When Vitou arrived several years ago, he was completely listless, could not lift his head, had huge swollen glands, fever, and a cough. I told our doctor that I doubted if the child could survive. Today he is a busy healthy five year old, on antiretrovirals for HIV, who rides his bike in the yard with the other “older “ kids. No one visiting the Orphanage would identify him, or any of the other HIV infected children as having a serious illness HIV / AIDS is a major problem in Cambodia where levels are second only to those in sub-Saharan Africa, and women and children are those most affected.

Despite an increasing number of treatment programs and decreasing numbers of cases, ENCHADS [The National Center for HIV/AIDS, Dermatology and STDs] estimates that approximately 9,000 children in the country are infected. Only about 2000 have been identified, and only 1, 100 children are said to be on antiretroviral medicines, which can usually control the HIV, and allow a fairly normal existence. [figures from Ministry of Health/ UNICEF/ USAID]. Furthermore, malnutrition massively compounds the severity of HIV, as does the concurrence of other infections, such as TB. Forty five percent of Cambodian children are estimated to be moderately or severely underweight. 670,000 children in Cambodia are thought to be orphans, many as a result of HIV in their parents TSF’s efforts are only a drop in this ocean of misery, but for the children we care for, a very significant drop. At this time, 20 %, or 11, of our orphanage children are infected with HIV, all of whom were infected before birth by an HIV infected mother. Sadly, it is culturally acceptable for husbands to frequent the sex trade in Cambodia where some 40 % of women are estimated to be infected. Husbands frequent this market, become infected, and bring HIV home to their wives, and subsequently, their infants. Some of our children have arrived at the Orphanage very close to death, due to lack of treatment, concurrent infections, and severe malnutrition. Our nannies take on the challenge, and it is amazing how, with high quality nutrition and care, a small skin-and-bones child soon becomes a lively member of our orphanage family.

Our children at the Orphanage take their meds at 8 am and 8 pm, so routinely it causes no comment from anyone. Originally, 4 years ago, we bought the medications through Maryknoll, but since December 22, 2005 the Clinton Foundation has funded all identified and registered children completely for their meds. Most of our children are on a “cocktail “ of nevirapine, lamivudine and stavudine; one child, who has had some resistance, is on other meds. These children are seen every eight weeks by Dr Ung Vibol, head of HIV at National Pediatric Hospital who came to Brown University a few years ago for a HIV fellowship at Hasbro Children’s Hospital. The infected children have blood tests to monitor their CD4 counts and viral load every eight weeks, plus regular liver and kidney screens, paid for by TSF, as it does not come under the Clinton funding.

There is nothing better than to watch our absolutely “normal’ HIV infected kids enjoying very normal childhoods! Three are old enough to go to the local primary school [we have 7 children now in Roteang primary] and it is an education for the Principal and teachers, that all of our children are completely healthy. Roteang Orphanage has become known for its quality of care; two more little unrelated boys, each 2 /12 years, with HIV and developmental delay are being admitted right now. I have no doubt, in the care of their own nannies, each will thrive, get chubby, and develop into a smiling happy kid, with well controlled HIV.