Caring for children affected by HIV

New Life Home in Nairobi, the Kenyan capital, has 51 abandoned HIV-positive babies under the age of two at its main centre, while several other satellite homes around the country care for older children. These are the lucky few. "We take in infants between zero and six months old. This is the group most at risk of dying from illness or malnutrition," Mary Beckenham, director and founder of the home, told Plusnews. "We give them formula milk when they are very small, and introduce fruits and vegetables later on. They all take vitamins every day." According to the United Nations World Health Organization, HIV transmission through breastfeeding may be responsible for one-third to half of all infant and child deaths in Africa. Breast milk alternatives are recommended for HIV-positive mothers, but for millions of African women, substitutes such as formula and animal milk are too expensive, and even when they can afford them, babies are at risk from diarrhoeal, respiratory or other infections caused by contaminated water or dirty bottles. Children often "carry their mother's antibodies, and therefore test HIV-positive at first, but this is a false positive - after several months, when the child is between nine months to a year, we test them again and, most times, they test negative," Beckenham said. "More than 90 percent of our babies who initially test positive later turn negative." The home provides treatment and closely monitors babies who remain positive with the help of three volunteer paediatricians. "If they are HIV-positive and healthy, we leave well enough alone, but if they start getting sick, we put them on antiretroviral [ARV] drugs after a viral load test," she said. New Life has an 80 percent adoption rate for its babies. It depends on private sponsors for funding and the United States President's Emergency Plan For AIDS Relief (PEPFAR) for drugs. THE OTHER END OF THE SPECTRUM The picture is very different at Amanda Marga Universal Relief Team (AMURT) day-care centre, run by Indian missionaries in a tiny classroom in the crowded and filthy Nairobi slum of Kangemi. Many children have hacking coughs and painful looking skin infections. Counselling, education, meals and healthcare are provided to 20 or so HIV-positive children or those whose parents are bedridden and too ill to care for them. Children who need ARVs are referred to another centre in the same neighbourhood. According to AMURT, one in seven people in Kangemi are HIV-positive. "Many of the children who come here are so poor that the food they eat here is the only food they will eat all day," said Irene Njoroge, programme manager at the centre. "We give them porridge in the morning, ugali [maizemeal porridge] and milk. When children are on the ARVs they get even hungrier than usual, but we don't have the finances to give them as much food as they need and at home they have nothing." AMURT also gives pasteurised cow's milk to HIV-positive mothers until their babies are a year old, but at present can only do so for 22 women. For many others, the choice is stark - they must breast feed at the risk transmission or watch their child starve. Faith Thuita, project officer for maternal and child nutrition at the United Nations Children's Fund (Unicef) in Kenya, said one of the main problems was a lack of counsellors trained in HIV and infant feeding. Unicef is working closely with the Ministry of Health to develop policy guidelines, so health centres can make Kenyan mothers aware of the available feeding options.