Children have been last in line to receive what literally is the difference between life and death. The courts had to force government to provide drugs that prevent the transmission of HIV to babies. Today, children still don’t have optimal treatment. While adults now have ARVs, those children whose parents were not so lucky continue their own battles as orphans or trying to survive in child-headed households.

Catholic nun Sister Sally Duigan served rural Limpopo’s people in the dark days as HIV/AIDS first ravaged its villages. Years later, Duigan and her Sisters – The Daughters of our Lady of the Sacred Heart – still do, now caring for more than 75 children in needs of a haven, still deeply affected by the disease.

“In the early days our efforts necessarily focused on offering comfort, basic essentials such as food and water and simply caring for those physically dying. Lifesaving treatment was hopelessly expensive and not available to the general public relying on state facilities. Families were wiped out. Parents died. Some left children and babies behind, themselves having to often endure the terrible suffering of the untreated disease.”

“After the treatment became accessible and affordable on a wider scale the mindless deaths were somewhat stalled and many are living with HIV/AIDS now, rather than simply dying.”

Some of the children orphaned in those early years are now part of the group living at Holy Family Care Centre, a non-denominational oasis outside Tzaneen – established and supported by Sister Sally’s Religious Congregation in the Diocese of Tzaneen. Many of the children at the Care Centre arrive ill, destitute, traumatised or all of it.

As the sun starts to set the children spill out of the smoking diesel bus having enjoyed a day of swimming at a public resort. The day in the water has reddened their eyes. They are tired and amble over to dinner. The nurturing food is gobbled up and one-by-one they head to a small building. It is the in-house clinic where Australian volunteer nurse Carmel Lawry administers “treatment”. The “treatment” is routinely dished out before shower and bedtime. For one child it is antiretrovirals and TB medication, for another it is pure joghurt or a plaster on a simple scratch as not to make a distinction between those who are HIV positive and those who are not.

Most of the children are orphaned, almost in most cases the parents succumbed to HIV/AIDS.

Rural Limpopo has been Sister Sally’s “home” and work place for the last 25 years where she heads up Holy Family Care Centre.

“Before 2004 it was pure hell. There was such suffering and denialism around HIV/AIDS and the stigma associated with it played a devastating role. We were literally forced to make impossibly tough decisions about who would live and who would die. Those who received the little medication we had thanks to private funders survived. It was a lonely fight with little support structures and many frustrating obstacles.“

Sister Sally says today children are more supported. Treatment for medical, psychological and other issues are now more easily available. Medication is provided for all via the local hospital and the children know that a positive status no longer equals death. Stock-outs are deeply problematic when they occur and the quality of care in the system still affects the children deeply.

“While much has changed and for the better, it does not mean we have no more problems. The general situation is still dire and often devastating …poverty still ravages the villages causing a cycle of suffering that is hard to witness.

“The focus on HIV/AIDS must continue. There is still devastating need and terrible suffering. Stigma still plays a role. Poverty is still the silent bedfellow of HIV/AIDS and children still die when they could have lived.”

The story of Joshua (name changed) is but one example of the challenges. When Joshua started school as a six year old he began to display anti-social behaviour. He went around collecting children’s school bags and throwing them into the pit toilets.

The fed-up principal followed him home to try to understand the boy’s behaviour. At the house he found four children including a very sick baby – living in squalor with two very ill parents both with HIV/AIDS and both mentally unstable. The children were surviving by going around the village begging and going through garbage bins. The baby was HIV positive and had received no treatment since birth and was very ill. All four children are now being cared for at Holy Family.

The first two including Joshua are attending school and doing well. The two young ones are in the centre’s creche and the baby is doing well on treatment.

The children’s stories are endless. Ten-year-old Saul (name changed) has not attended school all year because he has been caring for his three siblings – all under five. One of the three-year-olds is his cousin – her mother died from an AIDS-related illness and her aunt took her in.

Saul’s mother abandoned the children and left them in a collapsing shack. Saul survived by begging and stealing – and he managed to keep the children fed.

He survived by being a bully and fighting his way through life with the neighbourhood children. The children are now at the centre and Saul is learning to read and write with one of the Sisters.

He is gradually learning that he doesn’t have to fight to get what he wants. He is learning to interact with the other children. The three little ones are doing well and have all had medical problems checked and received treatment for their various conditions.

Many of the girls are also rape survivors – with the perpetrators often fathers, uncles and grandfathers.

“So, yes, we celebrate 10 years of ARVs. We could be so much worse off. But the challenges and sadness is far from over,” says Sister Sally.