Sunday Times (Johannesburg) - October 24, 2009

All children are vulnerable, no matter the continent or country or community into which they are born. But African children face an additional and terrible challenge that most children in the world will never know: the threat of HIV and Aids.

On the continent we are facing the potential human, social, and economic devastation of Africa's future generations as a consequence of the impact of HIV and Aids on our children.

Of the estimated two million children in the world who are living with an HIV infection, 1.8 million are in sub-Saharan Africa. The numbers of infected children in the six countries where the Campaign to End Paediatric Aids (Cepa) is being launched are staggering:

* In Zambia, at least 95000 children are living with HIV;

* In Mozambique: at least 100000;

* In Uganda: at least 130000;

* In Tanzania: at least 140000

* In Kenya: at least 155000

* In Nigeria: at least 220000; and

* Here in South Africa: at least 280000.

I have said "at least" because these numbers are from 2007, the most recent year for which there are official World Health Organisation estimates. You know that the numbers are in fact worse now, at the end of 2009.

We must focus our efforts on ensuring that life-saving medications reach all children who need them.

We must also ensure that our health systems are strong and fully resourced, with the capacity to provide care and treatment to all who need them.

We are all too painfully aware of the shortcomings and failures we face today:

* Our friends here today from Mozambique know that in 2008, some 22000 children under the age of 15 died as a result of HIV-related disease;

* Our friends from Zambia know that the waiting time for an infant's HIV test result to come back from the lab can be anywhere from eight to 16 weeks; and

* Here in South Africa, we know that an estimated 40% of HIV-positive children who need treatment still are not able to get access to it.

Our friends from Nigeria, Tanzania, Kenya, Uganda, Zimbabwe and Ivory Coast have equally sad stories to tell.

These numbers are tragic, but they are all the more tragic because we know that the world, collectively, has the means necessary to end the epidemic of paediatric HIV and Aids.

Children are dying needlessly in Africa.

We know this, and it causes us all great sadness.

With more than 25 years of experience in combating HIV and Aids, civil society organisations all across Africa know that dispensing pills and providing care will not by themselves end the epidemic.

Civil society must join with funders, governments and paediatric practitioners to encourage leadership at all levels of society. Leadership is key to breaking the terrible cycle of this disease in Africa.

We must hold our governments accountable to the promises they made to children. They must put systems in place to implement these promises. They must create good public policies and do all in their power to end paediatric HIV and Aids on our continent.

We must engage the private sector to work with civil society to achieve common goals.

We must capitalise on existing global initiatives such as the Global Alliance for Vaccines and Immunisations; the Global Fund to Fight Aids, Tuberculosis, and Malaria; Pepfar (the US President's Emergency Plan for Aids Relief); the Task force on innovative international financing for health systems; the Global Campaign for Health Millennium Development Goals; and United Nations agencies, including WHO, Unaids, and Unicef, and Unitaid, among many others.

These initiatives are working to strengthen health systems and to reduce maternal and child mortality in Africa. We must encourage them to continue doing so, and to align themselves with the Campaign to End Paediatric HIV/Aids, Cepa.

But we must do more than this.

* We must monitor the allocation of global resources; for example, how much money coming into the region is earmarked for treatment and how much is specifically earmarked for paediatric treatment;

* We must ask how much of that money actually gets to the ground;

* We must monitor national health budgets to see how much money is earmarked for children;

* We must monitor national health targets and hold our governments to their promises; and

* We must train more paediatric practitioners, nurses and social workers to provide care specifically for children with HIV and Aids.

A focus on children has been an important part of my life's work. As a mother, as a teacher, and as someone who has been involved in the struggle for human rights, I have always kept the wellbeing of children everywhere close to my heart.

I believe Cepa will achieve its goals, and that we will one day see the end of paediatric HIV and Aids in Africa - indeed, throughout the world.

I am happy to be counted among those in Africa and elsewhere who are standing up to help end paediatric HIV and Aids.

I look forward to learning of your successes, reading about your victories, and - one day - celebrating with you the end of paediatric HIV and Aids, for we all believe that day will come, and it will come due to your hard work on behalf of Africa's children.

** This is an edited version of a speech Machel gave at this week's launch of the Campaign to End Paediatric HIV/Aids, where she was appointed chairman of the Cepa leadership council

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Always watch for outdated information. This article first appeared in 2009. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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