LIANE HANSEN, host:
South Africa has one of the highest rates of AIDS cases in the world. One in eight South Africans is infected with HIV and about a thousand people in the country die of AIDS-related conditions every day. The death toll is not confined to adults. It's estimated that the number of children with the disease or orphaned by AIDS will reach 18 million within the next three years.
NPR's Charlayne Hunter-Gault reports from Johannesburg on a new effort to end pediatric AIDS with the goal of keeping both the mother and child alive and well.
CHARLAYNE HUNTER-GAULT: Tucked away in small quarters on the grounds of South Africa's largest public hospital, the Harriet Shezi clinic is tackling a huge problem: HIV positive children, many of them AIDS orphans who get sick and die. Fourteen-year-old Suki(ph) has a chance to live.
SUKI (HIV Patient): I know that I mustn't use any plates, which was used by someone - unprotected sex, teenage pregnancy and stuff like that. That's I mustn't do.
HUNTER-GAULT: Suki has lost both her parents to HIV/AIDS. She's had to learn to learn without them and to live with the virus. Counselors like Vineli Dlamini(ph) had helped her over this sad mountain of problems.
Ms. VINELI DLAMINI (Counselor, Harriet Shezi Clinic): As black people in South Africa and then bereavement counseling, it's always done to elderly people. It's not done to children. And nobody talks to the child. They've got this grieving and unanswered questions. That will lead them maybe sometimes to anger.
HUNTER-GAULT: But sometimes, the mountains are just too high.
Ms. DLAMINI: His viral load is now increasing. We suspect that maybe he's failing to the treatment. He doesn't have the support.
HUNTER-GAULT: Dlamini telling of another 14-year-old they may have found too late.
Ms. DLAMINI: He comes alone in the clinic. He must remember the appointments. He must take his TP treatment, ARVs wherever. He must always do things by himself. He's responsible for himself. He may not make it.
HUNTER-GAULT: The Harriet Shezi Clinic is a project of the Reproductive Health and HIV Research Unit of the University of the Witwatersrand in Johannesburg. It has a caseload of 2,000 orphans. But there are some 300,000 HIV-infected children in the country, and that number and the high death rate among them is motivating health professionals like these to think outside the box.
In a country where little attention is paid to the physical or the emotional health of HIV-infected children and orphans, they've created a model they hope to take to the entire country - treating HIV-infected orphans with antiretrovirals and also counseling them, an approach virtually non-existent here.
At the same time, they're also working on stemming their growing numbers by using antiretrovirals to treat pregnant women throughout their pregnancy and not just at birth, improving the mother's chance of living to raise their children and not transmitting the virus to them. This approach is standard operating procedure in the west, but virtually non-existent in the developing world including South Africa.
Ms. DLAMINI: If we could make sure that women's health was - that needs were met, you know, even before pregnancy, during pregnancy and then after pregnancy, and make sure that we know - we identify women and get them through into the treatment programs, we could probably prevent a lot of the orphanhood happening.
The liver's looking ok, so there's no problem from that point of view for starting ARVs.
HUNTER-GAULT: Here at Johannesburg Hospital, another of the city's big public hospitals, a tiny post-natal clinic operated by the University staff works in tandem with the Shezi clinic on just such a prevention program - what they see as a holistic approach to stanching the flow of AIDS orphans. The few mothers they reach early enough in their pregnancies are put on a treatment known as HAART, Highly Active Antiretroviral Therapy, which has all but wiped out pediatric AIDS in the developed world.
Unidentified Man: Where are you? Are you around the hospital premises?
HUNTER-GAULT: Clinic professionals treat some 40 women a month, over 850 in a year. Admittedly a drop in the ocean of the vast numbers of HIV pregnant women in the country, one in three is HIV-positive. But in this little model program, the transmission rates of the mothers placed on HAART dropped to under four percent. Dr. Vivian Black is in charge.
Dr. VIVIAN BLACK (University of the Witwatersrand): It should be lower, but it's not, and that's because a lot of women still present very late in pregnancies.
HUNTER-GAULT: Women like Evalyn M.(ph).
Ms. EVALYN M.: I didn't know I'm positive.
Ms. M.: Because I couldn't make a blood test that time, because I didn't like to take the blood test.
HUNTER-GAULT: Denying the possibility of HIV infection, Eva Lanem is a typical case. It wasn't until after her baby was born that she found out she was HIV-positive, and so was her infant daughter.
Dr. Black says fewer than half of the country's pregnant women who are HIV-positive know their status and that is one of the major challenges: getting women comfortable enough to be tested early in their pregnancies and then having sufficient staff to treat the vast majority of people who are now falling through the cracks and dying. In South Africa, some 230,000 people are on antiretrovirals, but some 600,000 are estimated to need them.
Dr. BLACK: So we're missing 400,000 people. Those 400,000 people die.
HUNTER-GAULT: At the same time, Tammy Myers says there's another challenge to meeting those needs.
Dr. TAMMY MEYERS (Director, Harriet Shezi Clinic): There's a huge human resource crisis in this region. In the last 35 years, 44 percent of Wits' medical school graduates have left the country. That's nearly half of the doctors that are trained here.
HUNTER-GAULT: And that creates a huge human resource crisis, another of the many challenges among the South Africans plodding away to save the future.
Charlayne Hunter-Gault, NPR News, Johannesburg, South Africa.
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