Starting to save HIV-positive children

Albertina, a 34-year-old mother of three children, has just learnt she is HIV positive. She appears to take it calmly and manages to remain focused on her youngest son, Pedro, who is waiting to see the doctor at the Paediatric Day Hospital in Maputo, the Mozambican capital. The brightly coloured waiting room where he is sitting with his mother is full of young children, some of whom are obviously sick, while others play with the toys pooled in the middle of the room. "I can cope with my situation, but it was very painful when I found out that my son was HIV positive," Albertina told PlusNews. His HIV status was confirmed three years ago, after he had been admitted to hospital six times with respiratory infections and severe diarrhoea. Albertina had to spend weeks at his bedside nursing him. "He could barely sit up. He had no body, he was just bones." After starting a course of antiretroviral (ARV) treatment in July last year, her son is looking robust, and had come for a routine check-up. "He is now at home and able to play with his brother and sister and his friends." Pedro is fortunate to be one of just 500 children who are on the government's free treatment programme – an estimated 69,025 children below the age of 14 need ARVs to help prolong their lives, according to Dr Paula Vaz, who works at the hospital. Despite the small number of children receiving anti-AIDS drugs, "it is encouraging to see that children are now on the agenda for ARV treatment," said Christiane Rudert, a project officer with the UN Children's Fund (UNICEF). Mozambique is one of the world's poorest countries, where only 40 percent of the population has access to basic healthcare. Around 15 percent of Mozambicans are living with HIV/AIDS, and 200,000 people should be receiving ARV medication, but the government's free programme, which began last year, only reaches 1,700 HIV-positive people, most of them in Maputo. The target is to double the number of sites providing ARVs to 47 this year, and expand treatment to 29,000 people. The Paediatric Day Hospital for children with HIV/AIDS is the only one of its kind in the country. "The other day hospitals tend to focus more on adults than children, probably due to a lack of sensitisation to the problem," explained Vaz. It is conveniently located, upstairs from the paediatric emergency ward and laboratories of the Maputo Central Hospital, and is equipped with its own pharmacy, consulting rooms for doctors and a psychologist. Every year around 30,000 Mozambican children are born with HIV. More than 50 percent of them die within their first year, the rest usually do not survive their second. Vaz, who has been working with youngsters living with the virus for 10 years, has 78 on ARVs, with her eldest patient aged 14 and the youngest just six months. The government aims to have 1,328 children on treatment by the end of 2005. But Vaz acknowledges that there are major constraints, including a lack of trained personnel and laboratories, and reagents to measure the viral loads and CD4 counts, which gauge the strength of the body's immune system. Two NGOs, Medecins Sans Frontieres and the Vatican-linked Santo Egidio, run model community-based care and treatment projects, which have a total of 4,200 people on ARVs. But the reality is that for many years to come, most children in Mozambique who need the drugs will not receive them.