South Africa child represents a small, significant victory over AIDS

CAPE TOWN, South Africa — Little Natasha is a giggling, wriggling bundle of mischief. She adores Barney the Dinosaur, claps along to her favorite songs, and throws a typical 3-year-old's temper tantrums.

Natasha, who picked up the AIDS virus in her mother's womb, also suffers from hearing problems, rashes and stomach upsets, and can't play outdoors too often because she easily catches cold.

But she is alive.

Natasha's health represents a small but significant victory over an epidemic gripping South Africa and neighboring countries. AIDS drugs are turning what was a certain death sentence for infants and young children into a manageable disease, providing a glimmer of hope on a continent of gloom.

But a long, hard road lies ahead. In sub-Saharan Africa, fewer than 10 percent of infected children are receiving the medication they need.

Last year, an estimated 950 South Africans died each day from AIDS-related diseases and a further 1,400 were infected each day, according to the Medical Research Council. UNAIDS head Peter Piot warned a conference in the coastal city of Durban this month that for every person in the country who started taking AIDS drugs, another five contracted the virus.

Natasha stood little chance of survival at birth. Doctors referred her to Bowy House, a home for orphans and sick children in Paarl, a town about one hour's drive from Cape Town.

The South African government, long criticized for doing too little, now has the world's biggest treatment program, and children are a focal point of a five-year AIDS program unveiled in May. Authorities have also vowed to step up prevention programs to stop fetuses from being infected. Other governments such as Zambia, Malawi and Botswana are also giving more priority to children.

UNAIDS and the U.N. Children's Fund say 2.3 million children in sub-Saharan Africa are HIV-positive. Globally, an estimated 530,000 children were newly infected last year and 380,000 died of AIDS, the vast majority in Africa. Without treatment, half of infected infants die before age 2.

Throughout southern Africa, child mortality rates have soared because of AIDS, but lower drug prices, easier diagnosis and better training of health workers augur a dramatic increase in the numbers of lives that will be saved. And government efforts are being boosted by the Clinton Foundation, the Bill & Melinda Gates Foundation, U.N. money and President Bush's Emergency Plan for AIDS Relief.

There are a whole host of other programs. For instance, backed by funding from drug companies, the Texas-based Baylor College of Medicine has an acclaimed pediatric AIDS initiative with children's clinics in some of the most ravaged countries, such as Botswana.

The impoverished Cape Town slum of Khayelitsha, where one in four pregnant women is infected, is now home to one of South Africa's busiest anti-AIDS programs, with about 500 children on medication. Wednesdays are dedicated pediatric days and the no-frills clinic set up by Medicins Sans Frontieres (MSF) reverberates with children's shouts.

Children have remarkably few side effects, partly because their systems cope better, says Eric Goemaere, head of MSF. But there are other problems; older children battle with rejection by family and friends and often lapse into depression, he says.

The very young can't swallow tablets and have to take multiple doses of syrup, according to a body-weight formula that can baffle caregivers — often illiterate grandmothers. The medicine needs to be refrigerated, difficult in poor areas with no electricity. And cash-strapped caregivers often can't afford the cost of driving kids to clinics.

But there is progress. Prices of drugs for children have come down dramatically over the past 12 to 18 months. The Clinton Foundation HIV/AIDS Initiative negotiated a reduction in the cost of pediatric drugs — often taken in combination — to $60 per year. Pharmaceutical companies previously accused of being greedy are now lining up to pay for children's projects in a complex network of public-private partnerships.

The local government provides drugs free of charge to Bowy House, where Natasha has spent most of her life and has come to regard its caregivers and children as her family. It's an example of the localized care that many experts say should be Africa's model. The government pays for the medication, but Bowy House's founder, Hester Veldsman, relies on donations for the monthly expenses of $9,500, and is always grateful even for donations of diapers and groceries.