Currently There Are an Estimated 2 Million Children with HIV Worldwide and About 2-300,000

March 2010 Prayer Guide

“Whoever welcomes one of these little children in my name, welcomes me; and whoever welcomes me does not welcome me but the one who sent me.” Mark 9:37

Currently there are an estimated 2 million children with HIV worldwide and about 2-300,000 in Kenya. Who will welcome the child born with an HIV infection? What are the challenges this child will face? And what can the church and you do to demonstrate the love of God to these special children? Let’s begin by praying for them and lifting their needs up to the Father in heaven who knew them when they were knit together in the womb. (Psalm139:13-16)

Story #1. Lucy is 1 years old and her brother is 4. Lucy is HIV positive. Lucy’s mother did not go to the clinic for prenatal care and she delivered at home because she did not have enough money to pay a hospital bill. Neither she nor the baby received PMTCT (Prevention of Mother To Child Transmission) care. The funeral expenses for Lucy’s father about 5 months prior had taken all the family’s remaining resources leaving nothing for family medical expenses. One week after giving birth to Lucy, her mother died causing an even deeper economic deficit because funds had to be borrowed to pay for her funeral. There was no money remaining for infant formula. Now their widowed grandmother cares for them along with their cousin whose mother died 2 years ago. When Lucy was only 2 months old she started getting sick a lot with diarrhea and was not able to feed well because of recurrent oral thrush infections. A neighbor helped the grandmother to take the baby to the clinic where she was diagnosed with HIV and referred for care to a comprehensive care center. During a home visit the community health worker advised the grandmother to go for VCT and to take all the children. It was then that the grandmother learned that she, too, was HIV positive and needed treatment. The cousin tested negative, but it was noted that she was very undernourished and had frequently been sick as well. The grandmother joyfully cares for these children, but she does not have enough resources to provide adequate nutrition and she cannot work as she herself is not strong. She does not have any land to farm, but does have a small plot for a vegetable garden. However, the water supply in her community is very limited and she cannot pay for water to irrigate her garden. Her house has not had any maintenance and repairs since her husband died 4 years prior. The roof now leaks and the door frame has been eaten by termites leaving little security for the family. What can a caring church community do to show the love of Christ to this family?

1. HIV has been around long enough now that we are seeing HIV infections in three generational families such as the one in this story. No age group is excluded from this epidemic. Let us pray for families and pray for families and pray that churches would reach out to multigenerational families to encourage VCT, offer ministries of helps and sound prevention strategies. Exodus 34:6,7 Pray that this generation will be the last to see children born with HIV and that a thousand generations to come will be blessed.

2. This family could have benefited from early PMTCT care, which would probably have prevented the death of the mother and nearly assured an HIV negative baby. With early interventions the risk of HIV transmission from mother to child can be reduced from 30% to less than 2% and the health of the mother can be sustained. Pray for ways to encourage more women to go early for prenatal care where they can be tested and treated if needed. Isaiah 49:15; Lk.11:27

3. Prolonged illness, recurrent health care expenses, funeral expenses, and frequent work absenteeism depletes family finances, limits employment and leaves families in deep poverty, debt, and without economic reserves to manage other problems. Pray for the many families that are at risk because of the poor health of even one member. Pray for community and church interventions to help these families before they reach such crises. Deuteronomy 15:7-11

4. Frequent illnesses in children always signify an underlying problem, but not always HIV. Malnutrition can trigger a host of illnesses even without HIV, but in the face of HIV such illnesses are magnified. Pray for adequate nutritional resources for families coping with HIV in one or more members. Pray also that they would have a source of clean water to avoid contracting diarrheal illnesses. Pray for community-based programs to empower families to produce their own foods (ie goat or chicken projects, kitchen gardens and other farm inputs as well as food distribution projects). Matthew 6:26 5. Grandparents often become the primary caregivers for sick adults and orphaned grandchildren, yet often their declining strength and health, lack of income or inability to farm places them at a great disadvantage from the beginning. Many are widows who may already be caring for children from multiple households, yet with little support from a depleted family. Pray for the many caregivers who need extra help and support from the community. Pray for their strength to hold out and for the community to rise up and help them. I Tim.5:3,5

