The South African government’s refusal to disclose the number of children receiving antiretroviral (ARV) drugs in KwaZulu-Natal province 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 2004, which has since been extended to March 2005.
Although there is no separate national target, the number of children currently receiving ARVs is said to be disturbingly low. The Aids lobby group, Treatment Action Campaign (TAC), recently conducted a survey in 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 rollout, and children were therefore not part of the programme,” said TAC provincial organiser Sifiso Nkala. There was a need, however, for children to be enrolled in the ARV programme, as 50% of HIV-positive mothers were unable to prevent transmission of the virus to their child.
He noted that efforts to establish the national status of the ARV rollout for children were futile, as the national 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 were more open about how many children were 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 healthcare 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 healthcare 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 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 (PCR) 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, Medecins Sans Frontieres (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 last 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 adhered 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 rollout.
Studies highlight aid efforts in context of HIV/Aids
Given the prevalence of HIV/Aids in Southern Africa, food aid programming needs to be adapted to address the multiple impacts of the pandemic, say two new studies.
The reports, both compiled by the Consortium for Southern Africa’s Food Security Emergency (C-Safe), Food for Assets: Adapting Programming to an HIV/Aids Context and Targeted Food Assistance in the Context of HIV/Aids, focus on ways of improving the effectiveness of aid programmes in the region.
In terms of targeted food aid, the latter study noted that ”while food aid provides a much-needed short-term safety net, it is only one piece of a much larger food security challenge”.
”The challenge lies in identifying the most appropriate food or nutrition intervention, targeting the right individual/household/community, and providing it [aid] at the right time (and for the right duration) for maximum effect,” the report said.
C-SAFE’s experience during the drought of 2001/02 in Southern Africa highlighted the ”complexity of designing food aid/security programming in the context of high HIV prevalence rates”.
The report noted that in order to ensure effective and appropriate aid programming, ”it is necessary to step outside the traditional practices and mechanisms of emergency relief and recovery”.
This entailed conducting targeted research, developing new partnerships and equipping aid workers with new sets of skills.
Apart from a solid understanding of relevant government strategies and goals regarding the prevention, care and mitigation of HIV/Aids, ”the planned involvement of people living with HIV/Aids will guide the development of a credible and effective strategy,” the report commented.
Having a designated staff member with a mandate to spearhead, guide and document HIV/Aids- related activities in food aid programming were also crucial to projects in high prevalence countries, the study found.
The C-Safe report on food-for-assets aid programmes noted that ”in Southern Africa, where HIV prevalence is the highest in the world, ‘mainstreaming’ of HIV/Aids is a crucial element of every intervention”.
Food-for-assets programmes, also known as food-for-work, aim to improve food security in asset poor communities by getting them involved in projects that will build productive assets, such as dams, to assist recovery and strengthen resilience to future shocks.
In return for working on these projects, participants are rewarded with food rations.
C-Safe noted that in areas where HIV/Aids prevalence was high, groups of people that food-for-assets programmes should target were: households caring for chronically ill members, including tuberculosis patients; households with pregnant or lactating mothers enrolled in a prevention of mother-to-child transmission programme; able-bodied individuals who had recently completed treatment of an opportunistic infection, and able-bodied people who were HIV positive. — Irin