Background/introduction Southern Africa has some of the highest rates of HIV with a prevalence of over 10% in the adult population. As we enter the second decade of the epidemic over 17.1 million people in southern and eastern Africa live with the disease. In Zambia around 100,000 children under the age of 14 and in Malawi an estimated 170, 000 children have HIV.

Aim(s)/objectives Case study of 2 paediatric patients in Southern Africa with diagnosis of HIV related complications.

Methods Individual cases were examined and followed up.

Results An 8 year old girl, is seen in rural Zambia with new diagnosis of HIV, moderate malnutrition, septic wounds and cough. She lives far from a rural hospital and during wet season is unable to cross the river to attend follow up. A 14 year old boy in rural Malawi is seen with severe malnutrition, HIV treatment failure after late diagnosis, chronic abdominal pain due to 3TC pancreatitis and new neurology. The family refuse to attend the palliative care team at central hospital.

Discussion/conclusion Zambia currently has an estimated ART coverage of 72%. Whilst this seems like excellent progress the child vs adult breakdown shows that only 26% of children with HIV have access to treatment compared to 84% of adults. In Malawi 51% of adults with HIV are on ART but only 30% of children receive therapy and 30% of paediatric cases receive a diagnosis of HIV within first 2 months of life. These cases explore the inequalities that children face with late diagnosis of HIV.