AIDS leaving infants without mothers and homes

By Debra Boyce
June 26, 1999

Phnom Penh - She was 10 days old, covered in a purple rash, and in need of a home. Her mother, a 19-year-old sex worker with AIDS, had died five days after her birth. Friends of the mother had brought the infant to the Missionaries of Charity with a letter from the mother begging someone to care for her child. A test showed the baby was HIV-positive and the nuns, who christened the sick infant Miriam, made tentative plans to take the baby to the government orphanage.

There was a time when a saga like Miriam's would have been unusual, but these days it is happening with alarming frequency. More and more HIV-positive children are being brought to charities, left on the steps of pagodas or the front gates of orphanages. Sometimes it is the fear of AIDS that causes the families to abandon the children, but most often the parents are simply too sick or too poor to care for them.

There are no available records to show how many children have HIV, but the administrators at the government orphanage in Phnom Penh say seven out of 10 children admitted in April were HIV positive and authorities there fear their meager resources may soon be overwhelmed. "For adults there are few options and for children the options are less," explained Geoff Manthey, country program advisor forthe UN joint program on HIV/AIDS. "They get left on doorsteps or abandoned. It's not malicious, but sometimes the parents don't see any options."

Ti Chanteay, 26, has put considerable thought into her future since her husband died two years ago and she subsequently learned both she and her daughter were HIV positive. "At first I thought about killing myself, but then I was worried about who would take care of my child," she said, explaining how her mother-in-law, with whom she is now living, could not afford to care for the little girl and Ti Chanteay's own family does not want her. If the baby out lives her mother, the child will go to live with the director of a small AIDS organization that has given her foodand financial assistance, says Ti Chanteay.

Her painful dilemma underscores one that increasing numbers ofparents will face as Cambodia's AIDS epidemic continues to spiral out of control. By the year 2000, health officials estimate, 200,000 Cambodians will be HIV positive - the highest infection rate in Asia. And in the coming five years authorities believe there will be between 30,000 and 50,000 cases of AIDS, overwhelming a health care system which has just 10,000 hospital beds nationwide.

The infection rate in married women, according to health experts,is 2.0 percent. One child in three born to an HIV mother is at risk of being HIV positive, says Manthey, and that risk increases if mothers breast feed. But few mothers in Cambodia, where 40 percent of the population lives below the poverty line, know this or have access to this information, he says. Pre-natal checkups are rare and many give birth at home instead of in a hospital.

Of the 100 children currently living at the institution, known as the Nutrition Center, about 20 percent are HIV positive, says Vice Director Chum Han. In 1998 there were 36 new arrivals with HIV, more than double that of 1996 when the center first started keeping track. And the number of HIV-positive orphans brought to the center looks set to continue rising.

From mid-March until the end of April, seven of 10 children left at the center tested HIV positive. Some are infants who will lose their mother's HIV antibodies after six months and then beadopted. Others, like Bun Heang, will remain there until he dies.

Bun Heang, 4, was left at the Nutrition Center's gates in 1995. No one knows what happened to his family, but he tested HIV positive shortly after his arrival. He is small for his age, and sores on his head from HIV have been covered in a purple-hued salve. Like the other HIV positive children, he requires special care and supervision. At meal time she sits at a tiny table in the tiled dining room with another HIV child, Sam Reth, and gets assistance from a staff member.

Nutrition Center administrators say they fear being overwhelmed by children like Bun Heang and Sam Reth who need special care that the orphanage can't afford. The center gets rice from the UN's World Food Program, and a French organization, ASPECA, provides funding. The government provides about four U.S. dollars per childper month, which Chum Han says isn't enough. There is no money for any special medication, such as Bactrin, which HIV infants take to stave off pneumonia.

Administrators have also asked the government for additional staff to help care for the sick children, but have yet to receive a response. In the meantime, a proposal has been made to move the HIV-positive children from the orphanage to a ward at the municipal hospital, although officials from both the hospital and orphanage insist the idea did not originate from them.

Even if the move does not happen, the Nutrition Center may soon not be an option for every HIV child. With expectations that the number of HIV children will rise by 25 percent again this year, the director, Youn Sovanna, says they will continue to accept HIV positive children brought in off the streets, but not from private orphanages or organizations already caring for them. "It's very difficult," acknowledged Chum Han. "We're very worried about the future."

For Miriam, the future may be happier than for the majority of Cambodia's HIV orphans. A Canadian resident of Phnom Penh, Janne Ritskes, who knew of the baby's plight, decided to take her home and is now in the process of adopting her. "The [orphanage] doesn't have the facilities to care for really sick children and Miriam was very sick," said Ritskes. "It would have been a death sentence."

Ritskes, who has run a community development organization in Phnom Penh since 1991, is setting up a volunteer network of foster parents for HIV-positive orphaned infants to keep them out of instutitional settings like the Nutrition Center. The move comes out of frustration after previous attempts last year to set up a hospice for children with AIDS were met with chilly responses, she says. Proposals sent to foreign embassies and bigger aid organizations were uniformly rejected, she says, one calling it "non-sustainable," another replying they only funded projects that were "success" stories. "Nobody wants to fund these children," said Ritskes. "They're throw away kids."

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