Treatment fatigue killing kids

Zandi Ndlovu* looks like a typical teenager. She rolls her eyes in exasperation, wears branded sneakers, "loves" lunch-time naps and studies hard so she can attend university.

But she is HIV-positive and has been from birth.

Globally, 2.1million children aged 10 to 19 are HIV-positive, with more than 80% of them in sub-Saharan Africa, according to the UN.

On Friday the UN released a report stating that HIV deaths are dropping globally - but not among teenagers.

Some children born with HIV are sick from childhood whereas others show symptoms only later in life.

Zandi became sick at 11 when she developed sores in her mouth.

She has "made peace" with her status and now appears more concerned with teenage "issues": being short, and thought of as younger than her friends.

"I am older than all of them [by months]. I saw the sun first," she said.

Since the death of her grandmother eight years ago Zandi has been raised by her aunt in Soweto.

Her mother died in 2003 from a head injury. Her HIV-positive father died from TB last year after refusing antiretrovirals.

"I don't understand the denial and anger," she said of people who, like her father, refuse to take ARVs.

She said she would rather have HIV than cancer because, with HIV, "one dies only of negligence" - not taking the medication - whereas cancer is not always curable.

Not all teenagers are as matter-of-fact as Zandi. Some struggle to take their medicine, leading to resistance to ARVs.

The director of child and adolescent health at Wits' Reproductive HIV and Health Institute, Johannesburg, Dr Lee Fairlie, works at Harriet Shezi Children's Clinic where a group of teenagers, who are resistant to the first-line ARV treatment, are given new and more complicated treatment regimens.

"Adolescence is a high-risk period for failing ARVs. Any adolescent or child failing needs intervention to improve adherence and might need to change medications.

"Adolescents with HIV go through the normal changes all adolescents do. These changes ... coupled with their busy lives and the fact that many have been infected since birth, can leave them with treatment fatigue."

At Nkosi's Haven, south of Johannesburg, an HIV-positive teenager committed "suicide" last year, according to founder Gail Johnson.

The girl, angry at having been infected when she was raped at the age of nine, refused for more than two years to take ARVs, despite counselling, therapy and being prescribed anti-depressants. She hid her ARV pills instead of taking them.

Johnson believes the teenager might not have had the "mental capacity" to cope with the trauma. She said teenagers are often angry when they learn that they have HIV.

Zandi said her treatment is keeping her healthy and allowing her to "live life to the full".

*Not her real name