On World HIV Day, we reflect on the resilience of children like "Chicken," whose story embodies both the challenges and hope in the fight against HIV. Her journey reminds us of the importance of accessible healthcare, compassionate caregiving, and community support. Despite the progress in reducing mother-to-child transmission, the battle against HIV in South Africa remains deeply intertwined with poverty, gender inequality, and systemic barriers. At Starfish Greathearts Foundation, we are committed to supporting vulnerable children like Chicken, ensuring they have not only the medical care they need but also the love, stability, and opportunities they deserve. Together, we can work towards a world where every child has a chance to thrive, free from the shadow of HIV.
"Chicken"
Chicken was a literal mini-celebrity amongst medical students and interns who rotated around the paediatric department. She spent her formative months living in a cot, around other long-stayers in the TB room of the hospital, those who needed longer admissions for treatment or other social issues. A cranky old TV sat in the periphery, siblings sitting on chairs or plastic stools watching video re-runs of Disney classics or Afrikaans TV. She had come to the hospital around 12 months of age, brought in by her grandmother. She was suffering from malnutrition and was born to a young mother unwell with HIV and drug addiction.
Her gingery curls stuck up in a wispy cloud, hence her nickname and she would glare with a furrowed brow, suspicious of this unfair and unusual nursery. She had intelligence within her little brown eyes, despite her numerous challenges - neglect, malnutrition, developmental delay, foetal alcohol syndrome, and an HIV diagnosis. Her little eyebrows unfurled as you gave her some more time and caught her intrigue, and she held her newly pudgy arms out to medical students, nurses, and doctors alike. She grabbed lanyards and sucked on name-badges with enthusiasm - her familiar toys.
She would be often slung on someone’s hip, and carried around during ward rounds. Scooped up after she was found toddling around the high-dependency room, inevitably chewing on a sweet given to her by one of the other children’s parents. Mums picked her up and carried her around, older sisters held her on their backs. She was loved by many, but lacked the home and consistent and stable caregiver that she deserved.
Paediatric HIV in South Africa
Chicken, like all children, was special, but sadly her challenges were not unique. HIV rates within the paediatric population in South Africa are declining but remain high, with babies commonly infected in utero, during birth, and through breastfeeding. The epidemic in South Africa has been exacerbated by social factors such as high numbers of refugees and political exiles, mass resettlement of populations, sexual violence, and high numbers of sex workers due to poverty.1 Even with the advent of effective and acceptable treatment - managing the HIV epidemic in South Africa has been complicated by the historical legacy of apartheid as well as legal battles against pharmaceutical companies to access generic and free drugs and historical governmental resistance.2
South Africa has made huge progress in regards to preventing mother-to-infant infection following the widespread implementation of the UN-backed Prevention of Mother-to-Child Transmission of Transmissible Infections (PMTCT) (now known as VTP - Vertical Transmission Prevention). The rate of intrauterine infection declined from 9.6% in 2008 to 0.9% in 2016, although this was disrupted by the Covid pandemic.3 High rates of HIV testing and treatment have led to a steady decline in HIV infection - this is in line with the UNAIDS 95-95-95 targets (95% of people living with HIV know their status, 957 of people with known HIV are on ART, and that 95% of people on treatment are virally suppressed).4
In 2024, new HIV infections are disproportionately seen amongst adolescent girls and young women in Eastern and Southern Africa5 due to the intersection of gender inequality, sexual violence, and limited access to appropriate sexual health services and education. New infections amongst these groups are four times higher than the UN 2025 targets.6 This has implications for the health and development of emerging generations as well as being representing health disparity along gender lines. There are well-established links between poverty and multiple health outcomes. The epidemic amongst young women has potential consequences for families and households.7
The intersectionality of poverty, communicable diseases, and poor access to health care in rural regions of South Africa is a perfect storm within which children emerge with unimaginable challenges. The aim of Starfish is to alleviate some of this burden and support childhood development for babies like Chicken, hoping to contribute to a brighter present and future for the next generation.
References
- The politics of AIDS in South Africa: beyond the controversies
- No Valley Without Shadows: The story of the early HIV movement in South Africa
- Prevention-of-mother-to-child-transmission (PMTCT) program outcomes in South Africa in the pre-COVID and COVID eras
- Future HIV epidemic trajectories in South Africa and projected long-term consequences of reductions in general population HIV testing: a mathematical modeling study
- 2024 UNICEF Snapshot on HIV and AIDS in children and adolescents - Eastern and Southern Africa
- The urgency of now: AIDS at a crossroads 2024
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Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral and Structural Factors and Emerging Intervention Approaches