left out: Children with AIDS

[Guest guest]

Left out - children with AIDS

Hiddleston

No India-specific guidelines for the treatment, care, and support of

children living with HIV have been distributed.

LAXMI* WAS 12 when her father remarried and sent her to live with her

grandmother. She was sold into sex work for Rs.35,000 and was caught

in a police raid after a year. Framed by the owner of the brothel she

was working for, she was taken into custody for running a sex racket

and sent to a remand home. At 14, she learned she was HIV positive.

Three years on, she lives with 36 children under 14 who have been

affected by HIV at the Community Health and Education Society (CHES)

ashram in Valasarawakkam, Chennai. Almost all of these children are

HIV positive; many are orphans.

Laxmi is one of an estimated 1.2 million invisible children affected

by HIV in India (World Bank, 2002). According to UNAIDS, 120,000

Indian children were living with the virus in 2004. The National AIDS

Control Organisation (NACO) estimated that around 60,000 new

infections occurred last year. Activists estimate that around 250,000

Indian children are HIV positive today but there is no accurate estimate.

On Wednesday, an Indian delegation sits at the United Nations General

Assembly Special Session (UNGASS) to review the 2001 Declaration on

HIV/AIDS. It included commitments to prepare by 2003 and implement by

2005 strategies for special assistance for children orphaned by, and

vulnerable to, HIV/AIDS,reduce the number of infections passed from

mother to child by 20 per cent, and roll out treatment and care.

Examining the progress made reveals that though the present government has

recognised the need to give adequate attention to HIV/AIDS, children in India

remain the forgotten face. No national strategy currently exists to aid children

affected by HIV.

P. Manorama, president of the non-governmental CHES , has worked in

the community on HIV/AIDS for the past decade. She says: " The beliefs

of people living in India are very different... Imagine trying to

counsel a child with an African or another country's experience...

How can you expect a child that is around 10 or 12, just because it is an orphan

to head a family? What is going to be their quality of life? "

In its Report on the Declaration of Commitment on HIV/AIDS 2005,

submitted for the UNGASS review this year NACO concedes it has made no progress

in designing and implementing programmes for children

vulnerable to HIV. According to Sujatha Rao, director-general of NACO, these

children will be accorded greater priority in the next National AIDS Control

Programme, NACP III.

Sources say this will include livelihood support and education

provisions. However, it is not clear whether they will be provided

with proper treatment.

No India-specific guidelines for the treatment, care, and support of

children living with HIV have been distributed. Government centres

administer paediatric dosages of antiretroviral (ARV) drugs based on

World Health Organisation recommendations by weight band. This is

problematic because children's bodies absorb and metabolise drugs

differently. Although India-specific guidelines have been prepared by

the Indian Academy of Paediatricians, sources say these have not yet

reached the NACO national network.

As of April, only 1,215 of the NACO-estimated 39,000 children who need ARVs were

receiving them, a document prepared by the International Treatment Preparedness

Coalition (ITPC) said.

Recently, Ms. Sujatha Rao announced that about 10,000 children would

be provided treatment. According to K.K. Abraham, president of the Indian

Network for People Living with HIV/AIDS (INP+), these dosages may still be

administered by dividing fractions of adult formulations, which often leads to

under or over dosage through human error, and over time, drug resistance. Since

the national programme does not yet administer second line drugs free of charge,

it would seem that any child who develops immunity has a short future.

" NACO needs to develop a concrete plan for providing ARVs. We should

no longer give excuses that we [india] have limited resources.

Develop a roadmap for universal access to ARVs; get support of various partners;

and mobilise necessary resources, " Mr. Abraham concluded.

There are no paediatric medical formulations available under the

government-sponsored programme. Until last year, some of the best

tools used in the fight against HIV in adults were not available for

children at affordable prices. " Now, there are at least 15 paediatric

drugs that have been approved for use by WHO, and six of those drugs

are made in India, " said Vineeta Gupta, director of Stop HIV/AIDS in

India Initiative (SHAII), a Washington-based NRI advocacy group.

Two paediatric three-in-one dose combinations available: are Emtri

(zidovudine/lamivudine/nevirapine), manufactured by Emcure, and

Triomune (stavudine/lamivudine/nevirapine), manufactured by Cipla.

Both have Indian Regulatory Drug approval. Emtri is already in use in

Africa, Latin America, and Asia. Triomune is being marketed to private hospitals

and NGOs. Although NACO has licensed State AIDS Control Societies in Tamil Nadu,

West Bengal, Mumbai, and Varanasi to procure paediatric drugs independently,

none is provided under the national programme.

NACO told this writer that paediatric formulations have yet to be

developed by the pharma sector and brought under GMP guidelines.

Crucial in the fight against HIV in children is providing ARVs to

pregnant women.

Less than three per cent of an estimated 189,000 HIV positive women in antenatal

clinics received ARVs last year. By NACO's own estimate,

over 7 million more pregnant women needed to be reached to meet the

2005 UNGASS target. (*To protect identity, the name has been changed.)

http://www.hindu.com/2006/05/31/stories/2006053124331500.htm