i~f sour fRN AFRICAN JDU NAL OF ~IV MfDICI f ------------DCTOHfR 2002

FROM THE

Antiretroviral therapy is at last receiving more attention.
Such is the scale of HIV morbidity that every health care
worker will need to gain expertise in this area. Children are
our future, and it is appropriate that their needs and those
of their parents are adequately addressed.

The concept of family therapy should now be emphasised,
as paediatric HIV reflects HIV infection of the parents as
well. For those tens of thousands of children needing
therapy, their caregivers' health is integral to survival. This
concept of family therapy represents a unique opportunity

ORPHANED BY AIDS

Recently a young TB researcher visiting us from New York
went shopping at the Greenpoint Sunday market and was
accosted by some thugs who relieved her of her bag. She put
up a brave struggle and her screams alerted some good
Samaritans, who gave chase. One of the thugs was
apprehended and the bag, with some contents, recovered. The
Samaritans put it into their car while they dealt with the
miscreant They returned to their car just in time to see some
street children making off with the now tVlice-
stolen handbag, and all the other contents of
the car!

It was just the weekend after, in the
Independent of 6 October, that I read the most
disturbing article entitled The AIDS orphans
time bomb': the pandemic 'will rob three million
children of parents in the next ten years,
bringing spectre of social chaos and even
higher crime rate: The reporter quoted the
Institute for Security Studies as saying that the
burgeoning orphan population will grow up
under extreme levels of poverty and will be sorely tempted,
and even obliged for its physical survival, to turn to crime,
drugs, gangs and the sex trade.

A staggering 300 000 children have already lost their mothers
to AIDS. Pre AIDS, 2.5% of the popula 'on in developing
countries were orphaned, and is proportion is expected to
increase to 17% in South Africa by 2010. It is estimated that
10 000 children currently live or work on South Africa's
streets. A stop at any city traffic lights will bear testimony to
this, and the number is set to rise dramatically in the near
future. The traditional African safety net, the extended family,
will probably not be able to absorb overwhelming numbers of
orphans. Research has also shown that households with one
or more members who have HIV/AIDS are much poorer than
others. When the breadwinner dies the economic impact on
the children left behind is drastic. Orphans identified their
priority needs as the most immediate basics: food, clothing
and education.

EDITORS

to southern African family physicians to develop strategies
to treat and strengthen families.

The concepts of antiretroviral therapy in children are
relatively easy and the principles are similar to those for
adults. Important differences include more use of liquid
formulations, surface area dosing for some medications,
the need to increase medication with growth, and the
importance of caregivers in maintaining adherence.

MARK CanON
Guest Editor. Southern Africon Journal of HIV Medicine

This problem must provide yet another most compelling
reason to implement countrywide antiviral treatment Debbie
Bradshaw from the Medical Research Council is quoted as
saying 'a large number of people are already infected with HIV
and will progress to AIDS, illness and death. Unless something
is done to prevent this, they are going to die and not be
around to look after their kids:

According to an MRC report published in May, orphaned
children are 'not only traumatised by the loss of parents, they

lack the necessary parental guidance through
crucial life-stages of identity formation and
socialisation. Psychosocial effects will be
worsened by accompanying threats to the basic
survival and security frequently experienced by
orphans:

Innovative solutions are called for. One example
is the non-governmental organisation called Big
Brother, Big Sister, South Africa, which screens,
recruits and trains adult volunteers to mentor
assigned orphans. The initial commitment is
only one hour per orphan per week, but one can

see how, as bonds grow, this time will increase. The idea is that
the orphan will have an adult who takes an interest in his or
her daily life and becomes a role model during important
stages of development

The story brought home to me once again the depths and
complexities of the AIDS pandemic, especially in a continent
like Africa. We really DO have to find a way to take that first
step to national ARV treatment Three cheers for the South
African Medical Associa 'on, who with Kgosi Le lape at its
helm has fearlessly moved headlong into mobilisation for a
national treatment plan - and a bold plan it is too. Using the
Mandela Children's Fund as a channel for collecting funds and
backed by a number of important South Africans, Letlape looks
set to pull it off.

UNDA-GAIL BEKKER
Managing Editor