Sunday, 27 September 2009

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Providing HIV care to children

The January 2009 issue of the Indian Journal of Medical Research (IJMR) contains a study and a commentary on the challenges of providing HIV care to children in India where 3.8% (approximately 100,000) of an estimated 2.5 million persons living with HIV/AIDS (PLHA) are children. Of the 1.78 lakh people on anti-retroviral therapy (ART) in 2008, 12,000 are children.

S Rajasekaran and others reported on the problems faced by children getting treatment at the Tambaram centre in Chennai. Over 60% of children in this study had to travel more than 200 km to get ART.

In their commentary in IJMR, Partha Haldar and DCS Reddy note the difficulties for children in getting treatment. Despite the scale-up of ART centres, there are still not enough centres to cover each district, especially in low prevalence states. Many children with HIV are orphans or their parents are ill and cannot accompany them. Further, it is not easy to diagnose HIV in children and put them on treatment quickly. For children under 18 months, the cheap tests often give false positive results. Malnutrition is a serious problem - up to 60% of children with HIV have protein energy malnutrition and may need to get better food before being put on ART.

Adults with HIV are not necessarily better off. A writer on the AIDS-INDIA egroup described his experiences trying to get his treatment shifted to an ART centre in Hyderabad where he'd been transferred. It took Kumar Nagarajan four visits, repeat tests, and innumerable documents before he got his medicines. On one visit he found the testing centre closed for a week. When he went with the all the documents he found the ART centre closed down at 2 pm.

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