Victory on the Third Line

Jeremiah was a “new year” baby, born January 1, 2010 in southwest Uganda. He contracted HIV at birth from his mother, Karen. For most of his early childhood, Jeremiah was sick, and his mother wasn’t well either. Karen says that they hardly had any food, and they lived under the terror of Jeremiah’s violent father.

Jeremiah’s father rejected Jeremiah, but Karen did everything to stay because, at least, she could grow food in the family’s homestead and get milk from their cow.

“There was nowhere else to go. Most of my family were far away,” says Karen. “Jeremiah’s father was ashamed and angry and wanted us out.”

One day, when Jeremiah was 6 years old, his father drove them from the family home. “He said Jeremiah was not his son,” says Karen. “He beat me and chased us away to live in a shack with a leaking roof, mud floor, and no food.”

Jeremiah was thin and weak, so neighbors urged Karen to take Jeremiah to a regional referral hospital in Mbarara.  Jeremiah spent several days there. He was stabilized and started on antiretroviral medication (ARVs).

For two years, Karen did her best to keep her son and herself on HIV treatment, but she wasn’t able to make it to the health center regularly because of her inconsistent housing situation.

Jeremiah eventually contracted tuberculosis, a common coinfection for people living with HIV who do not have a suppressed viral load.  He was admitted at the health center and treated.  After running tests, the clinicians decided to put Jeremiah on second line ARVs because the first line drugs were no longer working. When a person living with HIV fails to take ARVs regularly, the drugs eventually become less effective and that person must be placed on a second line drugs. If second line drugs stop working, the person must then be placed on third line drugs, which are the last effective deterrence of HIV.

Jeremiah was a favorite. Volunteers, health workers, everyone checked in to see how he was doing almost every day. Viola Nagasha, Jeremiah's counsellor

“Jeremiah was a favorite. Volunteers, health workers, everyone checked in to see how he was doing almost every day,” says his counsellor Viola Nagasha. Eventually Jeremiah was restored to health.

Karen took on odd jobs at the hospital, including helping other families take care of their patients, washing clothes, and preparing meals. She used her earnings to take care of Jeremiah.

Seeing the financial distress of Karen, Viola created a team to help the family. One resource was the USAID Supporting Orphans, Children, and Youth (SOCY) project,¹ which provided emergency food, clothing and school supplies and helped Jeremiah get back into school. IreneTukundane was the parasocial worker from SOCY assigned to this project. Medrine Mbabazi, a mother living with HIV, provided peed support. Team Jeremiah helped find a place for Jeremiah and Karen to live with an auntie.

The team also approached the community development officer (CDO) to report Jeremiah’s father for his continued threats and child neglect. The CDO issued a restraining order for Jeremiah’s father and ordered him to provide some financial support.

During all of this time, Jeremiah continued to exhibit symptoms of illness, including rashes over his body. When health workers tested him, everyone was dismayed to learn that Jeremiah’s viral load remained high. Additional tests were conducted and the clinician at Kabwohe Health Centre IV recommended Jeremiah be put on third line ARVs. This was his last hope.

“We couldn’t understand why Jeremiah was still not suppressing,” says Irene. The team decided to dig deeper through intensive home-based counseling to assess the family and their adherence plan.

During one of the home visits by the EGPAF team, Karen revealed that she woke up early every day to farm as a way to contribute to the home, and she wasn’t always able to give Jeremiah his meals on time or supervise his medication. Without consistent lunches, Jeremiah was not taking medication regularly.

With Karen’s permission, the team invited the expert client, Medrine, to a family meeting that included the auntie who took them in. Medrine talked about HIV and the importance for Jeremiah and his mother to take their medication on time consistently and to eat and live healthy. The expert client told them about her similar situation her child, who is thriving.

The expert client told them about her similar situation with her child, who is thriving.

Karen and Jeremiah had been bracing themselves for another rejection, but to their surprise the relative committed to support Jeremiah. Subsequently, Karen was allowed to cook meals in the morning and help Jeremiah with his medication before tending to her farming. In a short time, Jeremiah gained weight, and started feeling better.

Any time the team stops over Jeremiah quickly changes into his best shirt and proudly shows off his schoolwork. He is at the top of his class. Jeremiah loves soccer and supports Arsenal.  He continues to adhere to his HIV treatment.

On June 15, 2020, emails at EGPAF and cellphones at Kabwohe Health Centre were buzzing, clapping and dancing as Jeremiah’s viral load test came in as suppressed. He had achieved victory on the third line.

¹USAID/SOCY-The Sustainable Outcomes for Children and Youth (SOCY) is a five-year USAID funded program designed to improve the health, nutrition, education and psychosocial wellbeing of orphaned and vulnerable children, as well as reduce abuse, exploitation, and neglect among this population in 22 districts in central, south western, and western Uganda.

“Team Jeremiah” was supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) through USAID Regional Health Integration to Enhance Services in Southwest Uganda (USAID RHITES-SW)

Jeremiah and Karen are pseudonyms to protect their privacy.