HEALTH-SOUTH AFRICA: Efforts to Get ARVs For Kids Are Still in Their Infancy

By Moyiga Nduru Reprint | | Print |

Moyiga Nduru

JOHANNESBURG, May 31 2004 (IPS) - When AIDS activists have locked horns with the South African government in recent years, it has often been over the provision of anti-retroviral drugs to pregnant women – or adults living with AIDS. The challenges of supplying the medicines to HIV-positive children appear to have received less attention.

That may change as the national programme to provide anti-retrovirals (ARVs) – which became operational earlier this year – gathers momentum. For 14-year-old Sthandiwe Gumede, such change can’t come a moment too soon.

"I used to cough a lot. Sometimes I had problems breathing and sleeping, especially at night," says the young girl, who lost her mother to AIDS in 2002 and is herself HIV-positive. "But now my health is improving," she adds, still coughing.

Heather Snyman, a therapist at the Nkosi Haven children’s home in Johannesburg where Sthandiwe lives, adds "She has just (come) out of the hospital. She has been sick on-and-off for years. She has a lung infection."

The home is named after Nkosi Johnson, a 14-year-old South African who became a well-known figure in the fight against AIDS both locally and abroad, and who succumbed to an AIDS-related disease in 2002. Nkosi’s Haven accommodates 43

children: 24 are AIDS orphans, eight are HIV-positive.

According to the Joint United Nations Programme on HIV/AIDS, some 250,000 South African children under the age of 14 are infected with the HI-virus. The children are part of the five million people, or about ten percent of South Africa’s population, who have contracted HIV (this according to official statistics).

Sthandiwe is hoping to be put on ARVs as soon as possible. The drugs prolong the lives of people living with AIDS.

"I always go to the hospital. This time I have been admitted for three days. I don’t know what’s going on," she told IPS, ending her sentence with a common Zulu interjection, "Aaish!"

It appears that the large number of people seeking access to the free ARVs which government has lately started to provide has prevented Sthandiwe from being put on the drugs. Bureaucratic fumbling has also delayed the process.

"Sometimes we would go to the hospital and the doctor would say ‘Take her to the adult section’. When we take her to the adult section they would say ‘She’s still a child, take her to the children’s section’," says Snyman.

Government is seeking to treat over 50,000 people a year free of charge under the ARV programme. In private clinics, it costs almost 93 dollars to put a child on the drugs for a month – about half of what needed to be paid two years ago, according to various anti-AIDS campaigners contacted by IPS. This amount is still beyond the reach of many people in South Africa, however, where 40 percent of the population lives below the poverty line.

Under South African law, a child younger than 14 requires consent from a parent or guardian in order to be put on the drugs. But in fact, doctors and local health authorities are still debating what the right age is for a child to start taking ARVs.

"Theoretically you can start putting a baby on ARVs as soon as it is born," Katy Vadda of Children’s Rights, a non-governmental organisation (NGO) located in the South African port city of Durban, told IPS in a telephone interview.

Doctors Without Borders, an international NGO, advises health officials to start treating a child as soon as it is discovered to be infected with the HI-virus. This is to allow the child’s immune system to be boosted.

Deborah Ewing of Children First, another Durban-based NGO, says she has seen the drugs deliver positive results with a child who was only a year old, and weakened by diarrhea.

"As soon as she was put on ARVs the diarrhea disappeared, her condition improved and she has no major health problem now," Ewing notes.

AIDS campaigners say the government is mostly concentrating on adults as far as ARV provision is concerned. "It seems children are not receiving the same attention as adults," Vadda says. "Children must deserve the same attention as adults."

Efforts by IPS to comment from government on this issue were fruitless.

However, Health Minister Manto Tshabalala-Msimang told journalists in Cape Town on May 27 that the provinces of Gauteng, KwaZulu-Natal and Western Cape had fairly large numbers of patients receiving ARVs. Gauteng was providing drugs to about 940 people, Western Cape to about 2,500 and KwaZulu-Natal to 153, she said.

"The other (six) provinces are not yet providing antiretroviral drugs to patients on any significant scale. They are all actively enrolling patients. This means conducting tests, counseling and educating patients in preparation for ARVs, a process that takes several weeks," Tshabalala-Msimang added.

"Getting information on children has been very difficult in South Africa," Vadda concedes.

In addition, Ewing told IPS that pharmaceutical firms have tended to concentrate on producing ARV tablets and capsules for adults. But, "Children require syrup," she said. "We need to push the pharmaceutical firms to produce more syrup for children."

Pending such a development, children’s homes like Nkosi’s Haven follow strict diets to strengthen the immune systems of their residents. "We provide a lot of vegetables and fruits. They are necessary for the children’s health," Snyman says. "We also encourage them to take garlic and ginger."

In the South African context, some would consider these inflammatory words. Health Minister Tshabalala-Msimang sparked a heated debate when she urged those living with HIV/AIDS to use garlic and olive oil to boost their immune system. Many accused her of refusing to face up to the severity of the pandemic.

But, says Snyman, "We have been encouraging the use of garlic even before the minister of health talked about it publicly…I believe in the power of garlic. But we don’t force it on anyone."