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Malawi Struggling to Address Paediatric HIV

Dingaan Mithi

LILONGWE, Nov 16 2010 (IPS) - There are 91,000 children living with HIV in Malawi. A shortage of resources means that many do not receive proper treatment and care.

The most recent AIDS Epidemic Update, published by UNAIDS and the World Health Organization, estimated that there were 2.1 million children under the age of 15 living with HIV worldwide in 2007; 1.8 million were found in Sub-Saharan Africa. The Campaign to End Pediatric AIDS (CEPA) estimates 370,000 African children were newly infected that year.

In Malawi, UNAIDS estimates that 91,000 children under 15 are living with HIV. Amongst the 27,000 of these children with advanced HIV and low CD4 counts, just under two-thirds are receiving anti-retroviral therapy.

Observers say this care is inadequate.

“There has been no paediatric treatment for children with AIDS in the country, making the administration of drugs difficult. They have had to be given tablets meant for adults, breaking tablets into half,” says George Kayange, executive director of the Child Rights Information and Documentation Centre in Lilongwe.

While this may provide a child with the appropriate dose, young children in particular struggle to swallow such tablets and maintain an effective treatment regimen. Oral ARVs would be one alternative, but Linda Malilo, training coordinator at the Baylor International Pediatric AIDS Initiative (BIPAI), says these are very expensive and in short supply in Malawi.

BIPAI and the Abbott Fund support one of the country’s leading sites for paediatric AIDS care, the Children’s Clinical Centre of Excellence in Lilongwe. The centre’s executive director, Dr Peter Kazembe, says the centre cares for for more than 2,200 children, including 1,535 on ART treatment there.

Among the organisations that refer children to the centre is the Edzi Kumudzi Association. EKAM is a community-based organisation working to assist children living with HIV in rural areas near Malawi’s capital, Lilongwe. EKAM works with more than 2000 HIV orphans, offering psychosocial support; a lack of resources prevents the community-based organisation from running other programmes, for example supporting good nutrition for HIV-positive children.

EKAM executive director Maxwell Mphoyo told IPS that currently there is poor coordination between organisations like his and the government.

“It would be easy for government to improve paediatric HIV care and treatment services if it worked with local NGOs who are always on the ground, helping children living with HIV and AIDS in Malawi,” said Mphoyo.

He argues that coordination between local NGOs and the government would improve care as organisations like EKAM are carrying out HIV and AIDS interventions in rural areas. This would still leave the government the difficult task of providing enough resources in the national health budget to complement the work of the civil society.

The principal secretary in the office of president and cabinet responsible for HIV and AIDS and Nutrition, Mary Shawa, told local media that the government is serious about achieving universal access to treatment for children and adults alike. One move to make treatment available to more people is a plan to establish a factory to produce anti-retrovirals in Malawi.

“Following United Nations regulations about establishing such an ARV drug company, there were a lot of steps that will have to be taken. We envisage the company being ready in two years time,” says Shawa.

EKAM says the government needs to ensure such a factory also manufactures ARVs specifically for children.

“The factory will be very important for children living with HIV and AIDS, as treatment will no longer be a problem,” says Mphoyo. In addition, he stressed the need to train more health personnel in paediatric HIV and the construction of more health facilities across the country to assist children living with HIV and AIDS.

The Campaign to End Pediatric AIDS (CEPA) is calling on governments across Africa to back their stated commitments to universal access to treatment for adults and children by increasing budget allocations for health. African governments committed to devoting 15 percent of their total budgets to health at an African Union meeting in Abuja, Nigeria in 2001.

Yet Malawi is one of the handful of African governments that achieved this level of spending in 2006, only to fall back: the allocation for health currently stands at just under 13 percent.