AIDS drugs needed for HIV positive children

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 percent 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," attorney with the AIDS Law Project, Fatima Hassan, told PlusNews. "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 percent 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 percent 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.