Bec Sompoa was about 18 months old and severely malnourished when she joined our nutrition programme in 1995. We were used to seeing skinny, sickly children returning to good health after just a few weeks of treatment and good food. Sompoa’s mother was a very good mother and really took the health lessons to heart, but Sompoa did not improve. We thought she must have tuberculosis and treated her. We saw a slight improvement that did not last. It was early days for AIDS in Cambodia, and although we had started an HIV and AIDS community education programme, we had not yet seen anyone infected with HIV.
After trying everything for Sompoa, we reluctantly discussed testing her and her mother for HIV. Anxiously we awaited the results: they both returned HIV-positive. At our next team meeting we wept, knowing this would be the beginning of a rapid increase of cases in both adults and children in Cambodia – affected, infected or dying of AIDS.
Rapid rise in children infected with HIV
The effects of HIV and AIDS have devastated the lives of millions of children around the world. The disease attacks families, communities, schools, health-care and welfare systems and national economies. Children were once considered fairly safe from HIV and AIDS. It was also thought that, once infected, they would die quickly. Little thought was given to their unique vulnerability. But today, over half of all new infections are in young people – their bodies are less resistant to the disease. Infant and child death rates have risen sharply. Nearly 3 million children around the world are now infected with HIV. Girls are hit harder and younger than boys.
Most of these children (more than 90%) become infected with HIV from their mothers. Babies may get HIV during pregnancy, delivery or through breastfeeding. The other 10% of infections are as a result of contaminated blood transfusions or blood products, the use of contaminated needles and syringes, sexual abuse or exploitation.
Children with HIV are very likely to become seriously ill from common childhood illnesses. The prevention of common childhood infections through immunisation, good nutrition, prevention and early treatment of infections is vital to improve their quality of life. Children with HIV, who show no symptoms of HIV infection, should receive all childhood immunisations at the recommended age. Children who show symptoms of HIV infection or AIDS such as skin infections, pneumonia or skin cancers should also be given childhood immunisations, but should not be given BCG (for tuberculosis) or yellow fever. They should have an extra dose of measles vaccine at six months of age, as well as the one at nine months of age. Polio vaccine should be given as an injection.
If children do not have access to anti-retroviral (ARV) treatment, HIV usually progresses rapidly, with nearly half of infected children developing AIDS and dying within the first two years of life. However, with good care and nutrition, children can live longer and healthier lives. Some children are now surviving into their twenties and are having children of their own, particularly in wealthier countries where good care and ARV treatment are available. Many deaths can be prevented by early awareness and the correct treatment of other illnesses. Children dying of AIDS should have access to adequate pain relief and drugs to treat diarrhoea and chest infections.
Women who know they may be at risk of sexually transmitted infections, including HIV, should be advised to use condoms at all times during sex, unless they want to become pregnant. Many Christians are very unhappy at this suggestion. For women at high risk, however, condoms provide protection against infection, death and an orphaned family. The church and Christian agencies need to be involved in raising awareness of these issues and encouraging men, especially, to change high risk behaviour.
Supporting children orphaned by AIDS
Children living in families affected by HIV suffer many social, economic and psychological problems. Many will become orphans. Worldwide, there are currently an estimated 15 million children under 18 who have lost one or both parents to AIDS. Medical care is certainly not enough to provide effective support for these children and their families. They will also need other help. Thought must be given to emotional, spiritual, social educational, and legal needs such as inheritance rights. When parents are infected and ARV treatment is not available, families and children need to discuss together where the child will live in the future. Ongoing support is needed to make sure these wishes are followed.
Responses to HIV and AIDS in Cambodia
Servants, a Christian organisation, is making an integrated response to the AIDS crisis in Cambodia (where 2.7% of the population are infected with HIV). We have a Peer-to-Peer education programme where young people share information, understanding and support with other young people. We also have a Home Care programme that trains families and community workers to care (physically and spiritually) for people with HIV. Over 500 benefit from this care.
Project HALO (Hope, Assistance and Love for Orphans) works with more than 600 children of parents who have died or are dying of AIDS. This project provides counselling and care within the extended family or surrounding community. It ensures that such children are kept off the street and out of orphanages. All children are helped to attend school or vocational training and their rights and inheritance are respected. HALO also runs clinics for babies born with HIV.
Local churches are involved as much as possible. Church members provide most of the Home Care workers and the youth volunteers who act as ‘big brothers or sisters’ to orphans. They befriend orphaned children, talking and playing with them and taking them on outings. All this work is integrated into wider programmes for community nutrition, immunisation and general healthcare. Our goal is to show love of Christ in the midst of a devastating pandemic.
Children and young people are at the centre of the HIV and AIDS crisis. They also offer the greatest hope for defeating the epidemic. They should be central to plans to halt the spread of AIDS – through education and full participation in discussions about their own future.
Kristin and Susan Jack work with Servants to Asia’s Urban Poor, Cambodia. Website: www.servantsasia.org E-mail: firstname.lastname@example.org