By focusing on treating HIV positive caregivers, the young international charity, Absolute Return for Kids (ARK), has ensured that almost 16 000 South African children grow up with their parents rather than as orphans.

ARK has rapidly expanded in the Western Cape and KwaZulu-Natal over the past two and a half years, currently treating almost 12 000 adults with anti-retrovirals (ARVs). Close to 8 000 of these are the caregivers of children, translating into 15 933 children being able to grow up with a biological caregiver.

‘€œOur main aim is to reduce orphanhood or the risk of orphanhood,’€ explains Dr Ashraf Grimwood, executive director for ARK in South Africa.

ARK is also busy expanding its antiretroviral (ARV) treatment programme for children, currently treating almost 400 children in KwaZulu-Natal (KZN) and 968 in the Western Cape.

ARK only works in public health institutions, introducing to the system doctors and nurses with HIV/AIDS expertise as well as pharmacists. A key element is to not poach staff from the already overburdened public health sector. ‘€œWe have brought a lot of nurses out of retirement,’€ Grimwood adds.

ARK also works hard to enable ARVs to be available at primary health clinics, where it believes the likelihood of patients adhering to their drug regimen is higher.

‘€œYou need to be at community level, where [the clinic] is close to where the patient lives, referring only the more complicated cases to tertiary level’€ explains Grimwood, adding that the nurses will need doctor and pharmacist support.

Maud (who does not wish her surname published), who lives in the Western Cape, encapsulates the experiences of thousands on the ARK programme.

The 31-year-old mother of three girls ‘€“ aged 3, 9 and 11 ‘€“ fell ill after her youngest was born. Her health continued to deteriorate. In 2004 she was referred back to the hospital as she was constantly tired, suffering from shingles and had lost her sight. Blood tests revealed she was HIV-positive.

As the primary caregiver for three young children, she qualified for ARK’€™s ARV treatment programme and within two months her shingles were healing, she had regained her sight and was less tired.

None of her children are infected, but her illness has left her unable to care for them. Her mother and sister have been helping the family to survive.

In spite of her situation, Maud is positive about the future and believes she will soon be well enough to work again and care for her family.

‘€œTreating adults is about children’€™s rights,’€ says Sonja Giese, Director of the Child Services Programme at ARK.

Giese and co-director Mokgadi Malahlela have been working tirelessly to establish the Child Service Programme in initial pilot sites in Nongoma and Nkandla in rural KZN and in areas around Cape Town.

In its simplest terms the programme involves offering more direct social support to vulnerable children in AIDS-affected communities.

A schools project is being piloted through eight schools in KZN and has been key in facilitating social grant access, access to birth certificates and identity documents, and feeding schemes that run seven days a week and 365 days a year, feeding over 3 000 children.

The programme was started with the help of the Media In Education Trust, a non-governmental organization that had been active in the Nongoma schools for two years already.

Giese said a key element has been the co-operation received from the departments of education, home affairs and social development.

A recent ‘€œjamboree’€ at a KZN school saw 500 grants and 700 birth certificate and ID applications processed.

‘€œIn terms of the Child Services Programm,e we are trying to find things that can have impact at a large scale. Something that is also in line with government policy,’€ explains Giese.

Malahlela has been driving the programme in Crossroads, Nyanga and Lower Crossroads outside Cape Town, working via the community care workers. Working with another organisation, Etafeni, ARK has also helped children to access birth certificates and social grants.

The children’€™s immunization records are updated, food parcels are distributed to those families waiting for grants. The programme is also an important roleplayer in negotiating the return of children to school and buying school uniforms.

Giese says it is important to ensure that whatever is introduced to the community is sustainable. ARK is currently in the process of establishing sustainable food gardens at schools, sinking boreholes, erecting water tanks, building a counseling room for child rape survivors and a kitchen to prepare food for the feeding scheme.

‘€œWhatever infrastructure is left behind will have to be maintained by the education department and staff appointments need to be aligned with current or pending government policy,’€ says Giese.

The programme will soon be expanded to include another 24 schools in KZN and Western Cape with the plan to eventually introduce it on a national scale.