By Matt Kelly, MD, MPH, David N. Pincus Global Health Fellow
As the Africa fellow for the David N. Pincus Global Health Fellowship, I split my time between Princess Marina Hospital in Gaborone, Botswana, and Sparrow Village — an orphanage in Johannesburg, South Africa. Looking back on my time in this fellowship and in these countries, I am most struck by the devastating effect that HIV has had on the region’s children.
On the wards of Princess Marina, I am constantly surprised by the number of children cared for by grandparents, aunts and uncles, or even family friends, as well as by the number of HIV-infected mothers who are too ill to support their families. Similarly, the impact of HIV on family life in South Africa is clearly evident at Sparrow Village. The orphanage, originally founded to care for a relatively small number of HIV-infected individuals, has since transformed into a home for more than 260 children orphaned by HIV/AIDS.
However, I am also encouraged by signs that the HIV epidemics in these countries are stabilizing, and that steps are being taken to ameliorate the effect of HIV on children. Botswana has implemented a model program to prevent mother-to-child transmission of HIV, markedly reducing the number of perinatally infected children, while providing those children who do acquire the virus access to a growing list of antiretroviral medications. Similarly, the care that Sparrow Village provides to HIV-infected children has changed remarkably since antiretroviral medications became available in South Africa. Perhaps the most visible reminder of this is an old tree in the main lobby of the orphanage on which a small, brass sparrow is nailed in honor of each child who dies of HIV at Sparrow Village. While the overall number of sparrows is staggering, the vast majority are from the pre-HAART (Highly Active Antiretroviral Therapy) era, when the facility functioned as a hospice for children with AIDS.
With lifesaving antiretroviral medications, Sparrow’s children are now surviving into adulthood, and the orphanage has moved from providing short-term care for terminally ill children to supporting health and development throughout childhood. Many of Sparrow’s HIV-infected children are now adolescents and are struggling to understand what it means to grow up with HIV — how they should approach relationships now and how they will transition from school to work and start their own families. This must certainly be one of the most profound examples of how far our ability to treat pediatric HIV has come; children who until recently would not have lived more than a few years are now thinking of a day when they might have children of their own.
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