Access to HIV services for children in low-resource communities in Nairobi, Kenya
Igonya, Emmy Kageha
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While efforts for prevention of mother-to-child transmission of HIV have been stepped up, elimination of mother-to-child-transmission of HIV is far from being accomplished in subSaharan Africa. The number of children infected with HIV continues to rise. The availability of HIV treatment brings about hope for HIV exposed children to live to adolescence and early adulthood. Regrettably, many children infected with HIV continue to die undiagnosed or are diagnosed during the late stages of AIDS. This study is aimed at exploring the determining factors of access and utilization of HIV services for children where free HIV services are available. The study identifies factors that constrain or facilitate access and uptake of HIV services for children. An exploratory and descriptive study employing triangulated data sources and qualitative methods supplemented by secondary data was conducted. The researcher mainly used; indepth interview, focus group discussion, key informant interview, life story/narrative, free listing and healthcare facility record tools to gather information from parents and caretakers, community members and key informants who included healthcare providers, teachers, religious leaders, local FM radio presenters and local administrators. NVIVO, a computer assisted data analysis software was used to code and organize data thematically. Free listing data was analyzed using Statistical Package of the Social Sciences (SPSS). The study findings indicate; knowledge about HIV infection, progression and identification in children is less understood among community members. In their treatment trajectories, parents and caregivers with children utilizing HIV services only came to know about HIV infection in children after experiences of long episodes of unwellness and after being encouraged to seek HIV services for their children by health care workers and the significant others. The study unveils a thin line between childhood illnesses and illnesses presented by HIV infected children. Complexness of negotiating treatment pathways in the existence of medical pluralism is aggravated by a lapse in healthcare referral system. Some parents deliberately avoid health facilities that render provider initiated testing and counselling services for fear of mandatory testing. Additional limiting factors to access of HIV services for children include; low uptake of HIV testing among parents, limited knowledge of the availability of services, service accessibility, stigma, denial, gender inequalities, cultural beliefs and healthcare facilities' structural issues. The study also demonstrates the motivating factors to access and uptake of services as advice from health providers and PLHIV lay counsellors, prolonged illnesses, a death in the family, availability of services and treatment and other motivations offered by HIV services for children such as free treatment of opportunistic infections, material and emotional support. Confronting enabling and constraining factors to access and uptake of HIV services necessitates in depth apprehension of the surrounding issues and sustained community education and mobilization.