An African Miracle

Addition Appended: November 30, 2006

It's hard to believe that these photos are of the same little boy. When 8-year-old Bokang Rakabaele arrived at the new pediatric-AIDS clinic in Maseru, the capital city of Lesotho, in May, he weighed less than 20 lbs. and was suffering from AIDS, pneumonia and tuberculosis. Today he's 18 lbs. heavier, his shy smile has returned, and he plays once again with other kids in the neighborhood. When I visited the clinic in August, Bokang was already on the mend. He was asked through an interpreter why he thought he was feeling so much better, and replied very simply, "It's the medicine."

Leave it to a child to get to the heart of the matter. For years, giving antiretroviral drugs (ARVs) to children living with AIDS in the poorest parts of the world was perceived as a lost cause. It's hard enough, the experts thought, to get ARVs to pregnant, HIV-positive women to reduce the chances they will infect their babies in utero or at birth. Pediatric versions of the drugs are expensive, and cutting down an adult dose of the medication to give it to a child is tricky. Without treatment, however, nearly a third of HIV-positive infants die by their first birthday, and half die by age 2.

Now Bokang and thousands of African children like him are getting the lifesaving treatment they need. What changed? Researchers showed that children respond faster and better than adults to ARVs, and it no longer seemed fair to ignore poor youngsters with AIDS. Then several groups rose to the challenge. The President's Emergency Plan for AIDS Relief allocated $63 million this year for the treatment of pediatric AIDS. The Clinton Foundation negotiated a 50% reduction in the price of a key medication. And a handful of nonprofit organizations, corporations and faith-based groups began sending more doctors to the developing world to help plug some of the health-care gaps for children.

The need is great. More than 2 million children in Africa under age 15 are living with HIV, according to a study published last week by UNAIDS and the World Health Organization. Of these youngsters, perhaps 660,000 are sick enough to require medical intervention. Yet only 1 in 20 children who need ARVs get them. In addition, fewer than 1 in 10 HIV-positive mothers receive the drugs they need to keep from transmitting the virus to their newborns.

This is usually the point at which most of us in the rich countries of the world throw up our hands in despair. Not so Dr. Mark Kline of the Baylor College of Medicine in Houston. "If you focus on the enormity of the problem, you'll never get started," says Kline, who has cared for hundreds of HIV-positive children over the years in the U.S. and has seen many of them grow old enough to have children of their own (see box). "You have to tackle it piece by piece."