Children being forgotten in ARV rollout

JOHANNESBURG – Children are being forgotten in the eagerness to provide antiretroviral treatment to the thousands of people in need of the life-extending drugs.

This is according to Dr Haroon Saloojee of Wits University’€™s Community Paediatrics Division who was speaking this week at the first ‘€œPriorities in AIDS Care and Treatment (PACT)’€ conference.

At best 3 000 children are on antiretroviral (ARV) drugs countrywide, whereas between 30 000 and 45 000 of the country’€™s 230 000 HIV positive children needed the drugs, said Salojee.

Saloojee, one of the respondents in the historic Constitutional Court case that led to Government being forced to provide Nevirapine to pregnant HIV positive women, said the most basic right, the right to life was not being respected in this country.

‘€œEven more so in the case of children who cannot toyi-toyi in the streets and do not elect politicians into parliament,’€ he added.

He said statistics showed child mortality had steadily increased since 1996, with AIDS-related diseases accounting for 40% of deaths of children under the age of five.

A further 10% died of diarrhoea while around 11% of deaths were due to low birthweight, both of which could be HIV-related.

He said Gauteng that had managed to place 1 319 children on ARVs. This translated into 12% of those accessing the drugs in the province.

But in Mpumalanga only 31 children, 1% of those on ARVs, were on the drugs and in KwaZulu-Natal, at best, 500 of its 9 000 patients were children.

However, Dr Chris Jack, director of KwaZulu-Natal’€™s ARV therapy programme, said the province aimed to increase the patient quota to include 10% children and disputed that his province was lagging behind the others.

Saloojee said a whole spectrum of roleplayers were to blame for the neglect of children, from government to hospitals and clinics, health professionals, the pharmaceutical industry, parents and the community.

He said government’€™s delay in finalising drug procurement had seen a sharp increase in waiting lists, while there was a huge staff shortage with up to one third of posts in the public health sector vacant.

‘€œWe are also still waiting for paediatric guidelines on treating (paediatric) patients. At the same time there are far too few sites accredited for paediatric anti-retroviral treatment. It’€™s too stringent. It is not feasible and it is unnecessary to have a full-time paediatrician on site,’€ Saloojee added.

Further hurdles identified by Saloojee included:

  • Reluctance by the clinics and hospitals to start treating children unless there is a paediatrician on the staff complement;
  • Parents being treated at different sites from their children;
  • Children being pushed to the back of the queue;
  • Lack of access to social services;
  • General lack of knowledge among health professionals;
  • Failure and reluctance to test children;
  • A lack of paediatric drug formulas;
  • High prices for paediatric drugs;
  • Complex dosages;
  • Foul tasting syrup, refrigeration requirements and quick expiry dates;
  • Failure by families to prioritise children’€™s health;
  • Reliance on herbal medicine;
  • Sharing medicine with family.

Saloojee called for the fast tracking of accredited sites, the urgent distribution of treatment guidelines, the incorporation of testing into primary healthcare services and the overall strengthening of the prevention of mother to children transmission programme (where many children would be identified in the first place).

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