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Clinton foundation puts forth plan to assist children with HIV

Initiative targets 10,000 globally

JOHANNESBURG -- The William J. Clinton Foundation, established by the former president in large part to fight HIV and AIDS globally, announced a plan yesterday to put 10,000 HIV-infected children in countries from the Dominican Republic to China on antiretroviral drugs this year.

The initiative, said AIDS specialists, is the first significant intervention specifically targeted for treatment of children, which many say is the most ignored aspect in the battle against the deadly virus.

Children account for one in six AIDS-related deaths, yet children represent less than one in 30 of those receiving treatment. Although US hospitals can reduce the chance of HIV transmission from mother to child to about 1 percent, those proven prevention measures are available to an estimated 10 percent of African women giving birth.

Yesterday, in a scene that is repeated daily in hundreds of locations across Africa, health workers at the Tsepong Clinic in the tiny mountain nation of Lesotho mourned a 5-year-old girl who just died of AIDS.

The girl -- health workers would not release her name to protect the family's privacy -- weighed less than 20 pounds. They had no pediatric antiretroviral syrup to give her three weeks ago, when she was last in the clinic for help.

They received the medicated syrup a week ago -- two weeks too late for the girl.

''She just broke my heart," said Sister Christa Mary Jones in a telephone interview from Lesotho, in southern Africa. ''She was like a little, tiny sparrow of a child. When she would sit on her grandmother's lap and look at you, it was like she was asking every question in the world about why she had to be this way. We don't want this to happen to another child."

In all, 3 million children are infected with HIV -- 2.8 million of them live in sub-Saharan Africa -- and an estimated 1,400 children with AIDS die every day. Most treatment advances are made for adults, little research is being done on pediatric drug formulations, and an estimated 50 percent of all HIV-infected children die before the age of 2.

''The world cannot continue to turn its back on these children," Clinton said yesterday in a news conference in New York. ''We can't give up on those who have been and continue to be born with the virus."

Clinton also said his foundation, along with the Partners in Health organization based in Cambridge, will begin an effort to battle AIDS in rural areas this year in Rwanda, Mozambique, and Tanzania. That program will receive funding from the Ruettgers Family Foundation in Boston.

Paul Farmer, one of the founders of Partners in Health, kicked off the rural initiative last week in Rwanda. He said it will be based on a model established by Partners in Health workers in rural Haiti.

''It's efforts like this one that are going to make a difference, even if they appear modest," Farmer said at the news conference. ''In over 20 years of working on the problems of poverty and disease, I've never faced any program with such optimism."

An estimated 15,000 to 25,000 children in the developing world receive antiretroviral medicines; half of them live in Brazil and Thailand. The Clinton foundation hopes its efforts will help 60,000 additional children receive antiretrovirals by the end of 2006.

While it will contribute $10 million to the programs to help children and those in rural areas, the foundation also is negotiating with Cipla, a generic drugmaker in India, to lower the prices of pediatric medicines.

Clinton said yesterday the two sides had not finalized the deal. The first orders of medicine will go in the next few months to China, the Dominican Republic, Rwanda, Tanzania, and Lesotho.

''We find this announcement to be groundbreaking," said Peter McDermott, head of HIV/AIDS programs at UNICEF.

McDermott said the initiative may represent ''the first real opportunity to scale up ARV [antiretroviral] treatment for children, and reduce significantly the deaths of children by HIV/AIDS."

At the Tsepong Clinic in Lesotho, health workers expressed their thanks for yesterday's announcement. But they also expressed doubts because of the lack of trained health workers to treat children with HIV or full-blown AIDS.

''Who is going to prescribe the drugs?" said Dr. Philip Berger, an AIDS physician and team leader of the Ontario Health Association's initiative in Lesotho. ''It's a good thing, but it's unrealistic because there's no one to give it out."

Last week, the government of Lesotho delivered enough AIDS pediatric syrup for the clinic to treat 35 children. The clinic has been cutting up adult antiretroviral pills and giving them to about 20 children who are old enough to swallow them. AIDS specialists say that process is flawed because medication may be spread unevenly in the pills, creating dosage problems.

Now, with the delivery of the pediatric antiretroviral syrups, clinic workers expect to be swamped with infected children, so they will continue to cut up adult drugs and administer them to older children.

''It's either break a tablet or watch the children die -- that is the choice," Berger said.

John Donnelly can be reached at donnelly@globe.com.

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