The South African government’s refusal to disclose the number of children receiving anti-retroviral (ARV) drugs in KwaZulu-Natal has raised fears among Aids activists that children’s rights to health care and life are being violated.
The national treatment plan, unveiled last November, initially targeted the treatment of 53 000 people by March this year, which has since been extended to March next year.
Although there is no separate national target, the number of children currently receiving ARVs is said to be disturbingly low. Aids lobby group the Treatment Action Campaign (TAC) recently conducted a survey at 13 of KwaZulu-Natal’s largest public hospitals and found that only 39 children were receiving anti-Aids medication.
According to specialist paediatrician Dr Neil McKerrow at Grey hospital in Pietermaritzburg, which has been dispensing the drugs since August this year, the province’s unofficial target is to have 2 000 children taking ARVs by March 2005.
”In most of these hospitals, paediatricians were not involved in the ARV roll-out, and children were therefore not part of the programme,” said TAC provincial organiser Sifiso Nkala.
There is a need, however, for children to be enrolled in the ARV programme, as 50% of HIV-positive mothers are unable to prevent transmission of the virus to their child.
He noted that efforts to establish the national status of the ARV roll-out for children were futile, as the Department of Health would not disclose the number of children on treatment in the public sector.
According to the Aids Law Project, provinces such as Gauteng and the Western Cape are more open about how many children are included in their programmes.
”Disclosure depends on how closely the provinces toe the department’s instructions not to share information,” said an attorney with the Aids Law Project, Fatima Hassan. ”Due to problems with paediatric formulations, many provinces started very slowly with getting children on ARVs.”
Delays in treatment have undermined children’s rights to access health-care services and could result in premature death.
”With paediatric formulations generally available, there are no good reasons for delaying treatment at sites where there are qualified paediatricians and the necessary support staff,” Hassan noted.
Nevertheless, doctors and health-care workers are still debating at what age a child should start taking ARVs.
Under South African law, a child younger than 14 years requires consent from a parent or guardian to be given the drugs, but campaigners are saying the ”right age” cannot be regulated by the government and should be assessed by doctors on a case-by-case basis.
Another obstacle to providing free drugs to children is the prohibitive cost of specialised tests for diagnosing HIV in children younger than 18 months.
The most commonly used HIV antibody test — the rapid test — is unable to discern between maternal and child antibodies in infants. Because HIV antibodies can cross the placenta and stay in a child’s bloodstream for 15 months, a baby needs a polymerase chain reaction test, which can detect small quantities of viral protein in the blood, to establish their status.
This test is not widely available and is ”substantially more expensive” than rapid tests, McKerrow said.
The international NGO Médécins sans Frontières (MSF) this week called for pressure to be placed on pharmaceutical firms to manufacture Aids medicines adapted to the needs of children.
Adult ARVs are available to children above three years of age, with specific formulations and dosages based on age and weight.
Despite paediatric syrup having been made more widely available over the past few months, not all caregivers, particularly those living in remote rural areas, have the refrigeration facilities needed to store the medication.
MSF has estimated that approximately 50% of all HIV-positive children in developing countries die before the age of two.
The adherence of children to the drugs is another challenge. According to Noreen Ramsden from the Children’s Rights Centre in Durban, only 70% of children adhere to the treatment plan.
”Because of the multiple side effects of ARVs, children need a lot of encouragement to stick with the medication,” she explained.
Orphaned children in child-headed households in both urban and rural areas, who lack supportive care and proximity to treatment centres, find it even more difficult to access the drugs.
McKerrow suggested that social workers would have to find treatment supporters to help orphans enrol in the ARV roll-out. — Irin