Medical care for children living with HIV in Mali

Plan’s vision is of a world in which all children realise their full potential: this applies equally to children affected by AIDS.

Some of Plan’s programs assist children affected by AIDS by:

• supporting the social safety net for all children
• focussing more directly on children who are at risk of slipping through this net

In Mali, Plan supports centres for voluntary HIV testing and counselling operated by community groups in remote areas.

In 2003, the Government of Mali adopted a policy of providing anti-retroviral treatment free of charge to children under 15 years of age.

The treatment, however, was only available in two central hospitals in the capital Bamako. It was inaccessible to the almost 100 children with HIV living in and around the Plan-supported HIV testing sites.

Plan therefore entered into a partnership with a private Malian foundation operating a paediatric hospital in Bamako. The two organisations established a reception centre for HIV positive children from rural areas in the vicinity of the hospital.

The reception centre provides transport for the children and their primary guardian to Bamako according to their established treatment schedule.

After clinical and laboratory examinations, and after the appropriate drugs are dispensed, the children return home. The local hospital and the community self-help group assure medical and psycho-social support between the visits to Bamako. Generally, the children and their primary guardian spend two to four days per month in Bamako.

The reception centre opened in April 2004 with the first 20 children. By December 2005, a total of 190 HIV positive children had passed through the centre for assessment, and 82 were on anti-retroviral treatment.

At an estimated average cost of USD 650 per child per year, this program is expensive. This cost, however, is an indication of the real cost a family would have to bear for the medical treatment of their HIV positive child, in a country where anti-retroviral treatment is “free of charge”. This financial barrier is insurmountable for all but very few families in Mali.

The objective of establishing the centre was to provide an interim solution while anti-retroviral treatment facilities were decentralised throughout Mali.

By the end of 2005, two provincial hospitals offered anti-retroviral treatment, in addition to the two central hospitals in Bamako. Further expansion of services is planned.

The clients of the reception centre constitute a critical mass of children on anti-retroviral therapy in the provinces. Without this group, decentralisation of services would be very difficult.