In our area of operation in central Africa (Nkhotakota district, Malawi) many children suffering from full-blown AIDS are effectively excluded from the Global Fund/governmental rollout of ARVs (the life-saving cocktail of antiretroviral medicines) - because they live too far from the hospital to be able to assess diagnosis and treatment; the reality is that their only future is an unpleasant, painful death.
Virtually all the children suffering from AIDS were infected at birth through mother to child transmission; most are orphans, their parents already victims of the AIDS pandemic.
We use WHO clinical staging to assess when to begin treatment, then use a holistic approach. There is no point giving these powerful medicines to a starving child so first we ensure the child is well nourished, whilst we treat any opportunistic infections; then we can begin the ARVs. We provide mosquito nets and visit them in their homes every month to monitor them and their social environment.
The results have been remarkable; when we begin treatment these children are desperately ill, skeletal, racked with coughs and diahorrea - they are now transformed, have put on weight, are able to go back back to school and smile again - they have regained their childhood.
From the clinical viewpoint, their CD4 counts are back to normal (from way below 50 in some cases). We give Cotrimoxazole for life, plus fluconazole if there has been a crytococcal infection. Likuni Phala is provided as a diet supplement.
The youngest child we have begun treatment for was just 10 months old; diagnosed through his symptoms as he was too young for an accurate HIV test, his HIV status was confirmed by viral load assay.