India failing children orphaned by AIDS.

www.thelancet.com Vol 375 January 30, 2010 363 13-year-old Seema lives with her grandmother Susheela and three other orphaned cousins, in a dark, poorly ventilated two-room tenement in a slum in Bangalore, the capital city of Karnataka state, southern India. She has lost her parents to AIDS, is HIVpositive, visibly malnourished, and has cataracts in both eyes. Seema is not yet on antiretroviral therapy (ART) as she has a healthy CD4 cell count, but she often becomes ill with fevers and body pain, which her grandmother attributes to the “worms” that she has in her blood. Susheela, who is the sole guardian of the children, has asthma and a heart ailment. She was running a small business selling short-eats from a pavement stall until recently, but is too ill to work now and has no income. The family has no access to support other than some food items provided to them once a month by Milana, a family support group for HIV-positive people based in Bangalore. Seema is just one of the indeterminate numbers of children that have been orphaned by HIV/AIDS in India. Stories similar to hers are being played out in thousands of homes across India and in Karnataka. But India’s response to caring for these children remains wanting, say campaigners. 3 years into National AIDS Control Programme Phase III (2006–11), which places special focus on medical treatment and after care, access to schooling, and adequate nutrition, government interventions for AIDS orphans are conspicuous by their absence in any area other than paediatric ART. While estimates for children orphaned by AIDS are unavailable there is evidence that 3·8% (nearly 100 000) of an estimated 2·5 million people living with HIV/AIDS in India are children. UNICEF estimates that there could be about 4 million aff ected children in India, located mostly in the high HIV-burden states of south and northeast India (aff ected children include those living with HIV or those who are orphaned by AIDS, and children whose parents are living with HIV).