Five-year-old Anastasia Enongo lies curled like a fetus in a hospital bunk here, coughing weakly, intravenous medicine dripping into her arm. Born to a mother who died of AIDS, the girl has always been sick, her relatives said, her life a parade of doctors' visits for fevers, coughs and diarrhea.
It was not until February that Anastasia was tested for AIDS. The result explained her maladies, but even then she was not treated, and when she arrived at the Chantal Biya Foundation Hospital here last month, she was nearly unconscious. Often, the children of Africa are still not getting AIDS prevention or treatment drugs, experts say, even though the drugs have become affordable and available.
In Cameroon, the government started providing drugs to prevent the transmission of AIDS from mothers to newborns in 2000, before Anastasia was born. It now offers the full spectrum of AIDS medicine free to children.
But Africa's systems to treat children and pregnant women are weak and overwhelmed by other diseases, and diagnosing HIV in young children can be difficult. So children like Anastasia may go without lifesaving drugs, even as the number of adults in treatment has significantly increased in the past two years.
Of the 15,000 to 40,000 children estimated to have HIV in Cameroon as of last year, only about 400 got the drugs they needed, according to government reports. Only a fraction of pregnant women are getting the two medicines to prevent the transmission of the virus to their babies -- although these are very inexpensive drugs that have eliminated pediatric HIV in Europe and North America.
"The delays in getting this to children are disheartening -- a huge failure," said Tido von Schoen-Angerer, director of the campaign for essential medicines run by Doctors Without Borders.
Although the high cost of AIDS medicines was once regarded as the insurmountable barrier to treatment in Africa, the advent of cheap generics and huge investments by international organizations have brought lifesaving medicines to the continent in the past five years. Beyond that, some new pediatric AIDS clinics have opened, and the treatment of children has begun to improve in parts of the continent.
Even so, UNAIDS, the UN AIDS program, estimates that 24 percent of adults in Africa with AIDS, or about 800,000 people, are getting therapy, a number that doubled last year alone. But experts agree that only a small percentage of HIV-infected children in Africa receive treatment; in some countries, the percentage of pediatric patients getting drugs is only 2 percent or 3 percent of those treated.
"The cost of drugs is an issue, but not the only or even the most important issue for children," said Kevin De Cock, the WHO's chief official on HIV/AIDS, who said at an international conference in Toronto this summer that treatment had "so far left children behind."
"You need to put the medicines into a system that functions," he said. "The fact that children aren't getting treated is a sign of the frailty of health systems."
Chantal Biya, the wife of Cameroon's president, has recently started African Synergy, a foundation of African first ladies whose aim is to address the issue of HIV in women and children, but the demand is overwhelming.
Preventive treatment gives mothers two drugs in the weeks before birth and at the time of delivery. The baby also receives a short course of treatment. Mothers are then advised to use formula instead of breast feeding, because up to 40 percent of mother-to-child transmission occurs during nursing.