EPISODE 3 - Children and ARVs

The village of Nyuswa in Mondini, Kwazulu Natal is not far from the N2 near Tugela Mouth. It's a place of rolling hills and poverty where over 40% of pregnant women are living with HIV.  It is also the home of Ma Busisiwe Hlongwane, her two-year-old granddaughter, Anele, and the five other children she cares for.

Inside her home, Ma Busisiwe Hlongwane picks up a picture of Anele. The child is lying in a hospital cot, attached to a drip. She stares up with an uncomprehending face. Hlongwane had taken Anele to hospital when she had taken sick, and she tested positive for HIV. But the tiny and emaciated little girl in the picture is a far cry from the happy, sturdy, two year old who plays at her grandmother's feet today.

The reason for Anele's remarkable turn-around is the anti-retroviral syrup that Hlongwane gives the toddler daily. Each morning, the forty-something grandmother must mix the ARV syrups in a precise combination. The amount of syrup changes as Anele grows, and it has to be done exactly.

Anele is lucky. There are over 600 000 children living with HIV in South Africa, and only 50 000 of them are on ARVs. The majority will die before the age of five, while those on ARVs can live a near normal life. No one knows what the life expectancy for a child raised on ARVs really is, but we do know it's long enough to grow, study, fall in love, have children and build a career.

children on ARVs

Far from Nyuswa, in Cala in the remote Goso Forest district of the Eastern Cape, another grandmother follows a similar daily ritual. Ma Mantlane Dedelo is a great grandmother in her 70s.  Tall, gaunt, regal, she peers out from behind very thick spectacles.

She cares for Mbali, a playful three year old on ARVs.  She explains how difficult it is for someone with poor eyesight to pull out the right amount of ARV syrup to mix for the child. She seeks daily help with this from younger women, so that at seven in the morning and seven in the evening, young Mbali gets his medicine. No professional nurse could be sterner or more determined.

But, says Dedelo, "I think it would be easier if all those syrups could be made into one, especially for us elderly people. I think those people who make the medication can help us and make one tablet to give the child - then everything would be easy".

children on ARVs 2

In fact, there are single dose tablets for children with HIV that can be safely used. They are available very cheaply, in generic formulations out of India. The US Food and Drug Administration has pre-approved them.

It is unclear why single dose ARV tablets for children are not yet available in South Africa. These inexpensive pills would do away with syrups and syringes and measuring, and would make life much easier for mothers and grandmothers like Hlongwane and Dedelo. They would also be a huge help in making ARVs available to the other 550 000 HIV positive children who need them.

pmtct

IT'S A FACT