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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

In Africa, almost a half a million children died of AIDS last year. Hundreds of thousands of others are in need of AIDS treatment; very few get it. Efforts to provide AIDS drugs in Africa still only reach a small percentage of the people in need, and those efforts tend to focus on adults. Treating children is more difficult, as NPR's Jason Beaubien learned on a recent trip to Kenya.

JASON BEAUBIEN reporting:

Kibera is one of the largest slums in Nairobi. Its rusted tin shacks sprawl down a hillside and, by some estimates, house a million people. Open sewers wind between the huts. Most people don't have electricity, and they buy water in jerricans from a few central taps. Even the Doctors Without Borders HIV clinic in Kibera doesn't have power.

Dr. RACHEL THOMAS (Doctors Without Borders): No, there's no electricity here. We just rely on the sunlight.

BEAUBIEN: Dr. Rachel Thomas is the HIV clinic coordinator. Like many slums across Africa, Kibera has been hard-hit by the AIDS pandemic.

Dr. THOMAS: If you want statistics, it's a bit hard to get accurate statistics for a slum because it's a transient population. Certainly for this district, as I understand from antenatal records where they have--they've been pushing for routine HIV testing, prevalence rate's approximately 14 percent.

BEAUBIEN: Statistics for HIV rates among children are even harder to come by, but by even the most conservative estimates, thousands of kids in Kibera are HIV-positive. Thomas says there are two main problems in treating HIV-positive children in places like this. The first is that the HIV tests that are available here can only be given once the child is a year and a half old.

Dr. THOMAS: So we have to wait until the child is 18 months old or older before we can do these tests. And it's well-known that without treatment, a child who's infected with HIV--if they don't get treatment, half of them will have died before they reach their second birthday. So basically, testing at 18 months is too late for too many children.

BEAUBIEN: The other big problem is that AIDS drugs are manufactured primarily for adults.

Dr. THOMAS: Not all drugs have a pediatric formulation, so they haven't been designed in the appropriate dosage or the appropriate form that a child can swallow.

BEAUBIEN: For instance, Catherine Attenyo(ph) and her daughter Joanna(ph) are both HIV-positive, and they're both on drug regimens that include anti-retrovirals. Thirty-one-year-old Catherine takes one pill in the morning and one at night, but her five-year-old daughter has to take three tablets: Septrin, nevirapine and Triomune 40. And Catherine says some of the pills have to be broken in half.

Ms. CATHERINE ATTENYO: I'm supposed to break that into two pieces. The reason why I'm afraid is that the time I'm breaking them ...(unintelligible) down and one part can be small and one part can be big. And something like Triomune 40, it is quite difficult to break.

BEAUBIEN: And Dr. Thomas says it's unclear whether the child is getting too much or too little of each drug at any one time. Some of the other AIDS drugs for children have to be refrigerated, which is almost impossible in slums like Kibera. Others need to be crushed and mixed with clean water, which again can be difficult in places with no reliable plumbing.

Catherine Attenyo and her daughter Joanna are in the examination room at the clinic. Joanna is wearing a frilly white dress that in a previous life may have served as a flower girl's outfit at a wedding. The garment is torn at the shoulder, and Kibera's muddy footpaths have dulled its shine, but the five-year-old is clearly smitten with the dress. She swivels her hips so her lace hem spins out around her. Catherine says Joanna was extremely sick when she went on the anti-retroviral drugs at the age of two.

Ms. ATTENYO: She was very sick ...(unintelligible) the people who came to see her, they were saying that, `This is one is going to die.' She was very thin. Imagine at two years, kid weighing six kilogram and cannot walk.

BEAUBIEN: Catherine says the drugs have worked wonders for her daughter. She's healthy, she's in school and Catherine hopes she'll grow up to be a doctor. But Catherine adds that the drugs are difficult to administer, and sometimes Joanna doesn't want to take the medicines.

Dr. THOMAS: This is a lifelong treatment.

BEAUBIEN: Again, Rachel Thomas with Doctors Without Borders.

Dr. THOMAS: So adherence to this treatment is very important, and the ease of taking the medicine is also very important.

BEAUBIEN: She says if AIDS drugs are going to be rolled out in Africa to the millions of people who need them, the drug regimens, particularly for children, need to be simplified. Jason Beaubien, NPR News.

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