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Conclusion

Taking visitors on a tour of St Petersburg’s Baby House no. 10 last March, chief doctor Olga Kim fondly passed through wards of smiling children playing with their caregivers. Dr. Kim knows each of her 35 wards by name, stopping to issue kind words and caresses to many of them.

“Isn’t it cozy here?” Dr. Kim says with motherly composure.

Baby House no. 10 is, in fact, about as cozy as a state institution can be. The children under Dr. Kim’s care had the good fortune of securing one of thirty-five places in an orphanage where the staff is commendably affectionate and interactive with the children. But the very existence of Baby House no. 10 casts a dark cloud on the future of other abandoned victims of MTCT. The establishment of a segregated system of orphanages only fuels the fears of society, reinforcing the idea that these children are a danger and they must be isolated. Furthermore, the number of children being born cannot keep pace with the number of beds at such specialized orphanages. Those who do not get in have nowhere to go; as a result they may be left in a barren hospital room for years on end with no opportunity to develop physically and mentally.

With a few exceptions, Dr. Kim says that almost all of the children under her care were abandoned by mothers who are dependent on drugs. And as long as Russian health officials fail to increase access to drug rehabilitation and harm reduction programs to the country’s four million drug users, Dr. Kim can expect that this problem will only get worse. There will be a longer and longer waiting list for the thirty-five beds in her orphanage.

Some believe that before Russia can win its battle against child abandonment, it has to give priority to the fight against drug addiction. But Russia needs to address more than drug treatment to battle the rising problem of mother-to-child-transmission. As HIV spreads from the high-risk groups to the general population, the percentage of “socially adapted” HIV-positive women with desired pregnancies will continue to rise. These women have a right to prenatal care that offers the greatest chances of giving birth to a healthy child. Russian health officials need to ensure that HIV-positive women have access to responsive medical care and accurate information about the available means of preventing transmission. They need unrestricted access to a short course of antiretroviral drugs; taken during pregnancy, this medication is known to significantly reduce the risk of transmission from mother to child. For those who are unwilling or unable to take this short course during pregnancy, hospitals must ensure that they have express HIV tests and doses of nevirapine (for mother and child) during labor and delivery to reduce the risk of transmission.

Instead of being urged to have abortions or sent off with threats to the local AIDS Center, HIV-positive women need to be made welcome, their privacy guarded, their options discussed. In short, Russia needs to lift the stigma of HIV/AIDS in order to protect unborn generations from unnecessarily inheriting a deadly virus. In a society as large as Russia this is a difficult task, but starting with the medical community is a step in the right direction. When proper medication regimens can reduce the risk of transmission from 30 percent to less than five, the sorry consequences of negligent prenatal care are that much more apparent.

Finishing off her tour of Baby House no. 10, Dr. Kim expressed concern for the future of her wards:  “Of course I am afraid for my children. I’m very afraid for their future, and how people will relate to them. These children are not dangerous to anyone. They can bring a lot of good to society. The most important question is that of adaptation. Society must adapt to our children and understand that they are valuable citizens. If they happened to experience tragedy, especially as children, then we should be that much more tolerant.”110



[110] Human Rights Watch interview Kim, St. Petersburg, March 18, 2004.


<<previous  |  index  |  next>>June 2005