This special space for children infected with or affected by HIV was set up in 2007 in response to growing demand. It is managed by the Centre for Solidarity and Social Action (CSAS), which provides HIV/AIDS care in Bouake, Cote D'Ivoire's second largest city, in the centre of the country.

"At the start of CSAS, in 1995, our first concern was for children. We heard people saying, 'My child isn't going to school, he's ill.' We lost a lot of [HIV-positive] children because we could only look after opportunistic infections," said Penda Touré, the centre's director.

"When children had periods of sickness, we suggested to their parents that they should be tested, but we were also scared of making them do the test and then not being able to do anything afterwards. Losing a child is terrible."

From 2000, the university hospital centre in Yopougon, a large working-class neighbourhood in Cote D'Ivoire's financial capital, Abidjan, about 300 kilometres south of Bouake, began providing a specialised service for treating HIV-positive children, which included prescribing paediatric antiretroviral (ARV) medication.

"If parents were able [to afford it], we tried to send them to Abidjan, but it was only four or five children," Touré said.

Eventually the centre was granted funding to launch projects aimed at children by the Elizabeth Glaser Foundation for Paediatric AIDS, and in 2007 the children's centre opened its doors.

Impact of the crisis

Today the paediatric centre sees about 200 children who are either infected with or affected by HIV, 80 of whom are on ARVs. Treatment is free of charge until the age of 18 - a crucial factor for many families.

"When a child tests positive, the first concern for mothers is knowing how to look after their child and how much it will cost - the issue of cost always comes up," noted Mah Awa Lohoua Cissé, a psychological and social counsellor at the centre.

Bouake became the rebel stronghold of the New Forces after an armed insurrection began in 2002, which divided the country in two. Many businesses closed down, inhabitants fled and jobs are still scarce.

"Some children have lost their parents due to the crisis and to HIV, and they are traumatised," said Lohoua Cissé. "For other children, their mothers do not have the means to pay for care. They try to set up small businesses but even when they do, they often don't generate enough income."

Jacqueline* has four children and is pregnant with a fifth. Before the crisis, she fetched vegetables from villages around Bouake and sold them in town. "During the crisis we couldn't move around and I couldn't do my work any more, so I used the money I had left to eat. Now I haven't got anything left; I haven't even got enough to start up a small business again."

Jacqueline discovered she was HIV-positive after the birth of her youngest son, who is now four and HIV-negative. She comes to the paediatric centre with him regularly and has survived, thanks to donations and support from the centre.

The level of destitution facing families affected by the conflict and HIV has also had a negative effect on the children's schooling.

"We managed to achieve an attendance rate of nearly 100 percent before the crisis, but now it is around 50 percent," said Touré. "People say school is free, but in reality that is not the case. Parents are often [asked for money]. We try to give a contribution, but it's not always possible."

Newborns

Because of poverty and the stigma that surrounded HIV, many pregnant women weren't reached by programmes to prevent mother-to-child transmission (PMTCT) of the virus, said Dr Victorine Dililo, the HIV/AIDS administrator with the United Nations Children's Fund (UNICEF) in Bouake, which supports the Ariel Glaser Paediatric Centre.

Even those pregnant women who are tested for HIV don't necessarily receive treatment to prevent transmission.

"When pregnant women do their test, they are given a number to prove they have been tested, but the result is not written on there, so if the mother doesn't tell the midwife, we cannot monitor them," Dililo told IRIN/PlusNews.

PMTCT services in Bouake are also hampered by the lack of healthcare workers, a large proportion of whom have taken refuge in the southern half of the country, which is under government control.

According to data compiled by UN agencies, of the 254 midwives who were working in the central, northern, and eastern regions of the country before the crisis, only 165 remained by the end of 2007.

PCR testing, which allows a newborn baby's HIV status to be determined from the age of six weeks - compared to 15 to 18 months for standard tests - can only be carried out in Abidjan, but samples must reach the laboratory within six hours of being taken, which is complicated and expensive to achieve.

Finally, many women do not want to give birth in medical centres because of the cost. Those who have been identified as HIV-positive are given an antiretroviral paediatric syrup for their newborn to take soon after birth, to limit the risk of the virus being transmitted.

Child-friendly

As a consequence of parents often refusing to have their children tested for HIV, some were already quite sick when they came to the centre, said Dr Paule Soro Ouattara, a paediatrician at the centre.

In an effort to encourage more parents to have their children tested, the centre has adopted a friendly approach reinforced by the incentive of games, activities and meals for the children.

Those who come to the centre are encouraged to express their hopes and fears, and to talk freely about their HIV-positive status, something they are otherwise rarely able to do. Oumou Meite, an activity leader at the centre, keeps their wishes in a book of memories, in which each child is given a page.

"I would like to be free as a bird, not have any secrets from anyone and be strong to fight this ugly disease, AIDS," said one child, aged 13.

"Peace - I want peace, so that I can be a daddy and a mummy in the future," said another, aged five. - PlusNews

* Not her real name