The Paediatric HIV response

A series of articles by guest writers for World AIDS Day Part of AVERT's World AIDS Day 2012 campaign, ‘Reflections on the Epidemic’ are a series of articles by guest writers. Our guest writers range from global leaders, writers, experts, activists, physicians and people personally affected by HIV and AIDS; and they represent various countries, experiences and backgrounds from all over the world. We are grateful to all our guest writers for their effort and the diverse and insightful viewpoints that they contributed to the world’s response to HIV and AIDS. We will be re-featuring these articles over the next few weeks on a weekly basis. Browse through this week’s featured articles, and see the full list below.

The AIDS community is living in a time of ‘yes’. ‘Yes’ to our successes, ‘yes’ to our hopefulness and ‘yes’ to all we can achieve together. The latest UNAIDS report was entitled 'Together we will end AIDS'. The Washington DC Declaration called for an end to the pandemic. AIDS 2012 was convened under the theme 'Turning the Tide Together'. This sentiment is unprecedented; the days of doom and gloom are just a few scientific advances behind us. A victory against HIV, once merely a pipedream, now seems possible.

This wave of HIV optimism is perhaps most evident when discussing paediatric HIV. Yesterday we were consumed with efforts directed at children living with the dreaded disease – how to treat and care for them. Today, we’re talking about eradication of paediatric HIV. EMTCT (Elimination of Mother-To-Child Transmission) is the new buzz word. Prevention is the new black. The Global Plan, supported by ‘Believe it. Do it’, calls for elimination of new childhood infections by 2015. Talk about programmes for HIV-positive children - ‘Why?’ some ask. ‘There should be no paediatric HIV beyond 2015.’

And yet. While this ‘prevention-as-gold’ resolve is empowering, there are a few truths that are difficult to shake. The fact, for example, that last year just 57 percent of the 1.5 million HIV-positive pregnant women in low- and middle-income countries received effective ART to prevent transmission. Or the 330,000 children newly infected with HIV in the same year. It warrants mentioning that of the Global Plan's 22 priority countries, only 8 will actually achieve their target/s if their MTCT decline continues at the current rate.

What does all of this mean? If we examine the data, it seems we’re not heading for elimination of new paediatric infections any time soon. Really. This is not a pessimistic, glum view of our progress. It is simply an acknowledgement of what is true, right now, in the field.

“It’s not glamorous. It’s not exciting. It’s still sad. It’s still frustrating. But it’s true. And the allure of prevention, in all its glory, should not out-shadow or deprioritise the paediatric HIV treatment response.”

There are currently 3.4 million children under the age of 15 living with HIV globally. 3.4 million. Last year alone 230,000 children died from AIDS-related illnesses. 630 per day. Another truth – paediatric ART coverage is still at 28 percent. The reality is that most children who need treatment – treatment that’s been discovered, tested and even ‘rolled out’– do not receive it.

So while I concede that various markers of success are improved from previous years, and I think the optimism brave and commendable, we still have an incomprehensibly large population of children on treatment, a larger group in need of treatment, and more on the way. It’s not glamorous. It’s not exciting. It’s still sad. It’s still frustrating. But it’s true. And the allure of prevention, in all its glory, should not out-shadow or deprioritise the paediatric HIV treatment response.

If we want to be optimistic as an HIV community, I’d rather we get optimistic about the truth – single stories of transformation that mean more than the numbers. I have the privilege of spending my days at Paediatric AIDS Treatment for Africa (PATA), an action network of paediatric HIV clinic teams across sub-Saharan Africa. One of our proud achievements is an annual African frontline healthcare worker forum which culminates in attendees developing their own clinic goals and deliverables, each of which is reported on to PATA throughout the following year. The upshot? My inbox receives almost daily notice of the triumphs of doctors, nurses, counsellors and pharmacists. Small achievements, some might say, but I say not.

Hortencia, a doctor from Angola reported recently that her hospital has managed to reduce its waiting time from 3 hours to 3 minutes. Frank, a pharmacist from Tanzania wrote to say his clinic has traced back 16 children who had been lost from care. To me, these are the successes we should be talking about, working towards. These are the goals we should be getting behind, helping to actualise. Because they are true, they are possible and they are making a visible difference to the lives of hundreds of thousands of children.

There was a moment in 2009 – the week of the AIDS Vaccine Conference – that I will never forget. Paris, windy, biting. It was dusk, and I was walking the streets after a heavy day of back and forth between talk of what it would actually cost to put a vaccine in the supply chain and what it was costing to provide treatment. Pull, tug, pull. I was tired, cold and in need of a taxi, but there was none in sight. If I pushed it I could walk home, but I’d have to do so with determination and speed. Or, I could stand firm on the side of the road, more likely to spot a yellow vehicle but not making headway if I didn’t. My experience mirrored the day’s discussions. What I needed to do, I knew absolutely, was walk, slow and steady, looking over my shoulder for one of those yellow promises. It was a bit sticky, complicated and not the easiest to explain or commit to. But it was what was needed.

Today, three years later, I am reminded of that moment again. Let’s pursue the grand goals, commit to them, but not forget to keep walking. Let’s never lose sight of those millions of children still in need of our attention as we turn our sights to something greater. Let’s be optimistic about, but not blinded by our hope for the future. And let’s never forget the facts.

Dr Daniella Mark is Executive Director of Paediatric AIDS Treatment for Africa (PATA), an action network of 188 paediatric HIV clinic teams across sub-Saharan Africa. A neuropsychologist by training, she has a special interest in the intersection of HIV and neuropsychology. Dr Mark received BSocSc (Hons), MSocSc and PhD degrees from the University of Cape Town and is now an Honorary Research Associate in the University’s Department of Psychology. Having worked in the field of HIV for 8 years, Dr Mark has produced 40 publications and convention presentations in the areas of community acceptability and uptake of HIV prevention and treatment, stigma and adolescent health services.

For further information on HIV treatment for children see AVERT's page or read Kate Iorpenda's contribution to 'Reflections on the Epidemic'.

Images: 'Young people at AVERT's Sisonke project', copyright: AVERT. 'Daniella Mark' courtesy of PATA