6. Access to safe water is an issue in so many communities, particularly in the impoverished neighborhoods in which many with HIV end up living. Inadequate sanitation, housing repair and maintenance is an ever-present problem for these families and leaves many children exposed to adverse living conditions. Pray for community assistance programs to help these families restore and maintain their homes for healthier, safer living conditions. Psalm 4:8

Story 2. Eunice is a 6 year old who was found to be HIV positive when she was 2 years old and diagnosed with TB. After completing her TB treatment she was started on HIV medications which she will need to take every day for the rest of her life. She stays with her mother and her baby sister, Lydia, who is now 9 months old. The baby sister was given medicine for the first few weeks of her life to prevent HIV and has so far tested negative for HIV. Her mother, who is HIV positive and single, weaned her baby sister when she was 4 months of age in order to be able to go to work at a nearby farm where she does not even earn a minimum wage. Eunice would like to go to school, but her mother does not earn enough money to pay school fees. She hopes to have enough money by next year to send her to a nearby school that also has a lunch program. In the meantime, Eunice stays home to care for her baby sister whom she loves. She has learned how to do a lot of the housework including making the baby’s food. Eunice loves to go to the clinic where the staff are very kind to her and sometimes give her treats. There she has learned the importance of taking her medicine every day which she never forgets even when her mom is too tired or busy to remember. But she often wonders why she has to take medicine every day when her other friends do not take any. Her mother has a boyfriend who sometimes brings her special treats, but other times seems very angry and has beaten her when she didn’t do what he asked. She gets very upset when he comes drunk and beats her mom and wishes he would just go away. But even though Eunice does not have nice clothes and often does not have enough food, she is overall a happy and very friendly child.

7. Early diagnosis and treatment of opportunistic infections and HIV can help children develop more normally and remain healthy for many years. There is an especially great need for TB screening in children many of whom are not diagnosed until they are severely ill. Research from South Africa has shown that very early treatment of HIV with ARV medicines can help HIV+ children to develop normally and to perform better in school. Pray that at-risk children would be taken to clinics that can screen and treat for these infections. Pray for greater awareness and promotion of the importance of early detection and treatment in the community and church. Luke 8:41, 49-55

8. There is much confusion about early childhood feeding. The consensus among experts is that infants in low resource settings should continue to exclusively breastfeed for the first 6 months of life and then be abruptly weaned. After weaning it is still necessary that the water used to make formula be boiled and handled carefully with clean hands and clean containers. Pray that the caretakers of infants would be given the skills necessary to feed these babies safely. Pray for them to have access to safe, nutritious foods and not to rely only on porridge, so the children can grow and develop well without illnesses or malnutrition. Isaiah 66:12,13

9. Mothers who work need safe childcare options. Pray that families dependent on older siblings to be the caretaker during the day would find the necessary supports for them. Pray for adult homecare volunteers so these older siblings may have a chance to continue their education. Pray that the churches in your community would consider how they could help these working mothers and their care-giving children. Isaiah 54:13-14

10. Adherence to taking HIV medication is vital to successful treatment. Even a few missed doses of medication can allow viral resistance to develop and result in treatment failure. But it has been demonstrated that sensitizing even young children to the importance of taking their medicine every day has enhanced the success of treatment in these children, who will be taking these medicines for the rest of their lives. Pray that all medical providers of HIV services would understand and take the time to help these children comprehend their treatment and to enlist their cooperation in an age appropriate manner, from pre-school on up. Isa.11:6 11. One of the greatest dilemmas in HIV care for children is the matter of disclosure. How a child is told he or she has HIV, by whom, and when: these make a tremendous difference in how they are able to accept their status and in their cooperation with treatment. Pray for their caregivers to have wisdom to know when the child is ready to receive what level of information. Pray for these children to receive the information they are given in a manner that encourages their cooperation. Pray for them to receive the empowering information and the compassionate support they need to live the abundant life God intends for them. III John 1:2-4

