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National AIDS Control Organization (NACO) Director-General Sujatha Rao said that her organization has “finalized the treatment protocol for pediatric AIDS” and “awaiting Government clearance” to “train doctors to start the program in medical colleges.” Refreshingly, for the first time in 3 decades, the Government looks like it is paying attention to HIV-positive children in the third stage of the National AIDS Control Programme. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) say that pediatric AIDS is grossly neglected throughout the world as pharmaceutical companies do not see profits to come out with children-specific cocktail dosages.

UNICEF representative Dr Chewe Luo says that pediatric AIDS program makes sense because if there is a successful mother-to-child prevention programme in place, there would be lesser number of children with HIV.” However, this makes it unprofitable for pharmaceutical companies as “investing on the development of pediatric dosages is not a viable.” A Director of the World Health Organization (WHO) Dr. Hans Hogerzeil proposed that India has the perquisites to become the leading supplier of HIV fixed-dose combinations for children. WHO Representative Dr Siobhan Crawley admits that “The success is not as much as the success we got with the generic industry for adult anti-HIV drugs.”

In India, NACO is talking to Indian drug companies and adding the pressure by roping in the Indian Association of Paediatrics. Together, they are trying to identify locations for diagnostic labs and to define parameters that would help decide who among the affected children need treatment. Rao says that her organization is “encouraging people to come forward for testing so that the extent of infection would be known.” This shows the extent of lack of information on the prevalence of AIDS in India and shows that the numbers thrown up by the Health Ministry are at best guesstimates.

The WHO says that globally 660,000 children require treatment, though only a handful gets it. In south-east Asia, there are 33,000 kids who need treatment and in India, out of 23,784 AIDS patients receiving anti-retroviral therapy, only three per cent are children.

Early and accurate diagnosis is impossible because all children born from a HIV-positive mother will have the antibodies to test positive, even if they may not have the virus and the common ELISA test is not a reliable tool. The only alternative available is determining the viral load in a costly polymerase chain reaction (PCR). NACO will buy six of these machines to be installed in six high-prevalence states.

Luo says that if the virus is not diagnosed early “30 per cent of the affected kids would die in a year and 50 per cent would die before they are two years old” and waiting for results with ELISA after 18 months may be “too late for many kids.” However, if detected early, children can survive for many years with proper medication till science catches up with the epidemic and provides a viable solution. Even then, the drug regimen is harsh and expensive for most. With the first cocktail mix, they can survive for a minimum of seven years before moving to the second regimen that can give them an additional seven years. Crawley says that the disease can be managed easily in children “like chronic diseases such as diabetes and heart disease.”

Meanwhile, the Tamil Nadu State AIDS Control Society is examining the possibility of establishing voluntary counseling and testing centers (VCTCs) in industries. The society is hoping to establish a partnership with industries that employ large number of workers. The Society has linked up with the International Labor Organization (ILO) to provide technical support to take this program forward. ILO admits that counseling and providing assistance to employees in the workplace is not a top priority for most industries.