Holistic models of care for HIV-positive children are almost non-existent in Ethiopia. In an area south of the capital with a high prevalence of of virus that can lead to AIDS, one school is an exception.
It's early morning in Shashamane, 250 kilometers (155 miles) south of Addis Ababa, and children are joyfully running through the gate of the Yawenta Center. Before classes start, they play in the green compound, greeting their teachers as they make their way into the main building. But this place is far from a regular Ethiopian school. Here, free alternative education and medical support is provided to over 100 vulnerable children. About half of them are HIV-positive.
"The project was initiated right when the government started to make the anti-retroviral treatment available to children," says Berenice Morizeau. The French woman took over the center six years ago and runs it with over 20 local staff, with whom she converses in fluent Amharic.
"The idea was, yes they are getting the free medication, but if they don't get proper food and hygiene support, it's not going to work. They would still be exposed to a lot of opportunistic infections. Then, because they are children, you also have to add education."
The center is recognized as an official school, and is largely inspired by the Montessori system. In addition to the core curriculum, children choose activities ranging from music to sports or sewing. Over the last few weeks, a well-known local artist has been coming to the center regularly to give singing and guitar lessons.
Ras Kawintesseb is a member of the city's famous Rastafarian community. As the school day starts, children sing to his acoustic guitar with a contagious enthusiasm. In the meantime, older pupils are busy building boxes out of wood, which they proudly show off as they near completion.
According to Berenice, these practical skills will bear a multitude of advantages for their future. "They're not all going to reach university, we know it already. It's extremely difficult for these children with the background they have to even reach high school, which is our basic aim. So giving them basic practical skills will work for them in different ways, whether they drop out of school and have to find a job, or whether they become doctors or engineers. They will have better opportunities to get integrated into society through this general knowledge."
Aids in Ethiopia
It is difficult to gauge the current prevalence of HIV in Ethiopia, especially since testing campaigns have had issues with data collection. But according to the Joint United Nations Programme on HIV and AIDS (UNAIDS), 690 000 people were living with the virus in 2018, about one percent of the adult population. Shashamane has a particularly high proportion.
"It has been taboo for years. In Shashamane, there is definitely a bigger ratio of people living with HIV, the simple reason being that it is the major crossroad for the southern region. There are a lot of truck drivers, a lot of prostitution, and some military camps. These are known as groups at risk for HIV," Berenice explains.
Keeping the children healthy is the main priority at Yawenta Center. Lessons about good hygiene practices as well as bathing sessions for younger children are provided on a regular basis. Two meals and two snacks are served every day. After breakfast, Misa Bekele, the head of the health department, makes sure the children take their anti-retroviral treatment. Colourful cups await, lined up on the table, while Misa takes note of the absentees. In a quiet routine, the children swallow their pills before running back outside. Ideally, they have to take them twice a day. But at home, it can be hard for them to stick to the routine.
"Some children have no mother, or their father is working, so they forget. As a result, the CD4 cell count decreases and they get sick," says Misa. CD4 cells, which play an important role in the immune system, are attacked by the HIV virus, which can ultimately lead to AIDS. "But even if they don't get the medicine at home in the evening, at least we are sure that they always take it the morning."
In very disadvantaged families, neglecting behaviors are common, which puts HIV-positive children at particular risk of health issues or stigmatization. Most Yawenta pupils come from very abusive backgrounds, with some having gone through traumatic experiences. Some of them are orphans.
The center provides psychological support in various forms. Disclosure sessions, in which younger children learn about their illness and how to cope with it, are especially crucial. "It's very difficult to let someone know that they are HIV positive. We have to gradually explain them that there is a virus inside their body and that they have to take the medicine in order not to be exposed to other diseases," Misa says.
Group sessions are also a way for the children to deal with emotions or address important topics such as money or death. Today, 14-year-old Eyob shares a memory of bad anger-management with his peers. He enjoys these talks, where he doesn't feel judged.
"We were consulting each other about what to do in difficult times, when we feel stressed or unhappy. Here we are not afraid to share because even if we did something bad, although it's a secret, we will not get punished and so the others can understand what happened," he says.
A model for Ethiopia and beyond?
Despite the financial challenges, Berenice sees the Yawenta Center as a potential model for the country. In Ethiopia, projects aimed at HIV-positive children are still rare and mostly very one-dimensional. This needs to change says the French woman who lost her heart to the East African country. "They come here every day and receive that attention from us, which they wouldn't get at home. We take them from a very young age and set goals for them - we want them to learn and we want them to succeed. This in itself is a great change in their lives, because a lot of parents are in such a difficult situation that they're just trying to keep their heads above water." In the long run, she wishes to open similar centers in other cities and see the approach expand to the entire country and beyond.