Budget cuts in the health service for Free State in South Africa from the end of 2008 onwards prevented new patients with HIV accessing anti-retroviral treatment.

The Thabang Society in Parys is one of the few places in the state where people have had access to ARVs. These ARVs are provided by Caritas/The Southern African Bishops’ Conference.

Dr Almud Pollmeier is a paediatrician and coordinator of the Thabang Society. She says any cuts to the health budget could have a bigger impact on children than adults.

“The care you have to give to a child on ARVs is much more expensive and time-consuming. They have to take different and a greater variety of medication to adults, also it has to be adapted as they grow,” she says.

Other difficulties in treating children with HIV in Parys are caused by an unreliable water supply. Not everyone has access to clean water, and sometimes it can be turned off for a few days.

 “With small children they have to take ARVs as a liquid which gets mixed at home,” says Dr Pollmeier. “You need clean water. If you don’t have access to clean water, you have to buy it.”

Liquid ARVs may also need refrigeration. Not all families will have a fridge. If they do, their electricity supply may not be constant.

“Liquid has to be stored in a fridge whereas tablets can be stored at room temperature,” says Dr Pollmeier.

In poor areas where there are problems with the water and electricity supply, it seems that tablets would be an easier option for children with HIV.

“You get medication in capsules and tablets which are too big for children to swallow,” says Dr Pollmeier. “But it’s getting better and pharmaceutical companies are coming out with more preparations adaptable to a child. However, it’s more costly to produce those medications.”

The TB challenge

Meanwhile, Dr Pollmeier says that a lot of effort has been put into diagnosing children with TB in South Africa.

“There are DOTS*supporters in communities, they even have programmes for defaulters to come and take their daily medicine in front of the nurse,” says Dr Pollmeier.
But despite progress in treatment, there are still difficulties in diagnosing children with TB.

“Sometimes it’s difficult to get sputum from children,” says Dr Pollmeier.  “Then you have to send a child for an X-ray and it’s costly and you have to have the facilities.”

It is also very difficult to diagnose extra-pulmonary TB. Dr Pollmeier cites the case of one of her seven-year-old patients who had HIV and became very ill. Despite visits to the hospital and treatment for a swollen stomach, it was only when she was sent for specialised paediatric care that extra-pulmonary TB was diagnosed.

*Directly Observed Treatment Short-course – A World Health Organization strategy for tackling TB.