UNICEF@75 Looking back: the story of paediatric HIV in Zambia

The first HIV case in Zambia was reported in 1988.

Nkole Nkole
Nurse Beatrice Chirwa squeezes a blood sample from 18-month-old Peter Chibeka onto an HIV test strip.
UNICEF/UNI107424/Nesbitt
08 August 2022

When Dr Chipepo Kankasa first started working in paediatric HIV in 1989, there were no antiretroviral drugs in Zambia, and testing for HIV in adults and children had only just begun.

Back then, unusually large numbers of children were being admitted to Lusaka’s main University Teaching Hospitals (UTHs) very sick, some with severe pneumonia and others with severe malnutrition. The number of children admitted to UTHs with malnutrition was so great that the hospital created a special ward to accommodate the influx.

“Once testing for HIV began, it was discovered that around 60 per cent of admissions were HIV positive... The government procured some antiretroviral [medicine] in 2003. I had been single-handedly lobbying for paediatric antiretrovirals."

Dr Kankasa

In Zambia, the first HIV case was reported in 1988. By 1991 the Zambia National AIDS Programme had recorded 15,000 cases which accounted for 14% of the country’s annual deaths. By 1998, the estimated adult prevalence rate (15-49 years) was 19% (much higher in urban areas) and around 90,000 people had died of AIDS. HIV & AIDS had become the greatest threat to development in Zambia.

Life expectancy plunged from 54 years in the mid-1980s to 37 years in 1998. With medical services under incredible stress, UNICEF Zambia played a key role in supporting home-based care including family-administered medication, and life skills training through NGOs.

In 2004, Dr Kankasa helped establish two consultation rooms at the UTH children’s hospital for children with HIV, and in 2007, with funding from UNICEF, spearheaded the development of Zambia’s first guidelines and training manuals on HIV in children.

“After we developed the guidelines, it became easier for us to scale up the treatment, including providing scheduled counselling and testing."

Dr Kankasa

In 2011, the Paediatric Centre of Excellence was opened, with the US Centers for Disease Control and Prevention as a key partner. It was a unique one-stop centre offering comprehensive HIV healthcare and treatment to infants and children. Dr Kankasa and her colleagues declared zero tolerance on paediatric HIV.

Initially, the centre would receive paediatric HIV patients from all over Zambia, but as HIV and AIDS care became understood, other provinces began offering services on preventing mother-to-child transmission, and HIV testing and counselling for young people, a process UNICEF still supports today including through adolescent friendly spaces in health facilities.

By 2005, 20% of all children in Zambia were orphans, over half of them due to AIDS, leaving a population of 11.7 million to support more than 1.2 million orphans. With one sixth of Zambians infected with HIV and only around 25% of those in need receiving antiretroviral therapy, AIDS continued to kill parents - it took the lives of around 75,000 adults in 2005.

Today, the mother-to-child transmission rate at six weeks of pregnancy is 1.3 per cent, down from 60 per cent when the children's clinics first started.

"When we just started, a lot of children had cerebral palsy like symptoms because the HIV had gone to the brain as a result of there being no drugs," says Dr Kankasa.

Over the past decade, Zambia has made progress in the HIV response. According to UNAIDS, annual HIV infections (for all ages) in Zambia have declined from 60,000 in 2010 to 51,000 in 2019. New infections among children 0-14 years declined from an estimated 10,000 in 2010 to 6,000 in 2019. Annual AIDS-related deaths have also declined significantly from 24,000 in 2010 to 19,000 in 2019, a decline of about 30%. Zambia has an estimated adult HIV prevalence of 11%.

__

This article was part of a series looking back on UNICEF’s work in Zambia as part of the UNICEF75 anniversary commemorations.