While better access to antiretroviral treatment means more people than ever live with HIV as a chronic disease, rather than dying from it, many HIV patients’ pain widely goes undiagnosed and untreated.
Pain is a major issue for people living with HIV and Aids − pain from the virus itself, treatment, infections and cancers. It can significantly affect people’s quality of life. Yet pain is seriously undertreated in 150 countries making up 80 per cent of the world’s population, according to figures from the World Health Organisation.
In Kenya, a case in point, the number of people taking anti-retroviral medicines has gone up by a quarter in the past year. But in Kenya, as in many other countries, HIV care often neglects assessing and treating pain. Five year-old “Gerard," who died in pain in a Kibera shanty town, was one. With no other option his mother tried vainly to treat him with Ibuprofen.
Many health care workers and patients view pain as inevitable, say Human Rights Watch. Essential pain drugs are often hard to get across the east African country’s medical centres. Morphine is available in just seven of Kenya's 250 public hospitals, and even these run out. It is not because the drug costs a lot, but because many see the opiate as dangerous. And because of a lack of training, healthcare workers are often scared of using it, for fear of giving people an overdose or making them addicted.
Many doctors even are often wary of giving morphine to children, mistakenly thinking that it would mean they were ‘giving up’ on the child. "When it comes to children, there is always some reservation,” one doctor told the rights group. “Putting a child on morphine is always a big issue ... Morphine is underutilised."
A woman who runs an orphanage in Nairobi said many of her children suffered tingling pain in their hands and feet, but she could not buy gabapentine, a drug to treat nerve pain, because it was expensive. There are cheaper alternatives but many doctors don’t know that they can be used to treat nerve pain.
The rights group has called on Kenya’s government to urgently improve the availability of and access to morphine and step up the availability of nerve pain drugs for children. It also wants pain treatment to be part of the country’s HIV policy and to make sure health care workers are properly trained to treat pain, especially in children.