Children of the Epidemic

A Doctor Nurtures a Growing Flock of AIDS Orphans

IRKUTSK, Russia (Aug. 13) --  Alexandra Denyak, head of the Children's Department at the City of Irkutsk Hospital for Infections, looks like that stern third-grade teacher who terrified you when you first entered her class. That is, until she starts to walk you through the hospital ward that is home for 23 HIV-positive orphans, all of them in Denyak's personal care. Once she sees the babies her face is filled with a broad smile. She picks up child after child, raising them high in the air, and giving each a kiss. They reply with giggles and grins.

We had received an e-mail from the Red Cross in Washington, D.C. suggesting that we visit the Russian Red Cross office in Irkutsk to see the good things they are doing, with American help. The local director, Liubov Ivanovna, received us warmly and took us to Denyak's ward in an Irkutsk hospital built nearly a century ago by a wealthy merchant. Located on the outskirts of the city, the three dilapidated buildings that on first sight seem to be have not been in use for years. But inside these buildings were a beehive of activity. They house the city's AIDs wards and a clinic for testing people for HIV.

The AIDS virus has come to Siberia in a sudden rush since 1999. In 1998 there were 26 reported cases of HIV-positive people in Irkutsk. All were drug addicts. This year Irkutsk has 10,406 confirmed cases. No one here was prepared for this epidemic. Alexandra Denyak knows that perhaps better than anyone in this old city of a million residents. When the first HIV positive babies appeared in her ward two years ago, "we were in shock," she said.

The shock of her colleagues was even greater. Denyak was willing to work with the AIDS babies from the beginning, but for eight months, she worked alone. No other doctor or nurse was willing to handle the first AIDS babies, she said.

The shock began at the city's "birth homes," clinics where babies are traditionally delivered in Russia. When blood tests showed that newborns were HIV positive, the staff panicked, Denyak said. They sent the babies to her ward immediately, sometimes when they were just a few hours old. The mother typically refused to take the baby, making it an orphan. Several others on Denyak's ward were simply abandoned; one was left in a dumpster.

After two years, other doctors and nurses have learned that they can handle these babies without danger to themselves. Caritas, the Catholic charity, has made significant contributions of equipment and clothing for the infants. A new AIDs ward has been regularized, made part of the normal routine of the hospital.

Irkutsk is in the grip of a drug epidemic, which has contributed to a surge in the number of HIV-positive citizens here. Hashish has been prevalent here for years, but in 1999 heroin appeared, and quickly caught on with the city's disaffected, often unemployed young people.

In the beginning, Denyak said, it looked like all the cases came from addicts sharing needles. But recently some of the babies were born to women who did not use drugs, but had sexual relationships with men who did. She fears this is an early indicator of a wave of HIV-positive babies still to be born.

Denyak and two nurses dress some of the children to take them for a walk outside in strollers. She has a hug, a tickle, a warm word for every baby. She is proud of the ability of her team of doctors and nurses to take care of these children, even as she acknowledges anxiety about the future. And, she says, there is no place for these babies to go in Irkutsk when they are toddlers, or older children. The city desperately needs an AIDS center, said the Red Cross's Ivanovna, which supports Deniak's clinic, "but there's no money."

According to Inanovna, Denyak lives at the hospital, and is with the babies around the clock. How is she compensated for her efforts. "We work for ideals, not for money," Denyak replied. Her salary is 2,000 rubles a month, or about $70. Her nurses make considerably less.

She worries that the babies don't get enough attention from adults. Whatever they get in the ward is all they get, she observed: "home is home, after all." But it isn't the sort of attention real parents give their children.

While showing visitors around the neat and clean ward, she repeatedly noted the generosity of Caritas, the Catholic charity, which has bought clothes for the babies and a lot of equipment. The American Red Cross gives basic foodstuffs, which Denyak said were invaluable. Ivanovna said it was "embarrassing" that the Catholics were so generous, and "our Orthodox church does nothing. We asked for help. The priest said, 'These children were born in sin. We cannot help them.'"

Denyak is encouraged that some of the babies have managed to defeat HIV themselves and had tested negative (a regular occurrence for a minority of babies born HIV-positive), indicating they had escaped the threat of full-blown AIDs. "I just hope that 60-70 percent of these children won't come down with AIDs. For the ones that do I hope our hospice will be built soon to provide them to live their short lives in good conditions."