This man has shown that, if managed well, HIV is just a chronic 'mild' disease

To be born, to grow up and to live with HIV as a chronic mild disease.

This, in simple words, is the aim of the Hadassah Paediatric AIDS Centre in Jerusalem, Israel, which "hasn't lost even one child during the last ten years. The children grow up and they live with HIV as a chronic and mild disease".

Making this bald statement at the last meeting, the mild-mannered Prof. Dan Engelhard, Head of the Paediatric Department at Hadassah University Hospital who is also the Director of the Paediatric AIDS Centre in the same hospital (one of the biggest in Israel), offered a novel approach to combating HIV/AIDS ."Art, Joy and Love".

In his lexicon, "Art" stood for antiretroviral therapy, or the treatment against the AIDS virus. "And joy and love is what we give to the children. We combine art, joy and love and give it to the children. This is a routine project for AIDS in children in Ethiopian orphanages. And we have come to see whether we can do the same here."

Prof. Engelhard, who was born in Jerusalem and educated at Hebrew University (he did his Fellowship in infectious diseases in the USA), started his talk by pointing out that one of the biggest obstacles in HIV therapy was adherence.

The patients had to take their medicines every morning and every evening, day after day, month after month, year after year. Only then could they hope to become healthy. But taking medicines in this manner was very hard. A ten-year-old required to swallow innumerable tablets twice a day, found it very difficult to do so.

If attempted in liquid form, the medicine was very bitter, thus making its intake even more difficult. To get over this problem, the hospital had started a "Pill School" where children were taught from the age of four or five years to take pills, sometimes with candies.

Another major problem was the psycho-social angle. Children born with the HIV virus had to live a secret life. They could not go on a trip with other school children, or even stay overnight at a friend.s place.

"The children have to grow in secret. It.s a family disease, because the children get it from the mother. They have a stigma, they have to lie; they cannot tell their friends that they take medication or that they have HIV. Often, they are isolated, feel rejected and suffer a lot of emotional stress."

Prof. Engelhard said these and other issues had to be dealt with to enable children to grow and to live with HIV "instead of dying with AIDS". Hence he decided to set up a multi-disciplinary team to help the children.

You may laugh all you want, but (medical) clowns have helped reduce the mortality rate among HIV-affected children in Ethiopia

Thank you very much for your excellent presentation. President Dr. Rumi Jehangir presents a memento to Prof. Dan Engelhard, the guest speaker at the last meeting

"And I think that's why we have such a successful outcome for our children".

This team consisted of physicians, nurses, psychologists, social workers, pharmacists, volunteers who went to the children's homes every week, a community coordinator (most of the patients were Ethiopians and it was necessary to know their culture), advisers and medical clowns.

Fortunately, HIV in children was not a major problem in Israel. But in the rest of the world the numbers were appalling. At the end of 2005 there were over two million children living with HIV and every year about 700,000 new children were infected. More than half a million children died every year from HIV.

"But now we know that they can survive and should not die... That's why we decided to share our knowledge. Initially, we contacted Ethiopia because many of our patients came from there. Now, in the fourth year, a team of physicians from Ethiopia is coming to our Centre, learning how to deal with HIV...

"They come to our centre for paediatric AIDS and we train them; and then they train others in Ethiopia. This is called 'TOT', or train of trainers, a course for Ethiopian health providers which is conducted in collaboration with the University of Washington in Seattle."

Apart from this, doctors from Hadassah went to Ethiopia to give mentorship. They discussed difficult cases and how to solve them; and also tackled other problems. As a result, the visiting Israeli team was able to make a direct assessment of the Ethiopian doctors. performance after receiving training at Hadassah.

Referring to the programme called "Art, Joy and Love", Prof. Engelhard said "Art" stood for anti-retroviral therapy or the treatment against the AIDS virus. Joy and love was given by the doctors to the children.

This was now a routine project for AIDS in children in Ethiopian orphanages. "We have come here to see whether we can do the same here."

Hadassah Hospital started its activities in Ethiopia at the beginning of 2005 when Prof. Engelhard visited an orphanage in Addis Ababa housing 400 children with a very high mortality rate of 25% a year. Anti-retroviral therapy was immediately introduced.

Finances required for the purchase of ART medicines came from the Bush administration in the USA under the PEPFAR programme of the US Center for Diseases Control.

"We convinced them that we can assure 100% survival because the sisters and the volunteers can give the medication every morning and every evening. If it was done on an outpatient basis and the children allowed to go home, then there was no assurance of adherence. So the children were the first to get treatment for HIV in Ethiopia."

Thanks to the total involvement of the volunteers and the medical clowns, the results were dramatic. The mortality rate dropped from 25% to only 1% per year. And the quality of life of the children improved unbelievably.

Of course, new problems arose, Prof. Engelhard said. Some of these were psycho-social but the main difficulty was in the field of education. This was not a problem earlier because then many of the children died. Now, they were surviving, they were going to become adults and so they would need education, vocational training and so on. These were new problems, "very good problems, but new problems".

Taking a well-deserved break. Some of the members of the team of medical and para-medical personnel who accompanied Prof. Dan Engelhard, the guest speaker at the last meeting, snapped while having lunch at the Taj. They are his colleagues at Jerusalem.s Hadassah University Hospital, which is the largest in Israel. Together, this team has helped reduce mortality among HIV-positive children in Ethiopia from 25% to 1%. An unbelievable achievement!

Convinced with the results at the orphanage, another institute, this one in Debre Markos (north of Addis Ababa and a six-hour drive away), joined the programme one and a half years back.

Among the first to reach the new centre were a dentist and a psychologist. Interestingly, the dentist.s task was more difficult. She had to teach the children how to brush their teeth, which was not a common practice earlier. But the team, with its doctors, nurses and others, gave the children a lot of loving care and ensured their survival.

"Now, we have decided to start a course for medical clowns in Ethiopia. Our goal is to create a team and support it... not to replace a team. This is how we take care of 500 children in two orphanages in Ethiopia.

"There is a new hope for Ethiopian children as "Art, Joy and Love" become available. We hope that we can collaborate with people here and contribute as much as we can, share our knowledge, send our volunteers."

Prof. Engelhard then screened a ten-minute film on his team.s activities.

Introducing Prof. Engelhard, Daniel Zonshine noted that normally the picture that the words Professor or Head of Department aroused were of a serious, sober and dignified person. But ."Prof. Dan is not a typical professor. He is open, curious, excited and takes everything. in his stride.

He agreed to come to India to visit an orphanage with HIV-affected children near Shahapur; he would see the place, interact with the authorities and assess whether he would be able to implement his project in India. Some of his colleagues from Hadassah accompanied him.

Dr. Nayna Dastur proposed the vote of thanks.

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