Mumbai Exclusive: Hundreds of city kids succumb to HIV

Drug addiction is one of the main causes of HIV-related deaths among children, especially boys. Pepresentation pic

Thirteen-year-old Darpan (name changed) died in his parents' lap at the Dharavi chawl last year, just eight months after he was diagnosed as HIV-positive. He is among 321 children under the age of 15 who have succumbed to the virus since 2013 in Mumbai alone. Like many of them, Darpan's drug addiction not only exposed him to the deadly virus, but also weakened his immune system further and ruined his chances of fighting back. Darpan's drug addiction had already ravaged his body, leaving him at a severely malnourished 45 kg. His use of needles exposed him to HIV and low immunity made him further susceptible. One day, he started bleeding from his genitals, and a doctor diagnosed him as HIV-positive.

Mum recalls
Speaking to mid-day, his mother recalled, "He was so addicted to drugs that his arms were riddled with needle marks. This led to the HIV infection. He became so weak that he couldn't get out of bed. Within five months of the diagnosis, he developed TB, but we didn't find out until it was too late. Three months later, he passed away."
A query from mid-day to the AIDS Control Society, Mumbai district, under the Right To Information (RTI) Act revealed that there were 321 HIV-positive children who similarly succumbed to HIV in the last five years. Although the number of deaths dropped between 2013 and 2015, the fatalities have gradually increased in the last couple of years (see infographic).

As per experts, one of the reasons is increasing drug use among children. "Nowadays, with easy availability of money, more children are getting addicted to drugs, both in the lower and upper classes. This has made them more susceptible to HIV infections," said Ganesh Acharya, an HIV-infected patient and activist. Higher drug use also corresponds to greater mortality rates among boys compared to girls.

TB, drug resistance
However, drug addiction is not the only reason behind the death of Darpan and other children like him. Tuberculosis is one of the leading killers among HIV-infected patients, particularly children. Acharya said, "India still lacks the TB medicine Delamanid, which helps paediatric HIV-TB patients. We only have Bedaquiline, which is specified to adult patients." Matters are further complicated when children don't receive their Antiretroviral Therapy (ART) on a regular basis. When a patient gets infected with HIV, he/she develops weak immunity, and without the medication, they fall prey to opportunistic diseases, such as TB.

"Irregular and improper ART treatment is the main reason why the children are developing drug-resistance. Due to non-availability of medicines at ART centres, patients skip medicines, which makes them drug resistant. Unlike TB, the second and third-line treatment for drug-resistant HIV is limited," said Dr I S Gilada, consultant on HIV/STDs and president of the AIDS Society of India (ASI). Experts raised the need for a national medical structure that would focus on inclusive medicine and nutrition, depending on the need of the patients. "When additional underlying disease doesn't get treated, the condition further deteriorates into immune reconstitution inflammatory syndrome (IRIS)," added Dr Gilada.

Officialspeak
"Due to rising awareness and better inspection, more HIV-related deaths are being reported. Field workers are knocking at the doors of all the registered patients. If anyone discontinues their treatment, they are re-registered for follow-up. Also, several TB programmes have been tied with HIV patients, which helps to collate the data. Hence, it would be wrong to say that deaths are increasing," said a senior officer from AIDS Control Society, Mumbai. Dr Padmaja Keskar, BMC executive health officer, said, "Now that there is more field work, we have traced more cases. It can take years for patients to succumb to HIV, so we can't call this a sudden rise in the number of deaths."

Rising danger among HIV+ children
Leading causes of death

Drug addiction weakens immunity; more common among boys
Drug resistance is hard to fight as India has limited second and third-line of treatment
Irregular supply of medicines leads to further development of resistance
TB is a leading cause of death, as India lacks medicines for paediatric patients with HIV-TB

321
No. of child HIV fatalities below 15 years since 2013

70
No. of deaths among HIV+ children in 2017

Also Read: West Bengal tops in curbing parent-to-child HIV transmission

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