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How did you become involved in caring
for children with HIV?
It just sort of happened. I was working at the county
hospital and someone told me there was a job at Texas
Children's working with HIV children. I thought it sounded
interesting. I applied for the job and I have been here
for 12 years.
What parts of your program are you
proudest of?
Being able to provide antiretroviral medications to
children in Romania. Antiretroviral medications are
used to stop or slow the replication of HIV in the body.
Antirertrovirals are grouped into three groups, each
one focusing on a different stage of HIV replication.
The groups include nucleoside reverse transcriptase
inhibitors, protease inhibitors and non-nucleoside reverse
transcriptase inhibitors. Combination therapy, the use
of three or more antiretroviral medications together-also
known as HAART or highly active antitretroviral therapy-is
the standard of care for HIV-infected adults and children.
The idea behind using combinations of anti-HIV medications
is that the stronger the therapy and the more ways HIV
is attacked by different drugs, the less likely it is
that the virus will become resistant to treatment.
We started treating children in Romania in 1996. At
that time, the children in the United States were getting
good medications, but Romanian children did not receive
any medication for HIV. We've been going back to Romania
at least once a month since then, and we provide nursing
and health professional education. We have a clinic
established there, where we work with a physician to
treat more than 1,000 children.
What are the greatest advances you've
seen in the last 10 years in pediatric HIV treatment?
The development of highly active antiretroviral therapies
in formulations that children can take. We also are
scheduling these medications in ways that are appropriate
for children.
What are your hopes for these children
during the next 10 years?
I hope that I can see a lot of the children I started
seeing 12 years ago graduate from college. I hope they
have to take medications only once a day and that HIV
is more widely accepted throughout the world.
What are the greatest challenges for
HIV-infected children in the United States and other
countries?
Taking medications. They have to take at least three
medications; this involves taking as many as 12 pills
two or three times a day.
Children must not forget to take their medications,
but this is especially hard when they have other priorities,
such as playing with their friends.
Children in Texas are lucky they can get antiretroviral
therapy. There are programs that provide funding, and
we have never had to turn a child away.
In Romania, there is a problem with access to care.
They provide some medications but not as many as are
available in the United States. There are few people
in Romania trained to care for people with HIV. Most
countries are not providing any medications to children.
The children are just trying to stay healthy without
medications. In Romania, we work in conjunction with
the government to offer medication.
In South Africa, we were the first ones to go into
the country and offer medications, but now the government
is starting to provide medications to children and adults
for free if they qualify, based on income.
What social challenges do HIV-infected
children face?
There is a stigma. Even in the United States, parents
don't tell their children that they are HIV-positive.
They are afraid they will tell other children and that
people won't want to play with their kids or invite
them into their homes.
I think people in the United States have coped better
because they have dealt with the disease longer. In
Romania and Africa, most people don't tell anyone except
their family members that their child is infected. In
Africa, the stigma is the worst. People can be thrown
out of their home and children are abandoned and live
on the street.
What challenges do nurses face?
We are educating health care workers about HIV and
how you can and cannot get it.
In Africa, 80 percent of people in hospitals have HIV,
and nurses don't want to care for the patients because
they are afraid they will get HIV. Many patients in
hospitals are neglected because nurses are scared. There
is a shortage of nurses in Africa partly because nurses
are dying of HIV, too. Nurses do not tell anyone that
they have HIV because they are ostracized. Nursing is
not a job that pays well in Africa, so the shortage
continues.
What are the goals of your program?
Education and medication. We need to provide medication
to women who are pregnant and educate providers to care
for women who are pregnant.
In Africa, there are programs for perinatal counseling,
but most women do not want to know if they are positive.
HIV treatment has come a long way, especially in the
United States, but pediatric HIV is still out there.
We need to continue to work to prevent the spread of
pediatric HIV and promote the acceptance of those with
HIV.
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