13. Pray for vulnerable children to be protected from abusive relationships within the home by parents, relatives or others. Children will rarely speak out against the abuse they receive in their own homes for fear of losing the love and care of the family. Pray that our churches would be stronger advocates for children and would teach and model appropriate relationships. Pray for children to be empowered to speak out against abuse and to receive the safety and protection they need. Pray for increased community awareness of child abuse, and that advocacy groups would step in when needed. Psalm 5:11; Proverbs 22:22-25

14. Just because someone may appear to be happy and adjusted does not mean that everything is fine. Children often suffer silently because they feel powerless to change anything. They are the quiet targets of poverty, socially vulnerable and are often the first to suffer nutritional deprivation. Children in war zones suffer even more. Today pray for the millions of children who are suffering with serious needs that are not being addressed. What can the Church do for these children? Psalm 71:1-7

Story 3. Charles is in the 8th grade and has been taking ARV medications for more than one year now. He is actively involved in sports in his school and has a few good friends who know he is HIV positive. He has accepted that taking medicine is just a part of his life. However, his sister Rebeka, who is in the 5th grade and also taking ARV medications, is not doing so well in school. She is always looking for reasons to skip school and frequently has refused to take her medicine. After school she spends most of her time by herself at home sulking. Her grades at school are not very good. She has frequent arguments with her grandparents with whom she has lived since her parents died two years ago. Her parents lived in a large city and had a nice home that was near a shopping mall where she and her friends spent time together. Now she has to live in a rural community where there is nothing of interest for her to do. The only person she feels she can talk to is her brother who does not spend much time at home. The grandparents are trying their best to take care of these children, but do not know how to help their granddaughter. There is no children nor teen HIV support group in their community and the family is not connected to any church.

15. The teens who can accept their HIV status, learn to take care of themselves and faithfully take their medicines can move on for fuller more satisfying lives. Pray for the teens who have recently learned that they are HIV positive to receive the kind of counseling and supportive care that will empower them to move on and live a normal life. May the counsel given follow the principles in I Thes.2:7; James 1:19,20.

16. Sports and group activities are essential for all well developed teens. HIV positive teens need that sense of being part of a team to an even greater degree in order to cope with all of their extra life challenges. For those who are not as physically strong, pray for opportunities for other group or team activities like music or drama. Pray for the acceptance of those who are HIV+ on sports teams at school or in the community. May they be incorporated into teams that function as described in Ephesians 4:1-6.

17. A common reaction of a newly diagnosed teen is denial that they are HIV positive. The truth with all of its ramifications is too painful to face. To accept the diagnosis of HIV they have to accept the potential causes of having HIV and the consequences of frequent illnesses and the possibility of an early death and/or taking medications for the rest of their lives. But the greatest concern for most teens is the loss of group esteem, friendships and the likelihood of being stigmatized. For most there is the fear of not being able to reach their dreams of a better education, a fulfilling job and a future marriage and family. Pray for these teens to realize that with good treatment it is possible now to maintain a normal social life and attain their dreams. Pray for them to hear words of hope and encouragement. Psalm 126

18. The worst stigma most will agree is self-stigma. Many teens allow their worst fears to take over their lives as reality and they stigmatize themselves. Frequent school absences when a teen is not sick, avoiding group activities for fear of what others think is another way of stigmatizing oneself. Some even try to punish themselves for having HIV. Pray for children and youth to understand that God loves them as they are even with HIV no matter the source of their infection. Pray for them to realize the plan for their life that God has designed. Psalm 38:4-11, 21-22 19. Grief over the loss of parents can be emotionally paralyzing for children and teens. Those with HIV cannot help but wonder if they are the next to die. For many children and teens, the loss of a parent means that they are taken out of their normal social stream and way of life. Those who are more used to an urban lifestyle and/or those who have been in homes with a more solid income base sometimes have to adjust to a more rural setting with a lower income household. This may also mean changing school systems and standards which can further compromise their adjustments. Pray for these children and youth who face these heavy losses. Pray for the church communities to which they have been transplanted to rise to the challenge of making them feel welcome and supported. Isaiah 25:7,8

