Courtenay Sprague and Vivian Black
8 April 2008
opinion
Johannesburg — ABOUT 260 children are born infected with HIV in SA every day - about 94900 children a year.
As indicated in a report recently presented to the health minister at the Perinatal Priorities Conference, 75000 children under five are dying each year. Significantly, more than half of these deaths - 40000 - are preventable. At this rate, we will lose more than 500000 South African children, primarily to HIV and other common infections, over the next seven years, unless considerable changes are implemented with urgency.
This is one of the most important problems SA has ever faced. Unlike other intractable issues, this one has readily available solutions. Many of the infections that lead to subsequent illness and death are preventable and treatable.
Although chance plays a role in determining poor health for every person, this is not a case of chance for South African children. The upward trend in deaths provides a picture of systematic, unfair and socially generated disparities in timely access to, and quality of, healthcare and treatment for children and for pregnant women who are HIV-infected. What we see is a clear pattern of difference in health outcomes between groups, which shows evidence of avoidable health inequity.
To constitute a health inequity, a disparity in health must be systematically associated with social advantage; one that
is frequent, substantial and persistent, not random or occasional. Evidence of skews in health associated with income, race or gender is troubling and raises questions about social justice. Moreover, this problem of premature mortality raises questions about the fairness of social institutions. There is nothing normal or natural about a child dying prematurely of a preventable or treatable disease in a society with our level of resources, wealth and talent. In fact, there is clearly something wrong. While SA is highly unequal, it ranks as an upper middle-income country. Other poorer countries -- such as Zambia -- are doing much more than SA with fewer resources.
Health is a human right in this country. Good health is an essential precondition for development. Neglect, bias and discrimination against HIV-infected pregnant women and HIV-infected
children can lead to disparities in access to treatment for these particular groups. Poor and unequal treatment is more than a
social degradation: it is a denial of their right to healthcare and results in further inequity and injustice for the worst off groups in our society.
The National Strategic Plan for HIV/AIDS and Sexually Transmitted Infections sets targets for maternal and child health vis-a-vis HIV/AIDS. A full commitment to and timely implementation of this policy document is needed. Thankfully, the health minister has just established three committees -- maternal mortality, perinatal mortality and infant mortality - to investigate these deaths. However, the newly revised guidelines to prevent the transmission of HIV from the mother to the child (PMTCT) do not go far enough in protecting the health of HIV-infected pregnant women and children. Government officials must oversee this process, ensuring that public health is protected, while creating the conditions for fair and equitable access to healthcare.
There is a great deal of published research indicating what can be done to address PMTCT coverage and uptake, HIV testing, and antiretroviral therapy in pregnant women and children. The following are several areas of intervention, which the committees must address without delay.
To increase survivability of infants, we need to conduct early HIV diagnosis. HIV screening and testing for children must be prioritised and expanded. The expertise of healthcare workers in administering antiretrovirals to infants must be improved. Systems for tracking and monitoring child deaths have been tabled and must be established. The newly revised PMTCT guidelines must be revisited in two areas: a baseline CD4 count of 350 cells/mm3 to initiate antiretrovirals should be utilised in line with World Health Organisation recommendations, instead of 200, which is currently used in SA; and the "tail" regimen to counter resistance must be included, such as including additional antiretroviral drugs to counter the drug resistance faced by women.
PMTCT needs to be treated as a women's health issue - not just a paediatric AIDS issue. Additionally, HIV testing for pregnant women must be increased and expanded.
This can occur by increasing the numbers of HIV counsellors and the quality of counselling, and by the formal employment of lay counsellors. Shortages
in health personnel, training and staff motivation must be addressed. The willingness and ability of healthcare providers to discuss sexuality, health and childbearing issues with HIV-positive women is also critically important.
Dr Black is from the Wits Reproductive Health and HIV Research Unit. Sprague is a lecturer at Wits Business School.
Be the first to Write a Comment!
Copyright © 2008 Business Day. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
