Joyce is 11 months but she looks much smaller. She has come to the Thabang Society clinic in Parys, South Africa, to receive treatment for HIV. Caritas supports the clinic by providing antiretrovirals (ARVs).

“Joyce is very malnourished and underdeveloped,” says Dr Almud Pollmeier, a paediatrician at the clinic, “she looks more like an eight week old child.”

This means that Dr Pollmeier has to adapt the dose of her medicine to make it more suitable to a younger child.

The fact that children constantly grow is one of the reasons why treating children for HIV is more complicated than treating adults. The children have to be weighed and their medicine increased accordingly as they grow and their body weight changes. This means child cases require constant monitoring by healthcare professionals.

Joyce and her family live in a poor township in South Africa. This further complicates her HIV treatment.

“Her family live in a shack and they don’t have a fridge. Joyce is on liquid ARVs which require refrigeration,” says Dr Pollmeier.

Liquid ARVs are sometimes provided in powder form. While liquid ARVs are easier for small children to take, they require families to have a regular clean water supply to mix up the medicine. In Parys, the water can sometimes be turned off for days at a time.

Joyce came to the Thabang Society with very bad oral thrush. This is a common yeast infection picked up by babies, but for a child with HIV any infection can spiral out of control because their immune systems are weakened.

“I sent Joyce home with antibiotics, and I told her mother to ring me if there were any problems. But then I realised that her family hasn’t got a phone. In these sort of situations, women in this area sometimes end up having to carry their children to hospital on their backs,” says Dr Pollmeier.

Joyce’s case is complicated on many levels: she will need access to nutritious food to grow into a healthy girl, she will need a constant supply of clean water to take her daily ARVs, her parents will have to be attentive and remember to give her the medicines at the right time and to act on any sign of deteriorating health, and she will need constant monitoring by healthcare professionals.

But the Thabang Society has been invaluable to Joyce and her family in their struggle against HIV. Besides providing Joyce with free healthcare and medicines, the clinic diagnosed Joyce early on in her life.

“We did a rapid test,” says Dr Pollmeier. “Fortunately there’s an oral rapid test which doesn’t require you to prick the child. Once the test came back positive we took blood and sent it away for analysis.”

Joyce was fortunate that her mother took her to the Thabang Society. In Free State where they live, a budget crisis in the local healthcare system means many people don’t have access to testing and treatment for HIV and some people have died because of this.

But with the ongoing help of the Thabang Society, Joyce has been given a head start on HIV.