Glaring lack of child ARVs and slow rollout

Children have been left out of national programmes to provide anti-AIDS drugs, the UN Special Envoy for AIDS in Africa, Stephen Lewis, said on Tuesday.

Although about 2.2 million children were HIV positive - at least two-thirds of them in Africa - paediatric antiretroviral (ARV) formulations were still not widely available and ARV rollouts were being assembled as if children did not exist, Lewis said during a press conference.

"In the instance of antiretroviral therapy, the scenario for children is, quite simply, doomsday," he warned.

Treatment for children is not that simple. Pharmaceutical companies have not yet developed fixed-dose combination treatments in dosages appropriate for them, and physicians often have to portion out a cocktail of three separate adult-dose medicines in different combinations as the child grows.

To determine correct paediatric doses most effectively, caregivers should ideally use the three drugs according to the surface area of the child - a number obtained by a complicated formula of multiplying the child's weight by its length, dividing by 3,600, and then taking the square root of that number.

Medecins Sans Frontieres (MSF), which has been publicly campaigning for child ARVs, claims that children living with the virus are needlessly dying because medicines have not been simplified for widespread dispersal. The medical humanitarian agency alleges that because most children with HIV/AIDS live in the developing world, there is little commercial interest in creating and marketing child-friendly treatments, and instead children are given small portions of adult doses.

Speaking about his recent trips to Malawi and Tanzania, Lewis also called on governments to involve people living with the virus in their programmes.

"It is a matter of continuing concern that lip service almost everywhere characterises the attitude and behaviour of government towards organised associations of people living with HIV/AIDS. It's hurtful and it's painful," he said.

Nevertheless, progress was being made in implementing ARV programmes and the World Health Organisation's '3 by 5' initiative - three million people in the developing world on antiretroviral therapy by the end of 2005 - was "driving the agenda" in Africa, he noted.

In Malawi the biggest drawback has been the lack of trained healthcare workers, with the Ministry of Health experiencing a vacancy rate of 67 percent. As a short-term measure, the British Department for International Development (DFID) was going to raise the salaries of local healthcare workers by 50 percent to reduce migration, he said.

Tanzania has estimated that 450,000 people need antiretroviral treatment, and although the government was aiming to treat 220,000 by the end of 2005, there have been "endless difficulties" in implementing these targets - the rollout was initially planned to kick off in March 2004 but was delayed until October.

The government has taken "some strikingly intelligent steps" by providing free generic fixed-dose combinations (FDCs) twice a day for first-line interventions, and allowing the US President's Emergency Plan for AIDS Relief (PEPFAR) to provide free drugs for second-line interventions, as well as for paediatric care.

However, Lewis remained sceptical as to whether the rollout had actually begun. "Somehow the desperate sense of emergency has just begun to grip the bureaucracy. The president is fully engaged, but his appeals to urgency are only now penetrating the wider political establishment."

"The change in priorities can't come soon enough," he added. "Everywhere we went, people were clamouring for treatment."