ADDIS ABABA, Ethiopia -- The young mother sat in the orphanage waiting room, a baby playing in her lap. At 22, Adelaw Astake had become so gaunt from illness that her dirty skirt was wrapped twice around her narrow frame and held up at the waist with rags.
She was there to ask a dreadful favor.
Wosene Maru cares for orphans whose parents have succumbed to AIDS. "They are still just kids," she said. "I know they don't have anybody."
(Photos Emily Wax -- The Washington Post)
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"I am dying," she told Addis Tamrat, the manager at Hope for Children International. "I want my child here at your place. He is too sick and no relatives will take him in."
The baby, 15-month-old Sintayenu, had a purple lesion on his forehead. He had recently come down with pneumonia, and weight had been pouring off his body. He had not been tested for HIV, but Astake knew, and so did her older son, who is 6.
"He's been kicking the baby, saying he doesn't want to catch the virus from him and get sick and die like me," Astake said.
The fate of Astake and her infant son are part of a quiet calamity affecting hundreds of thousands of Ethiopian mothers and children. Although the country's overall infection rate of 4.4 percent for HIV/AIDS is far lower than those in countries such as South Africa and Zimbabwe, it has the highest rate of HIV-infected children in the world, according to a United Nations report issued in December. More than 200,000 Ethiopian children are living with HIV/AIDS, the U.N. report said. Every day, 70 babies are born from HIV infected mothers, and the Ministry of Health estimates that 750,000 children are without parents because of AIDS.
Poverty and cultural taboos are largely to blame, health workers and government officials said. The society deeply shuns those living with HIV, and several landlords are in court in the capital for evicting HIV-positive tenants.
Poor mothers often breast-feed their children, thus transmitting the disease, because they can't afford bottled milk or are ashamed to acknowledge their illness. When Tamrat gently prodded Astake about how her baby had become sick, the young woman said she had not realized she had the virus until she was diagnosed with tuberculosis several weeks before.
"When I was pregnant, I didn't know I had HIV," Astake said. Tamrat asked whether, once Astake had been told, the nurse had explained that she should stop breast-feeding to protect her baby.
"She did," the mother mumbled as she rocked Sintayenu, who was crying.
"Were you able to stop?" Tamrat asked. "Be honest with me."
"I kept going," Astake said, folding a hand over her eyes. "I thought my lady neighbors would know. They would say, 'Why aren't you feeding? What is wrong with you? Are you HIV-positive?' Also, I can't afford the cans of milk. It's too much."
UNICEF and Ethiopian donors pay for milk for 35 HIV-positive mothers. For Astake, Tamrat took change from her own purse and sent the mother to the shop next door, telling her to be sure and spend it on milk.
"Society is slow to change," she said. "Meanwhile, it's our children that are suffering."