20. Parenting teenagers is a challenging task for anyone, but is doubly challenging for grandparents who are removed by another generational gap. These grandparents also have needs that often have to be set aside in order to accommodate their orphaned grandchildren. Many of them do not have adequate resources or energy to care for teens. Pray for community and church support for these grandparents and even parents who are caring for HIV+ teens. Maybe the church could consider starting parenting and grand parenting support groups to help. I Tim. 5:8; Rom. 12:5; Eph.4:12

21. There are not enough youth HIV support groups in all the communities where there are teens with HIV. Understanding and compassionate church youth leaders and programs in churches could help to bridge the gap for at risk teens like Rebeka. Pray for our church youth programs to be sensitized to the needs of those teens that are risk because of HIV. Pray for active youth programs in each community to reach out to the HIV+ teen who needs to know that they are just as much loved by God and are just as valuable to the community as anyone else. II Corinthians 1:5-7

Story 4. The Chimi Family is deeply affected by HIV. Both the mother and father are HIV positive. Four year old Simon is also positive and now takes ARV medications. His 10-month-old baby brother has been attending a clinic for prevention of mother to child transmission and has been tested with a DNA test for HIV and remains negative. His mother stopped breastfeeding him at 3 months of age because she was too sick to continue. Since then, most of the family income has been spent on buying milk for the baby. Simon’s mother is now very sick with an enlarged swollen leg and is unable to walk. Simon’s 8 year old sister who has tested HIV negative frequently stays home from school to care for her mother while her father tries to earn some money at a low-paying job as a watchman. He has to miss work to take Simon and his mother to the clinic and has been threatened with losing his job if he misses any more days of work. He does not dare disclose his status or that of his family. Simon tries to help his sister and mother by finding some firewood and carrying a little water in an empty paint can. But he is mostly left to play by himself in the yard around their house. He enjoys playing with the piglets and chasing the chickens. He has had numerous episodes of diarrhea and is regularly treated for intestinal worms. A few months ago he was taken to a traditional healer to have the jiggers removed from his feet and even some on his hands. A few days after the jiggers were removed he developed a deep infection in one of his feet making it difficult to walk. He then had to go to the clinic for a more expensive treatment. But his main worry now is his mother, who appears to be dying. (She has Kaposi’s sarcoma, a type of cancer.) He just doesn’t understand what is happening in his home right now.

22. When one or more family members are infected all members of the family are at heightened risk. Ministry to this kind of family requires careful evaluation of the needs of each member. Pray for those who are providing medical care to consider the unique needs of each member including those who are HIV negative. Pray for your church to consider how it can minister to families affected by HIV. I Cor. 12:25-27

23. Frequent illness and a weakened condition of even one of the parents puts the whole family at risk from problems of poverty. Absenteeism or inability to perform a normal work load is a common cause for HIV infected people to lose their jobs. Another family member may need to set aside their usual activities in order to care for the one who is sick causing further loss of productivity. Income commonly decreases while the cost of living increases with additional medical expenses and the need for higher cost foods. Pray for these families to find economic relief and to learn how to manage their dwindling resources wisely. Pray for community leaders to consider their needs and to develop programs to help. Romans 15:1-4

24. Children as caregivers of sick parents are especially at risk. Not only do they not have the skills needed to care for their parents, they will have the memory of helplessly watching their parents suffer and die. This could lead to excessive fears and dread of what could lay ahead for them. They are also missing the usual childhood activities and often even school while staying at home to care for their parent. Pray for other adults in the community to come forward to help these families. Pray for these children to be allowed to attend school regularly and be involved in normal childhood activities. Psalm 72:4 25. Sustaining infants nutritionally after they are weaned is a very difficult problem for most families affected by HIV in the developing world. The cost of infant formula is formidable and the complications of preparing it using potable water and hygienic conditions nearly impossible for a majority of these higher risk families. Pray for the provision of less expensive or subsidized feeding options to be made available to these families. Could enough churches in your community consider assisting one or two infants each with formula and infant cereals to help families for a few months until they are able to manage on their own? Proverbs 22:9

