The Mohau Centre is a place of last resort. The 32 children who live at the orphanage are all HIV-positive, their mothers having already died from the virus. The mothers were mostly transients, without records. Even less is known about the children's fathers.
Children at the Mohau Centre, which is attached to Kalafong hospital near Tshwane (the new name for Pretoria) in South Africa, are mostly aged under five. Until recently they would probably have died before they were two, but new drugs have made survival possible. But these children have no identifiable history or background, and they face an uncertain future, dependent on new, untried drug regimes.
The children appear unadoptable, partly because of the constant medical attention they require, and partly because of the stigma attached to their circumstances. The social workers in the project have failed to find one adoptive parent.
The Mohau centre is in a barrack- like building, a converted nurses' home.
It is not designed for children. Although it is immaculately clean, it is also very bare. None of the children living there have a single personal possession, not a cuddly toy nor even one identifiable piece of clothing.
I was taken to the orphanage by Joan Orr, who is a senior lecturer in health attached to the University of South Africa. In my eyes Joan is something of a saint - she has brought up her own family, and now looks after four AIDS orphans herself. She is on the management board of the orphanage, and has tried desperately to influence the regime there.
Despite volunteers, in-service training, and successful fundraising for toys and equipment, she cannot crack the organisational culture which assumes that possessions are meaningless for such children. Toys and personal playthings are part of a consumerist culture, and in many parts of the world children grow and develop normally without the manufactured toys and specialised equipment that we consider to be an indispensable aspect of early childhood. But in the Mohau orphanage the lack of possessions is more than that - it is also an expression of the lack of worth of these children.
The children have good medical attention, they are clean and well-fed, and that is assumed to be sufficient, even generous, for those with such precarious lives ahead of them, in a country where poverty is endemic.
No safety net
The scale of HIV/AIDS in South Africa, as elsewhere in Africa, is unimaginable for us. In the UK, despite creaking health and social services, we still assume there is a safety net for the poorest families.
This is not the case in most African countries, where the family is the only or the main source of security. If family members die it can be catastrophic.
South Africa has better social service systems than most African countries.
Even so, there are an estimated two million orphans in South Africa, cared for by elderly relatives or living within child-headed households. An estimated 2.1 per cent of all children themselves have HIV/AIDS.
Although, technically, carers of orphans are entitled to an allowance, the system requires a level of paperwork - proofs of identity, naming of adult carers - that is beyond many families. These difficulties were explored in some detail in a recent research project, carried out from the University of Kwa Zulu Natal. It explored the impact of HIV/AIDS on the education system in one local town and its surrounding district. Many orphan children received no help. They missed out on benefits. Schools, with rare exceptions, cannot cope with the epidemic and are suffering losses of their own staff. Children go hungry and cannot come to school because they have no money for the basic shoes and uniform and other small schooling costs.
Helpful efforts
Of course, a great deal is being done to help. As well as the big international agencies like UNICEF, the World Health Organisation and the Bill and Miranda Gates Foundation, there are many smaller charities that focus on HIV/AIDS victims.
The Nelson Mandela Children's Trust is a leading charity in South Africa helping children, although recently it has got mired in a lawsuit about missing or misspent monies. Ante-retroviral therapy, which halts the progress of the virus, is becoming more widely available, and an estimated 30 per cent of children who need such treatment are now receiving it in South Africa. But the therapy requires constant medical attention and monitoring, and puts extreme burdens on an already overloaded and under-funded health service.
Yet there are new and surprising initiatives, like attempts to provide good palliative care and at least help those who are dying do so in dignity and without pain. There are charitable projects working with dying mothers, to help them provide memory boxes, and to ensure that the paperwork necessary for their children to access schooling or to claim benefits is in place before they die.
As well as treatment, a great deal of effort is being put into prevention, and into lessening the stigma associated with HIV/AIDS. For example, early childhood organisations such as the Early Learning Resource Unit (ELRU) and TREE have projects which provide various kinds of family support services in rural districts. These projects offer relief care to grandparents and other carers of orphans. ELRU has produced a book called Am I a lion that eats people? (see pictures) that deals head-on with the issue of children who are stigmatised and ostracised because they and their families are infected with HIV/AIDS.
The South African health minister, Manto Tshabalala-Msimang, who became an international laughing stock for advocating beetroot and garlic as a way of coping with the disease last year, no longer speaks for her Government.
Attitudes towards HIV/AIDS are shifting, but not quickly enough.
In some African countries people do not now expect to live beyond the age of 40. The neglect of orphan children is storing up trouble for the future - uncared for children are unlikely to become caring adults.
Some leading researchers say the only way to deal with the epidemic is to treat it like a war of liberation and to mobilise all the country's resources into combating the enemy. In terms of death and destruction, the damage done by HIV/AIDS outstrips any war. It deserves the same attention.