Age offers little protection against Aids, children are often the disease’s unwitting victims. Yet for the young ones in Southern Africa, treatment is only just beginning.
But the long-term health implications are still largely unknown while lack of child-specific dosages presents another major challenge.
“There are very few paediatric formulas internationally and the amount of research is minimal,” says Lynde Francis who runs a centre in Zimbabwe with 200 HIV-positive children.
“I think it’s partly because it was acceptable that a kid with HIV would die,” she adds.
Around three million children in Sub-Saharan Africa, the world’s worst-affected region, were living with HIV in 2003, according to the Joint United Nations Programme on HIV/Aids (UNAids) and the World Health Organisation (WHO). In the same year, 700Â 000 children under the age of 15 were newly infected with HIV/Aids, 88.6% of whom live in sub-Saharan Africa.
In neighbouring South Africa, which has the highest HIV burden in the world with five million people infected, including over 250Â 000 children below the age of 14, the treatment of children appears to be gathering steam since the launch of the government roll-out programme in 2003.
But paediatrician Tammy Meyers, who works at the country’s largest referral hospital as well as at the University of the Witwatersrand, says children are still having problems accessing treatment. “I think paediatric roll-out requires a champion at almost every facility, where this does not exist the care is slow or not happening,” she adds.
The children’s clinic at Chris Hani Baragwanath Hospital has more than 500 children on treatment, through the government plan. Meyers is part of a team that conducted a study on 262 of the children. Results show that while 18 of them died while on treatment, none of the deaths was due to the life-prolonging anti-retroviral drugs (ARVs) they were taking.
The release of the study findings comes after the country’s health minister, Manto Tshabalala-Msimang, voiced suspicion over ARVs. Attacking the WHO for pressing South Africa into accelerating its ARV roll-out, the minister maintains the drugs have negative side effects. Instead, she advocates the use of garlic, lemon, beetroot and olive oil to slow the progression to Aids. This has enraged activists presently engaged in legal battle with a champion of multivitamins. The latter’s efficacy against Aids has not been conclusively proven.
In Zimbabwe, the government says it only has resources to provide ARVs to 10Â 000 people. But there has been no explicit mention of children in a country where 300Â 000 people need treatment.
Officials in the Ministry of Health’s Aids and Tuberculosis unit are loath to shed much light on the government’s plans for infected children. According to the United Nations Children’s Fund (Unicef), HIV-related illnesses claim a child every 15 minutes in Zimbabwe.
“There just are no drugs,” Francis says. Part of the reason, she explains, is that Zimbabwe’s ARV roll-out programme — launched early last year — was based on an unsuccessful application for $218-million to Global Fund to Fight HIV/Aids, Tuberculosis (TB) and Malaria.
But other activists still question the government’s commitment to fight the disease, citing the recent purchase of Chinese-made military hardware including four fighter jets that cost an estimated $120-million when the country is hardly facing an external threat.
However, treating children goes beyond financial commitments. According to Ruedi Luthy, who runs a Swiss-funded clinic that has 50 adolescents and children who receive ARVs, prolonging the lives of infected children — especially the very young ones — presents several challenges.
“Their clinical presentation is different, the diagnostic work-up is different and often more difficult and medications are often only available for adults,” he says. Since children are not merely “small adults” with regard to their illnesses and treatment, additional expertise to increase the number on ARV programmes is required, but hardly available.
Located in the capital Harare, Connaught clinic provides “comprehensive care” for HIV-Aids patients, including drugs, for those who cannot afford medical care. The youngest patients are three months old. ”It is absolutely magnificent to see how well most of the children do — even after a period of only four weeks,” Luthy says.
He adds: “experience from the First World tells us that children respond to treatment just as well as adults do, but parents need to be committed and well instructed to achieve this success.”
In Zimbabwe’s second city, Bulawayo, the Spanish chapter of MÃ