids have a right to learn, and that they do not present any danger if the right precautions are taken."


Apart from providing care and treatment for 93 children orphaned by and infected with HIV/AIDS, Nyumbani also provides medical care by means of mobile clinics for more than 900 HIV-positive children in the communities around Nairobi.

These children, most of whom are still in kindergarten or early primary school, are dying at the rate of between seven and eight a month, because the life-prolonging anti-retrovirals available on the market and HIV-testing equipment are still too costly for the outreach programme, according to D'Agostino.

In consequence, they are only treated for opportunistic infections. "Don't believe any junk you see in the newspapers about cheaper drugs being available," D'Agostino told PlusNews. "The drug companies are still killing 25 million people in Africa. Hitler killed only 7 million people. He did it for some crazy philosophy. The companies are doing it for profit," he said.


In response to the HIV crisis in Kenya, the education ministry had begun providing regular training for teachers through government- and NGO-sponsored seminars to discuss HIV/AIDS-related problems in schools, and ways of supporting pupils infected and affected by HIV/AIDS, Ndung'u said. "We go to the seminars to make it easier for us to deal with the situation."

In addition to counselling, the Kenyan government also recently introduced HIV/AIDS education into the primary school curriculum.

Although HIV-related illnesses tend to occur among children in earlier classes, most schools have started an HIV/AIDS counselling programmes, but only for pupils belonging to the more affluent sectors of society. "Older children need more education as they understand more about the stigma related to the disease," Nding'u observed. "Younger children do not discriminate against others, because they don't know about the stigma associated with HIV/AIDS."

Ndung'u has noticed that older children at her school are beginning to become increasingly sympathetic to chronically ill fellow pupils, even exempting them from heavy class tasks such as cleaning. "The children have learned to support their colleagues. They don't laugh at their colleagues any more. They even request to go and see a sick colleague in hospital," she said.


There are also legal technicalities limiting the extent to which teachers are allowed to delve into the HIV-related problems affecting their pupils, according to James Owino, a head teacher of a primary school in Kibera, another densely populated slum in Nairobi.

In Kenya, like elsewhere, an individual's HIV status is a confidential matter between patient and doctor, and schools are accordingly unentitled to inquire about their pupils' HIV status.
"It is impossible to tell if a child has HIV. Such information is confidential," Owino told PlusNews. "So it is difficult for us to go into why or which children are infected with HIV. We cannot even pursue such a case with parents. They would accuse us of ill intentions."

Besides confidentiality, pupils brought to school a mixture of traditions from their various family backgrounds, which rendered it next to impossible for schools to adopt HIV/AIDS programmes for children that would be acceptable to all parents, Owino added.

"As a teacher, the extent to which one can go in guidance and counselling is very limited. There are communities which are against sex issues being taught in school. They want this to be done by parents in a traditional way, so that blocks teachers," Owino said. "Much more sensitisation needs to be done on the public side. In most places, not much has been done to sensitise the youth," he added.


Despite the confidentiality, Owino believes that screening young children through specially established voluntary counselling and testing centres and starting early treatment of HIV-infected children could be one way of preventing early deaths of infected children.

Such a screening programme should be modelled along the government immunisation campaigns for early childhood diseases, but under which all parents should be encouraged to take their children for HIV screening, with the aim of starting treatment as early as possible for those infected, he said.

He said the government had so far concentrated testing and screening on the adult population. "If the government could come up with such a plan to screen children, they would help such children at school," Owino said. "Right now, many children are infected, but they don't know they are infected. The parents don't know either. When they go to hospital, they treat the information as confidential. And things end there."

It was only after screening that the right kind of data on the needs of such children could be assessed and addressed, he argued. "Children cannot go to the screening centres in town. If the government had been able to eliminate some of the early childhood deaths, then HIV infection among children could be detected and treated early," he said.


Recent KENYA Reports
Bridging the reproductive health gap for girls in Nairobi slums,  14/Jan/04
Confusion over HIV prevalence rates ,  13/Jan/04
HIV/AIDS - "People's Tribunal" demands access to life,  23/Sep/03
Activists demand better access to antiretrovirals,  19/Sep/03
Corruption allegations plague AIDS body,  1/Sep/03
The Global Fund to fight AIDS, Tuberculosis & Malaria
Youth against AIDS
Making A difference for Children Affected by AIDS
Children and AIDS International Non-Government Organisation Network (CAINN)

PlusNews does not take responsibility for info in links supplied.


PlusNews is produced under the banner of RHAIN, the Southern African Regional HIV/AIDS Information Network. RHAIN's members currently include:

  • IRIN
  • Inter Press Service (IPS)
  • Health Systems Trust
  • Health & Development Networks
  • GTZ/Afronets

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