26. Stigma often affects not only the HIV positive person, but the whole family. Children may find themselves being left out of activities or more openly made fun of. Continue to pray for stigma reduction in your community and especially in your church. Pray for the children of those with HIV to be compassionately treated by not only the adults in their community, but by their peers in school and at home. Psalm 31:1-5

27. When the mother is sick or too busy trying to earn the family income, young children are very often left to amuse and care for themselves. It is an unintentional form of abandonment resulting from not having any other alternative ways to care for the young child. Pray for extended family and the church to help out in these situations. Pray for creative solutions to provide for child care for these families in hard times. Pray also for the children who may perceive that things are not right at home, but do not really understand what is really happening. Pray for people who can take the time and explain simply and understandably what the child needs to hear so their imagination does not make it into something worse. Isaiah 40:27-29

Story 5. Evelyn is a 13 year old girl with HIV living in an orphanage that is home to about 50 children. There are 3 other HIV+ children in the orphanage. She is clothed and fed well, and provided with health care and education. There are only 3 workers plus the matron in charge who care for the children. The other children and even two of the workers do not know that she is HIV+. In order to protect her from stigma the matron does not allow her to attend an HIV support group for teens that is held in that community, and forbids her from talking about her status with anyone. A few of the other girls have asked her why she has to take so much medicine every day. It is getting harder to think of a way to answer them without disclosing her status. She fears that they will make life very difficult for her if they knew, and she desperately wants their friendship. She just has to pretend that she is like all the other children except that she has a chronic illness requiring her to take a lot of medicine and go for clinic appointments every other month. Now that she has entered puberty her body is changing and she has no one in whom she can confide or ask questions.

28. Being fed, sheltered, clothed and educated is not enough for teens who need friendship and mentoring from a caring adult who can be trusted with confidential information as well as a sense of belonging and a hope for the future. Pray for all children in group homes to find the personal and individual attention that they need. Pray particularly for those who are HIV positive and need extra support to overcome the additional bashing from self stigma which often has destroyed their own sense of self esteem and value. Pray for Christian youth and caring adults who can act as big brothers and sisters or surrogate aunts and uncles for these youth. Pray for someone to fill in the gaps. Proverbs 27:10

29. Disclosure is particularly delicate in group homes and boarding schools. The risks of broad disclosure are huge, yet it is difficult to keep such knowledge hidden for the child or teen who is taking large quantities of medicine every day and frequently having to go to the clinic. Pray for these young folks to have the courage tempered with wisdom to know how and to whom to disclose their status. Then pray for them to have an adequate self image to help them not to crumble when peers make unintended hurtful comments. Pray for the administration and leadership of the homes and boarding schools to be respectful and sensitive to the needs of these teens to keep personal matters private. Proverbs11:13;25:9-11

30. Unusual medical problems further compound the normal adolescent adjustments for the HIV infected teen. Sorting puberty and adolescent issues from more specific HIV issues can sometimes be difficult to discern. Pray for understanding and knowledgeable adults to be available to help these teens sort out these issues and their solutions. Pray for these at risk teens to have a healthy body image, to set appropriate boundaries and to be comfortable with their own limitations. I Corinthians 6:19,20

31. The fatalistic attitude which is very common to African culture easily leads to depression and social withdrawal in the face of HIV. With the attitude, fed by misinformation, that nothing can be done to really change the outcome of an early death from AIDS, it is difficult for teens to take charge of their lives, cooperate with care and make their dreams for a future come true. Pray for accurate information about treatment and a healthy lifestyle to reach youth with HIV. Pray for them to see that their behavior and cooperation with treatment can make a very significant impact on their lives and longevity. Pray for our churches to teach Biblical truths that our God is ready, willing and able to offer grace to overcome all our guilt and shame and to set out feet upon stable ground to establish His people irregardless of HIV. Lamentations 3:19-24 * Please note that no real names or exact stories have been used, though stories are based on real situations.