The Hindu Business Line : Heal the world...

Parvati is nine years old but looks smaller than a three-year-old as she hunches in the tiny room that is her paternal aunt's house in a slum in Andheri, Mumbai. She is HIV positive and progressing into AIDS. Her parents succumbed to AIDS and her two sisters who are not HIV positive have to work as housemaids for a living. They shuttle between this house where they eat their meals and their maternal aunt's house where they sleep

The aftermath of HIV infection in a family is always a challenging issue that becomes more complicated when children are involved. HIV/AIDS makes children doubly vulnerable, regardless of whether they are `innocently infected' or born in families with HIV positive members. These are children who have to give up their childhood to work and earn so that they can take care of ailing parents and siblings, sometimes even grandparents. Forced to take up the mantle of heading households at a tender age, these children have poor access to healthcare or antiretrovirals. To top it all, they are stigmatised and discriminated against.

But this is a situation that is `preventable'. While the cure or the vaccine against HIV and AIDS is still elusive, antiretroviral treatment (ART) that suppresses the effects of the virus to some extent, is available. This enhances the quality of life for the children and their parents.

And the prophylactic treatment for pregnant HIV-positive mothers that prevents the transmission of the disease to the child (called Prevention of Parent to Child Transmission - PPTCT in India) is the closest medical science has come to a cure for the virus and has made a difference for hundreds of children around the world.

The Indian government made a commitment to provide free ARV drugs to one lakh people living with HIV and AIDS (PLHA) by the end of 2005. With initial constraints in rolling out the programme the target date was postponed to 2007 and to 1.8 lakh by 2010, 2 lakh by 2011, according to NACO's (National AIDS Control Organisation) progress report for 2005 submitted to the UNGASS.

"She is on the list for ART," says Parvati's paternal aunt who herself has to work three jobs to feed her two children and keep them in school. "Even if we do get ARVs, I am not sure how Parvati is going to take the medicines. She cannot even swallow the medicine for her infections."

Until NACO rolled out paediatric protocols in all the ART centres countrywide on November 14, 2006 — Children's Day, there were no norms on formulations suitable for children, and adult doses were broken up and given to children. This created multiple problems including drug resistance springing from under- or over-dosing, violent side-effects that lead to abandonment of treatment and related resistance as well as nullification of medication effects due to lack of nutrition.

While the launch of paediatric ART provides a ray of hope for children in six high prevalence states of Andhra Pradesh, Karnataka, Tamil Nadu, Maharashtra, Nagaland and Manipur, what about children in other states?

This incremental provision of drugs for PLHA, especially mothers and children, is a mockery in the face of a gruesome reality. It betrays our callousness towards our children and the challenge of HIV and AIDS. The needs of children affected by HIV and AIDS are real and now.

On the PPTCT front, the Government has done remarkable work in scaling up the provision of this service started in 2002 to 488 centres by the end of 2005. These centres have reached out to nearly 10 lakh women during this period in the six high prevalence states. This would cover less than 10 per cent of the children who are born infected — statistics say that there are around 30,000 of them.

"To reach this figure (of infected children with prevention) we need to have 6.9 million pregnant women accessing PPTCT services," according to NACO's report to UNGASS. That is close to 6 million women short of target.

Universal access to free paediatric ART and mandatory provision of PPTCT protocol to all women attending ANC at all government hospitals is a combination that could stop this pandemic in its tracks. While the PPTCT regimes would prevent new infections being added to the paediatric side, age appropriate ART for children already infected would give them a chance to live a life as normal as possible.

But we need to act now to turn the tide. The goals that the government with the support of corporates such as pharmaceutical majors, NGOs, faith-based organisations and other civil society members should be focusing on are universal access to ART for at least 80 per cent of children with HIV and access to PPTCT services for 80 per cent of all pregnant mothers at risk of transmitting the virus to their unborn child by the year 2010.

The Government of India indicated its commitment to children by making children the focus of our 11th Five Year plan. But Parvati may not be living to reap the benefits.

In Africa the response to orphans and vulnerable children started only when almost every family had someone who had died of AIDS.

In India we cannot afford to wait for that situation. "Those who ignore history are condemned to repeat it," is the saying but we cannot afford to do that... for the sake of our children.

More Stories on : Health | Children & Parenting | Social Welfare

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