Six months old and healthy, she has never left the hospital where she was born.
She tests positive for antibodies to the AIDS virus.
The infant, born at D.C. General to a drug-addicted mother who also carries the AIDS virus, is one of a growing number of hospital "boarder babies" whose parents abandon them or are unable to care for them. These babies must stay in the hospital nursery indefinitely until they can be placed with other relatives or in increasingly scarce foster homes.
The growing number of boarder babies is directly related to the rising number of births by women infected with the AIDS virus through intravenous drug use or sexual relations with an infected partner.
But in the next week or so, the little girl will finally leave D.C. General for a new home. She is the first child to be placed in the first District group home set up specifically for abandoned babies and young children who test positive for human immunodeficiency virus, or HIV, the virus that causes AIDS.
"She's an alert, cheerful, warm baby," said Joan McCarley, program director for Terrific Inc., which organized the new home. "But nobody wanted to take her home."
Terrific Inc., which will run the home under contract with the District's Commission of Social Services, is a private nonprofit organization that helps provide housing for senior citizens and the developmentally disabled and others who are often discriminated against or left out of the conventional housing market. The name is an acronym for Temporary Emergency Residential Resource Institute for Families in Crisis.
"We are trying to help abandoned children who are also caught in a health crisis," said Debbie Tate, founder and president of Terrific Inc. Not only do such children lack the nurturing influence of a family, she said, but they may suffer from the double stigma of being identified with both drug addiction and AIDS.
The new home, called "Grandma's House," is in a restored five-bedroom Victorian house in the Logan Circle area in Northwest Washington. Officials asked that the exact location not be disclosed.
The home is called "Grandma's House," Tate said, because in broken families "grandma traditionally has been the stabilizing force, the one who steps in to provide the piece that's missing." It will be staffed by a live-in homemaker, a 40-hour-a-week caretaker, with additional part-time help arranged by Terrific.
"Grandma's House" has room for four children under the age of 6. The first children -- including the 6-month-old girl from D.C. General -- are expected to be transferred to the home from area hospitals next Tuesday, Tate said.
The house was purchased by Terrific late last year, with a $60,530 loan under the District Department of Housing and Community Development's congregate housing assistance program (CHAP) program, a bank loan, foundation grants and private donations. Several area department stores have expressed a willingness to donate furnishings and decorations.
First-year operating funds of about $240,000, including some start-up costs, will come from the District's Commission of Social Services and private donations.
It is not clear how many of the HIV-positive babies will actually come down with AIDS. What is clear is that finding a home for them is extremely difficult.
"People are reluctant to take them in because of fear of the disease itself, worry about health care needs, and the possibility of the child dying of AIDS," Tate said.
Dr. Reed Tuckson, the District's Commissioner of Public Health, praised the opening of "Grandma's House" as a "humane and compassionate step" by the community.
The problem of boarder babies in the District is growing, but it is dwarfed by the dimensions of the problem in New York City, where one of every 61 babies born last month tested positive for antibodies to the AIDS virus.
"I don't want to see this city reproduce the terrible experience New York is going through," Tuckson said. "We cannot turn our back on these boarder babies."
In Washington, said Janice George, a social worker at Children's Hospital, "we're just starting to see them in substantial numbers. But with more and more cases of pediatric AIDS and given the nature of the families they are often born into, we're going to need more and more alternative facilities or foster homes."
Most boarder babies have no symptoms of AIDS. Many have some medical needs -- usually related to withdrawal from a drug or alcohol addiction in the mother -- but can be easily cared for at home if a home were available, George said. Precise statistics on the number of HIV-positive babies born in the District are not available. Health Commissioner Tuckson said there are "at least 100" HIV-positive babies under the age of 2 in the District, and social workers in the Commission of Social Services have come across about 190 HIV-positive babies in District hospitals.
How many of those babies are actually infected and at risk of developing AIDS is not known. In some cases -- half or more by some estimates -- an infant's positive result on the HIV test merely reflects the presence of antibodies passively acquired from the blood of the mother, rather than antibodies produced by an actual infection. In such cases, an HIV-positive infant may turn HIV-negative when it develops its own antibodies -- usually within six to 12 months after birth.
In the District, 10 cases of AIDS in children under 13 have been reported, according to the Office of AIDS Surveillance in the District's Commission of Public Health. Six of the children have died. Of the 10 children with AIDS, three were infected by blood transfusions before blood donations were screened for HIV, and the other seven were infected in the womb or at childbirth.
Some HIV-positive babies, abandoned by their parents, have ended up staying in pediatric hospital wards for weeks or months because they could not be placed in a foster home, said Dr. Wayne Greaves, chief of infectious diseases at Howard University Hospital.
Not only is that a waste of hospital resources, Greaves said, but the hospital is not a stimulating environment for a child to grow up in. "A home where someone will care for these babies is preferable to keeping them in the hospital," he said.
A team at Children's Hospital is following 35 HIV-positive children ranging in age from a few months to 9 years, social worker George said. Most of those children are living with one or both parents or with other relatives. Four have been placed with foster families. One is at the Gift of Peace house run by Sisters of Charity in the District. Another is still in the hospital, awaiting placement.
Damien Ministries, which runs two homes for adults with AIDS in the District, hopes this year to open a third that will accommodate older children and teen-agers with AIDS, said Lou Tesconi, executive director.
The Whitman-Walker Clinic runs six houses in the District for people with AIDS, including a six-unit apartment building that is available to parents with children.
"An orphan who is HIV-positive is obviously very hard to place," said Jim Graham, director of the Whitman-Walker Clinic, which has led the community's response to the AIDS crisis in the District.
"You're still dealing with a tremendous amount of fear in the community, and foster parents are very reluctant to take an HIV-positive baby," said George Baker, a social worker and chief of foster care and continuing services for the District's Commission on Social Services.
With the pool of foster homes already drying up in the past decade because fewer married women stay home, Baker said, it's hard to place any infant, let alone one who may have withdrawal symptoms because of its mother's drug addiction and is at high risk of developing AIDS.
So far, Social Services has been quite successful in placing most of the HIV-positive babies with a parent, grandparent or other relative, Baker said.
"But we're about at the breaking point." Despite the best efforts of the pediatrics staffs, Baker said, hospital nurseries are no match for a family home as a stimulating environment for a newborn.
Babies who stay in the nursery too long may suffer a delay in development, even if they convert back to HIV-negative and are no longer at risk from AIDS, Baker said. What's more, a long stay in the hospital may unnecessarily expose a baby to other infections.
"Hospitals are filled with disease," Baker said. "That's why we have them."
The new "Grandma's House" project gives abandoned babies a healthy home while social workers continue to try to place them in a foster setting or reunite them with their families if that is feasible, Baker said.
"We've got to get these children out of the hospital," he said. "This gives us two options."