HIV/AIDS in developing world children
By Chuck Miller, M.D.

"In 36 years of practice in the U.S. I had only about six or so children in my practice die, and only one from AIDS. In my times in mission hospitals in Africa, I see that many children die each week, and sometimes in one day.” Chuck Miller, M.D.

Editor’s note: Dr. Miller wrote this article in response to the following recent Q&A the HIV/AIDS Caring Community posted:

Q: I’ve heard that the numbers of people with HIV/AIDS is inflated. Some say the problem isn’t as bad as they say. What do you think?

A: You’ve heard the statistics: 40.3 million people infected with HIV/AIDS; 6,000 new infections each day among those 15-24 years old; 3.1 million AIDS related deaths last year (UNAIDS). There is no viable evidence that these statistics are inflated. However, if they are wrong, the essential fact remains: Too many people are infected and affected globally by HIV/AIDS. The remaining question is: Exactly how many people need to suffer for me to care?

Dr. Miller’s response:

AIDS is the number one medical emergency in the world today, and is especially tragic in third world children. It is estimated by the World Health Organization that half of the adult population in sub-Saharan Africa will be dead by the year 2020; and infections in children are reaching almost 30 to 40 percent as many as adults.

As a medical missionary, I have made 12 trips and spent nearly three years treating such children, and I can assure you that numbers like these are not inflated. In fact, so many children are born in the bush areas where there is no medical care and no knowledge of how many lived or died, that the numbers are more likely to be even larger than thought.

According to ANECCA’s (African Network for the Care of Children Affected by AIDS) handbook, compiled by 19 of the leaders in the care of AIDS in children and sponsored by USAID, the transmission rate from mothers is between 30 and 40 percent, mainly due to the high rate of maternal infection, high birth rates, lack of access to interventions, and prolonged breastfeeding. In 2003 there were 40 million cases of AIDS; 2.1 million of these were children, 90 percent of whom are living in sub-Saharan Africa. This translates into 630,000 new cases per year, or more than 1,600 new cases per day of infants infected by HIV positive mothers.

My experience has borne this out. In 36 years of practice in the U.S., I had only about six or so children in my practice die, and only one from AIDS. In my times in mission hospitals in Africa, I see as many children die each week, and sometimes in one day. I do not have the figures, but about one in four has AIDS. It is next to impossible to do much for them except treat complications and try to prolong their lives, since definitive treatment is nearly impossible. It is heartbreaking to see so many under-nourished, weak children who are usually suffering from other diseases as well – too weak to do anything but lie on the bed, and usually accompanied by a mother in the same condition.

"Most non-churched programs have not been taken seriously by the local nationals. The only ones that have had success have been both church-related and coupled with teaching of Christian principles." Chuck Miller, M.D.

There were almost no drugs to treat AIDS until two or three years ago, and even now there are large areas where they are not available. Couple this with the lack of convenient medical facilities, mostly understaffed, and the inability of the impoverished Africans to get to them, and the problem becomes larger. Add to this the lack of education, the 'macho' male-dominated society structure, and the concept that they only need to take medicine when they feel sick – and the problem of giving drugs four times per day for a lifetime becomes almost insurmountable. In spite of these obstacles, mission hospitals staffed by dedicated doctors and nurses, though in short supply, do much to improve the health of these patients, even with limited supplies of drugs.

Remember, though, that AIDS also cannot be put in an isolated category. We are used to diagnosing and treating one condition at a time in the developed world, but in the third world this is rarely the case. Malnutrition and resulting poor immune systems, plus concomitant tuberculosis and malaria, are the rule more than the exception, making the care even more difficult.

What churches can do
What can we, especially our churches, do? There is much. We must work to train community health care workers to educate their people about ways of prevention, voluntary counseling and testing (VCT), and the need for treatment for AIDS. We need to support the programs now just getting under way by The World Health Organization (WHO); The Global Fund for AIDS, Tuberculosis and Malaria; and the U.S. government's Presidential Plan for AIDS Relief.

However, there is much more. Most non-churched programs have not been taken seriously by the local nationals. The only ones that have had success have been both church-related and coupled with teaching of Christian principles. When people relinquish polygamy and sexual promiscuity for monogamy and concern for each other, much is gained. People are needed to go to these areas, show concern, and teach.

Private programs, especially those which are church-sponsored, can reach the people in the outlying areas, but government-sponsored programs meet with poor success due to the amount of time and red tape involved, plus the fact that most of the local governments are corrupt, and much of the money is pocketed rather than going where it was intended. Organizations such as CARE, World Vision, Save The Children, Samaritan's Purse and others are making a difference and need our support. Editor’s note: These organizations are doing amazing work and are worthy of our support. However, make it a point to get your church involved in church-to-church, hands-on ministry. Learn how your church can make a significant difference >>

But above all, the most important and effective thing that we can all do is pray, pray, and pray!

Dr. Miller is a pediatrician. He spent 36 years in private practice in Delaware and now serves with Samaritan's Purse/World Medical Mission. He's been to many developing world countries including Zambia, Kenya, Rwanda, Niger, Togo, Bangladesh, and Papua New Guinea.