Awakening

DR Namakula Katende tells the 544 HIV-positive children she treats that they have to take their anti-retroviral drugs to make their "soldiers strong".

Nine of every 10 children she treats at a clinic at the rural Shongwe Hospital, about 20km from Malelane, Mpumalanga, were born HIV-positive. And 10% of her patients, aged up to 18, contracted the virus from the men who raped them.

To her very young patients, bewildered by having to take medicine at the same time every day, Katende, 32, says: "You were born with a condition where your soldiers are very, very low. But, when you take this treatment, your soldiers are very, very strong."

Katende's children are a tiny fraction of the 70000 born HIV-positive in South Africa every year - despite the Treatment Action Campaign's Constitutional Court victory in 2002 in its case against the Department of Health. The state was ordered to provide treatment to HIV-positive pregnant women to prevent their children being infected by the virus.

There has been a change in government policy on the availability of antiretrovirals under the administration of President Jacob Zuma, but serious obstacles persist in the implementation of the widespread distribution of ARVs.

The deputy director of the SA National Aids Council, Mark Heywood, said: "Theoretically, [the programme to prevent mother-to-child transmission] was introduced in July 2002, but it has not been well managed."

Health Minister Aaron Motsoaledi said yesterday that doctors must test babies at birth if their mother was HIV-positive.

"If there is any province not doing so, that is a grievous problem," he said. "Every child diagnosed HIV-positive must go on treatment immediately."

Katharine Hall, of the University of Cape Town's Children's Institute, and Child Count, said the most recent figures for HIV-positive children on anti-retroviral treatment were two years old.

A 2009 report from the children's Aids organisation Catch found that the Free State had the worst treatment rate, at 22%. Other badly performing provinces were Eastern Cape (27%), Mpumalanga (29%), KwaZulu-Natal (31%) and Gauteng (46%).

The good news is that Western Cape has got 97% of its HIV-positive children on antiretrovirals, Northern Cape 96% and North West 51%.

Hall said that though the number of children being treated with ARVs was increasing, it was "not nearly enough".

"There are huge problems with roll-out in Eastern Cape. Administrative problems, difficulties in accessing treatment, clinic problems and budget issues," she said.

Motsoaledi said irregular supplies of ARVs were hampering the department's efforts to treat HIV-positive children and adults.

"The issue of drug [shortages] worries us," he said, adding that the department intended to solve the problem by centralising the procurement and distribution of all Aids-related medication nationally.

"All will be procured centrally so that it is not a matter of each province doing their own," he said.

The 544 children Katende has on treatment are among the fortunate 29% of Mpumalanga's HIV-positive children receiving ARVs.

"Most of the children I treat are born HIV-positive. We see a few who get HIV through rape, but it is difficult to assess this because even fewer will admit to it because of 'the shame'," Katende said.

"There is a lot of rape going on in the community."

Every month, 6858 Aids patients collect their medication at the crowded Shongwe Hospital pharmacy, which is dedicated to dispensing ARVs.

Outside Katende's consulting room, grandmothers sit with their grandchildren on their laps waiting to see her.

School children arrive in uniform to collect their monthly supply of ARVs, which are stuffed into their backpacks.

Katende, who is from the North West town of Mafikeng, has no children of her own, but said she "loves" her young patients, who suffer from a condition "just like asthma or diabetes".

She said she is extremely proud of how religiously the children take their medicine.

She runs support groups for them on Wednesday afternoons at which they discuss the importance of their medicines and the stigma attached to the disease.

"Adults are a lot more difficult - they've already got their own stereotypes, wondering what their neighbours will say," she said.

Pointing to one patient's file, she said ARVs were very effective in children.

A 10-year-old girl she saw earlier that day began ARV treatment in February when her CD4 count - a measure of the severity of the infection - was a precarious 154. It is now at 619, well out of the danger zone.

The patient files give Katende hope for the next generation.

"These are just the children I've seen this month and they're all going to school," she said.

When an HIV-positive 15-year-old girl walked into Katende's office recently, she gave her a hug and told her: "You are a miracle."

The teenager, born HIV-positive, had been on ARVs since the age of five. Ten years later the motivated schoolgirl's future looks bright - her CD4 count is more than 800.