At the tender age of 12, Pedro Moniz* is already a veteran when it comes to observing the regimen of anti-retroviral drugs that keeps Aids-related illnesses at bay.
“I take one tablet at 6am, another at 1.45pm just before school, another at 5.45pm when I return from school — and the last at 10pm,” he says, without pausing to think. “I take them so I don’t get sick and so those spots don’t come out again.”
The son of a now-deceased member of Kindlimuka, an association for HIV-positive persons, Pedro was born with the HI virus. He began taking anti-retroviral drugs (ARVs) three years ago — one of the first children in Mozambique to receive the medication.
Pedro benefits from a programme supported by the American branch of the Save the Children NGO, which is implemented by Kindlimuka.
Under this initiative, 2 112 children between the ages of seven and 17 who have been infected or affected by HIV and Aids are visited by trained activists who make sure that their basic needs are met. This includes checking that the children are in school whenever possible, and that they have educational materials, clothes and good food. About 50 of the children are also on ARVs.
Drop in the bucket
As heartening as this and similar programmes are, however, they only target a fraction of the children who require Aids treatment in Mozambique — which has an HIV prevalence of 15,6%, according to the government.
There are now 91 000 children under the age of 15 living with HIV in the Southern African country. By June of this year, 500 children were registered on the government’s free ARV treatment programme; yet more than 60 000 children aged 14 and below are estimated to be in need of the drugs.
Aids is increasingly emerging as one of the most important causes of illness and death among children in Mozambique. Of the 97 000 people who died from Aids-related illnesses in 2004, 17 500 were children under the age of five.
An average of 500 new HIV infections takes place every day, 90 of them among children who contract the virus from their mothers.
This grim array of statistics begs the question of how authorities can possibly meet the needs of HIV-positive children in Mozambique. Are they effectively in a position of spectating on the death of vast numbers of young citizens?
“The government has a multisectoral approach, which aims to capacitate all the actors, especially those in the community, to help ensure children who are disadvantaged — who include children affected and infected by HIV and Aids — have their rights met,” says Estrela Herculano, head of the department for women and the family in the ministry of women and social action.
Assistance not enough
HIV-positive children who are unable to access ARVs are entitled to a package of assistance that includes treatment for opportunistic infections, food aid from the United Nations World Food Programme and school materials. Some also benefit from the home-based care programme that is coordinated by the ministry of health.
Yet, says Herculano, children appear to be slipping through the cracks.
“We don’t know how many children we’re reaching. We encourage local authorities to make sure children are registered. But … in some places there are no roads, so we do not even have access,” she notes. “Many families don’t even know that that their children are HIV-positive, even when they are sick. Most don’t get tested.”
The difficulties that surround provision of care to HIV-positive children reflect the larger problems the country faces in catering for its youngest citizens. Vast and sparsely populated, Mozambique is one of the world’s poorest states: only about half of school-aged children have the opportunity to study.
And even with the smallest of the small, stigma presents a problem.
“We don’t want to single out children who are sick with Aids-related illnesses because of the stigma. They might be discriminated against,” says Herculano.
Pedro keeps the fact that he is HIV-positive secret from his neighbours and teachers.
“His teacher just knows he gets sick, but we don’t tell her he is on ARVs or is HIV-positive, because he could face discrimination,” says Anifa Amade Ibrahim, a representative of Kindlimuka. “The most important thing is that the children who are sick with Aids should be treated like any other children.”
Says Pedro, shyly: “I used to miss a lot of school when I was small because of fevers.”
Although he has a persistent cough and is very small for his age, Pedro is in far better health than he used to be. It’s ironic that this improvement can’t be celebrated publicly.
* Certain names have been changed to protect the identities of the individuals concerned