Kasisi Children's Home currently has sixty (60) children living with the AIDS. Of this number only thirty-five (35) are on Antiretrovirals (ARVs). The remaining  twenty-five (25) children still have relatively high CD4 count.

The eldest child living with AIDS at Kasisi Children's Home is sixteen (16) years, was brought at the age of three (3) months. As at that time,  not much about HIV/AIDS was known the only treatment this child used to receive were different doses of Antibiotics. It was not until the early 1990’s, that the she took an HIV test and was found to be HIV positive.  Since then, the Home made a policy  that all new children accepted would be tested for HIV.

In 1994, a new wing of babies was opened with the vision of providing total care, love, hope, and education to the children living with AIDS. The house, called House of Hope, has a capacity of twenty (20) beds for children aging from zero to three (0 - 3) years old. For children from the age of four (4) years and above, there is another wing called St. Martins house.

The "Where from" of Children at Kasisi
The children at the Home come from all the different parts of Zambia, and with varying reasons. There are families (extended, spouses that have lost a partner) that due to extreme poverty, as they do not have the strength or means necessary to bring up a baby, and have had no recourse but to bring the babies to the Home.

Children also come through other agencies. These are mostly social welfare department, non-governmental organisations, police, victim support unit, and  local communities.

"Children who are HIV positive have no time limit of staying with us, which means they can stay with us until death. With this type of children, family members are often not willing or able to take care of them at home, so we take care of them because of their status. In case relatives wish to take them home, we allow them to do so. The problem we have had in the past when discharging HIV positive children is that in all cases the children we have discharged have come back in a very bad condition - with sores all over the body, visible weight loss, etc. This has discouraged us from discharging them, because it becomes a great suffering for the child and later for the staff. We however encourage the relatives to visit the children and take them home for short periods of time. They are also advised on how to care for the child at home, and to bring the child for treatment when early symptoms of any opportunistic disease become visible."

The Present situation
Administration of Antiretrovirals (ARVs) at Kasisi Children's Home started about four (4) years ago. The drugs were obtained free-of-charge from the University Teaching Hospital (UTH) scheme. The Home, however, had to meet the costs of CD4 count and Liver Function Tests (LFTs).

Before the start of administering Antiretrovirals (ARVs), all HIV+ children at the Home were only treated for opportunistic diseases. The mortality was high, with most children dying before the age of five. This was because the drugs and tests were too expensive, and the Home did not have a sustained Donor for purchase of drugs and hence, did not want to run the risk of discontinuing treatment because of lack of funds.

The situation today, is relatively better, but a lot of challenges still remain.

Today, the Home has put in place several HIV/AIDS strategies, that mostly constitute palliative care measures and counselling. A brief overview is provided below of the measures presently in place at the Home, for HIV/AIDS associated ailments, and indeed other ailments.

Pain
When the child is in pain, the simple measures like giving them Paracetamol or Aspirin are administered whenever they are in pain. In case this step fails, a progressively high dosage of pain killers is used if pain persists. First, codeine is administered progressing to morphine or ephedrine. These drugs are controlled and very difficult to get. It is only doctors who can prescribe and administer such drugs. Sadly, they are often needed when the doctor is not around.

Diarrhoea
Where a child has no fever and no trace of blood in stool and the diarrhoea is not severe, Oral Dehydration Salts (ORS) are provided, and when  a child becomes dehydrated with all those signs of dehydration, intravenous feeding (IV) fluids are administered.  The type of food given is closely monitored until the diarrhoea has run its course. The management of diarrhoea is easy when noticed timely.

Constipation
A lot of fluid intake is encouraged when this condition is observed. However,  this condition is not very common at the Home.

Nausea, Vomiting and Weight Loss
This is very common in children less than two (2) years old, and the problem is mitigated by use of nasal gastric tubes for feeding. For those above two (2) years old, a balanced diet is provided, and where vomiting can not be controlled some anti-emetics are used. Multivitamins are also provided too.

Oral Thrush
For this ailment the Home administers, gentian violet in the mouth once a day for 2 – 3 days.

Fever
Fever can be a sign of secondary infection, and usually efforts are made to investigate and treat the underlying causes. The Home has often used Analgesics for symptomatic treatment.

Drug management
Antiretrovirals (ARVs) are always in stock and kept safely. All children are given drugs by the sister-in-charge, through the office, usually twice a day.

"Actually it is encouraging and uplifting to see the joy these children have as they come to get their drugs. Each one of them knows which drug he/she takes, whenever it is a half tablet or a full tablet and once you purposely try to pretend you have mixed up in giving then they will always tell “no! This is not my medicine.”

 Counselling
The children living with HIV/AIDS receive counselling from the early stages of their life onwards. This is necessary, especially for older children, as it is very hard for them to cope with being sick, having lost their parents or relatives, being in a strange environment, and having to meet many new people – children as well as adults. The Home has trained counsellors to help newcomers adjust, help them in their grief when they lose friends or carers, or cope with illness.

in the dawn of  Antiretrovirals (ARVs)

"It is brightening to see children who were at one time dying now enjoying their life to the full and playing with friends. Almost all of them have responded well to the drugs."

The availability of ARVs at Kasisi Children's Home has to saved many lives. The mortality has gone down compared to the previous years.  In addition, the time spent at the hospital has also reduced, as children on ARVs seem to develop few or no other complications. And indeed, the Home always has medical volunteers at hand.

Noteworthy, is that from the time the Home started administering the ARVs, the children have not shown much complications relating to their illness.

OUTLOOK & CHALLENGES
Today, Kasisi Children's Home has a positive outlook in its caring for children, and in particular children living with HIV/AIDS. This more so because over the years the Home has gathered a wealth of knowledge and experiences. A wealth generated from times of no hope for children living with HIV/AIDS, to times of hope in the dawn of Antiretrovirals (ARVs).

Although there has not been much intervention from the government, there has always been a wealth of individuals in the medical field and other endeavours who have taken it upon themselves to help the children living with HIV/AIDS, and indeed to make the Home independent in HIV/AIDS testing.

Despite these successes in managing HIV/AIDS at Kasisi Children's Home, the Home's overriding challenges of providing adequate nutrition and indeed meeting the costs of administering such a huge institutions still remain.