NAIROBI, KENYA — Susan Awino will never know her mother, and her father is a stranger.
When the now chubby-cheeked infant arrived here seven months ago, she was too weak to crawl. Her father, diagnosed as HIV-positive, was too ill to care for her. Her mother, also diagnosed with AIDS, died shortly after giving birth.
Susan's temporary home has been one of 14 wooden cribs crammed into a gray room at the Dagoretti Children's Center in Nairobi. And her story mirrors those of her cribmates. But it's also a testament to heroic efforts - often funded by American charities - to tackle one of the most devastating trends sweeping Africa: children orphaned by AIDS.
Before the AIDS epidemic began, about 2 percent of children in developing countries were orphans; now, in the African countries hit worst by the disease, one child in 10 is an orphan, the UN estimates.
The social earthquake caused by AIDS has shaken Africa so much that traditional family customs are breaking down. Until the 1990s, extended family members took in most children whose parents had died. But with the huge increase in the number of orphans plus the stigma of AIDS, that's no longer the case.
Some of the children in the orphanages being built in response to the crisis had parents who died of AIDS-related illnesses. Others were brought by an HIV-positive parent who assumed that either they or the child - or both - would soon die. Some were simply abandoned. "Fewer and fewer relations are willing to take in orphans," says Roselyn Mutemi Wangahu, who led a study of AIDS orphans in Kenya for UNICEF.
The study found that AIDS orphans taken in by relatives tend to be treated as second-class members of the family, discriminated against in everything from schooling to food, sometimes abused, and often forced to work. While most people who answered study questionnaires said orphaned children should be cared for by relatives, most family members caring for the AIDS orphans admitted in focus-group interviews that they preferred institutionalizing the children.
"They've realized they are not able to cope anymore," says Ms. Wangahu.
Poverty - made more desperate by the cost of AIDS medical treatment and loss of income because of AIDS-related illnesses - is testing the strength of family ties. The result is an increase in children's homes like the one where Susan Awino lives. New orphanages are being built, and existing ones are expanding.
Last month, the New Life Home, which opened in 1994, added a new wing, doubling the number of beds available. Earlier this year, the group created what it calls a rescue center for abandoned babies in the western Kenyan city of Kisumu. It plans to open more in other parts of the country, where the HIV-infection rate is high, says Clive Beckenham, New Life Home's director. Nairobi's two other homes for AIDS orphans are full.
Today, the Oklahoma-based charity Feed the Children will open its Frances Jones Abandoned Baby Center, a new home for the youngsters who have until now shared the crowded room at the Dagoretti Center.
The new $300,000 facility was built through private donations, almost entirely from the United States. Forty new wooden cribs stand ready in four bright, clean rooms. Schedules are posted on the walls for the "housemothers," hired to give the children food, hugs, and stimulation. "If we promoted this facility today, we would have it full tomorrow," says Ian Harris, international director of Feed the Children. "We haven't advertised this center at all, yet we've had offers from Mozambique, Zimbabwe, and South Africa to do the same thing there, because it's a huge need," he says. "It's something I don't think governments have come to terms with."
International Children's Care, a Washington-state based relief and development organization, is building five orphanages near the Zambian copper-mining city of Ndolo. Gospa Missions, a missionary group based in Pennsylvania, is raising funds for a new orphanage in Ogoja, Nigeriaj. And the AIDS Orphans Education Trust, a nongovernmental organization in Jinja, Uganda, is doing the same there.
Orphanage staff don't consider their beds to be long-term solutions for the children. All are looking for foster arrangements, adoptive parents, or even family members willing to claim the abandoned children. Plans for the Frances Jones Center include a community outreach program focused on HIV prevention and finding homes for the children.
Children who are given up by HIV-positive mothers at an early age have a strong chance of overcoming their prenatal past, say medical experts. While children born to infected mothers often test positive for HIV in infancy, they may not have contracted the virus, but are simply carrying some of their mother's viral antibodies, causing a positive test. Transmission of HIV is considered more likely to occur after birth through breastfeeding than during pregnancy.
More than 90 percent of the 260 babies brought to the New Life Home for infant AIDS orphans in Nairobi have eventually tested negative, says Mr. Beckenham.
Meanwhile, housemothers like the Dagoretti Center's Maria Njoki Kimeu count their victories one at a time. "When Susan came here [in January], she was not very happy," Mrs. Kimeu says. "She was thin and not all that healthy." Today, Susan is a playful, curious toddler with a glow in her cheeks.
"I have to give these babies love and care and support," says Kimeu, whose two children are adults. "We have to give them the love we would give our own babies. This will give them a good start in life."
Tomorrow: A South African treatment program for mothers diagnosed with AIDS.