Baan Gerda: The story so far
Please visit www.baangerda.org

Background: HIV situation in Thailand
Thailand has an estimated 30,000 HIV infected

children. The actual figure may be far higher.
Antiretroviral therapy (ART) is free

6,500 children currently receive through the

Ministry of Public Health
The majority of children present for treatment with

advanced HIV disease

Challenges in paediatric services
Prevention, diagnosis and treatment of children

with HIV: international priority
Evolution of HIV treatment in Thailand has been

rapid since 2001
Diagnosis

Management of OIs

ART is clinically and socially complicated even in

this community
Inadequacies in capacity of health facilities to

provide ART

Baan Gerda Ideology
It is the duty of adults to fulfil the rights of

children
Entitlement to medical care is a fundamental

human right
Commitment to delivering ART to children in a

loving environment until it is possible for
vulnerable children to survive in their own
communities

Philosophy
To create families

 Teach good manners, discipline & duty
 Non-religious
 To support and
love one another

Financing BG
We support 75 Children, 18 caregivers, 10 other

staff members
Financing – approx. 12,000 Euro per month (Baht:

Source of funds – child sponsorships and initially

from European contacts
Increasingly from Thai donors

Costs vary significantly from month to month


The early days of Baan Gerda
First children arrived in 2001 (via Wat

Prabaat Namphu hospice)
We had no experience and very little

knowledge. Our greatest challenge!
ART initiated for first 10 residents in 2001

Few regimens available, some imported

Dramatic intolerance with generic ddI


Baan Gerda grows
New children arrived every few weeks

Most arrived in a very poor physical and

psychological condition
But some turned out not to have HIV at all…

Many had suffered stigma, bereavement, and

neglect
Many were emotionally withdrawn for a long

period

Daily life
8-9 children of varying ages per house

with two care-givers
Food prepared from a central kitchen

Meals either in communal hall or at home

Medication is taken at home – including

OI prophylaxis

Ever-changing population
We have lost 12 children to AIDS

Some children have returned to their

communities
Others were sent back again

Unfortunately many parents feel unable to

stay with us
Some parents have had to be asked to

leave

ART at Baan Gerda
Our children use several ART regimens

Our first line is NVP/3TC/d4T (or AZT)

Resistant cases take Kaletra

Children with concurrent TB take EFV and

later switch to NVP

Drug issues
Medicine and hospital bills initially a major

expense
We have many resistant cases

Limited PIs now free by government

Concern about future imported drug costs for

second line treatment failure

Challenges: Parents
Finding parents

Keeping our parents

Preventing conflict and power issues

ART training

Giving them a reason to stay: paid craftwork


Solutions: Communal hall
Important for the organisational structure

Reduces power issues and conflict

Ensures privacy in the houses

Activities


Multi-purpose hall

Seasonal flooding

Challenges: local medical
infrastructure
Local health personnel – frequent

changes in medical staff
Lack of knowledge about HIV

Busy staff

But, not necessarily stigma


Solutions
Expert advice

Well trained staff

Keep staff informed about developments

in paediatric HIV practise
Take full responsibility of the medical,

monitoring and psychosocial needs of the
families
Keep a good stock of general and

antiretroviral medicines

Health issues
Most of our kids are now stable on their

treatment
Often they come to us with very low CD4

and no records of past medical treatment
Health conditions often rare and difficult

to diagnose without specialist help
Difficult cases sent to Bangkok

Many children have below average growth


Education
Since 2002 the children have been accepted in local

schools
All children attend if they have good health

Our children are in classes mixed with non-HIV

infected kids, stigma and teasing is rare but not
unheard of
Most of the kids do relatively well, however some of

them had many years without education

Stigma
Attitudes for PLWHA have changed in the

past 10 years
Thai attitudes to HIV

Community responses

School

Families


Activities
Life at Baan Gerda is a bit easier than it was…
 Annual visit to the beach
 Orff music lessons
 Outings in the holidays

Music lessons

The Future
Many kids now reaching adolescence – sex

education and social responsibility are
important issues now
Preparation for the world outside Baan

Gerda: higher education, careers,
independence
Children who grow up and leave Baan Gerda

will always have a home here.

Finally
Thailand has made great advances in the
provision of ART, and we are aware that the
best place for most children to be is their
home community.
However, we would hate to turn away a child
with HIV, and unfortunately children are still
being turned away from their homes.

But, sometimes, a child
comes here just too
late…

Thank you for listening