Obstacles and inspirations, lessons and limitations in the management of paediatric HIV: specialist paediatric HIV services in the UK and the provincial paediatric HIV service in KwaZulu-Natal, South Africa

The HIV pandemic is the most pressing public health emergency in the world today. Most infected individuals live in Sub-Saharan Africa. However, experience with antiretroviral treatment is concentrated in the developed world, where relatively small numbers of children benefit from the latest advances in the field, and are cared for in long-established specialist chronic care clinics. Antiretroviral therapy is now being rolled out throughout the developing world. Although many of the clinical lessons learned in the developed world setting can be usefully translated from it, there are considerations beyond the medical that must be taken into account to make treatment in the developing world truly accessible and sustainable. This review compares and contrasts the UK and KwaZulu-Natal experiences to explore these issues.