[procaare] Re: Pre-6th HCC:Theme 2 - Children:Infected or Affected by HIV/AIDS (3)

[Noerine Kaleeba <procaare@healthnet.org>]

Re: Pre-6th HCC:Theme 2 - Children:Infected or Affected by HIV/AIDS (3)
-Noerine Kaleeba,Geneva
******************

Children orphaned and made vulnerable by AIDS

Many sobering predictions have been made about the global HIV/AIDS pandemic over the last
decade. It is only recently, however, that the impact of the pandemic on the family and
community structures is beginning to be appreciated. One such impact is the increasing
numbers of children made vulnerable or orphaned by AIDS.

To date, sub-Saharan Africa registers by far the biggest numbers of children infected,
orphaned, or otherwise made vulnerable by AIDS. However, in the next decade, the numbers
of these children are also expected to increase dramatically in countries such as India,
Honduras, Haiti and Ukraine.

* Impact of AIDS on children

Impacts of HIV/AIDS on children and families are diverse. They range from health, social,
psychological or economic effects. Children whose parents have AIDS are threatened by the
potential loss of one or both parents, and may live with that fear for many years long
before the parents die. My own children often reflect on the days following their father's
death when they lived in fear that I would soon die. They feared the loss of family and
loss of their identity which would follow as they would have to be split and divided among
the surviving relatives.

Children suffer grief resulting from death of parents and other family members. They may
suffer from depression and demoralisation; psychological stress as well as loss of income
resulting in increased malnutrition/starvation; loss of educational opportunities;
homelessness, vagrancy and forced migration; increased vulnerability to HIV infection.
Families suffer loss of skilled labour; loss of agricultural inputs and labour; and
reduced access to health care.

Clearly, the needs of children and adolescents affected by HIV/AIDS are vast. It is also
becoming clear that AIDS affects children long before their parents die. For example,
children, especially girls, give up school to care for sick parents and younger siblings
or to do odd jobs for extra income. Loss of educational opportunities for millions of
children is one of the legacies that the AIDS epidemic will leave behind, long after
infection rates have gone down.

AIDS-related deaths have given rise to another category of "orphans" - namely the elderly,
who are faced with multiple deaths of their children and end up having to take care of
orphaned grandchildren. In most developing countries where there is no state welfare
systems to take care of the elderly, parents depend entirely on their adult children for
their welfare. But as AIDS continues to take its toll on young adults troubling scenarios
emerge: grandmothers struggling to care for orphans; households headed by children, many
of them primary school age, who are caring for younger siblings; and worse, children with
nowhere at all to turn end up on the streets becoming exceptionally vulnerable to HIV
infection, violence and drugs.

The breakdown of families further exposes children, especially girls, to HIV infection.
Girl children compose a large proportion of women who are exploited for commercial sex
purposes. Orphaned girls are often target of abuse, trafficking and exploitation.

Orphans will dramatically add to the estimated 250 million 5-14-year-old children who are
engaged in economic activity in developing countries. Africa already ranks first in
economic activity participation of children - with over two-fifths of children involved in
some kind of work - and the agricultural and manufacturing sectors are cited as the
predominant workplaces. In addition to hazardous working conditions, many of these child
labourers are victims of sexual and physical abuse.

* Vulnerability of Orphans and children to HIV

It is also important not to overlook the growing number of children and adolescents who
are either HIV-infected or have AIDS.  In 2002, an estimated 800 000 children under 15
years were infected, including 720 000 thought to be infected through mother-to-child
transmission of HIV.

Disease progression in HIV-positive children is more rapid in Africa than in developed
countries, probably because African children are exposed to multiple, early infections,
have high rates of malnutrition and micronutrient deficiencies, and limited access to
health care.  At least one-third of HIV-infected children in developing countries die
within the first year of life. Recent advances made in HIV treatment have not resulted in
equitable treatment for children, mostly because this dimension was not adequately
foreseen.

Poverty and lack of social services in many heavily HIV infected countries mean that
children, families and communities provide the bulk of care to children and persons living
with HIV/AIDS. This accords with economic realities and African value systems, but pushes
families in poverty to their financial and emotional limits.  Surveys show that poverty,
the main constraint on a family's willingness to foster children, increases with AIDS.
AIDS causes decreases in income, production, consumption and savings.  In Tanzania, Cote
d'Ivoire and Thailand, income of families with HIV/AIDS has dropped by 60%, agricultural
output and food consumption has declined, while spending on care has increased, wiping out
savings and security.

One study in Uganda showed that 65 percent of the AIDS-affected households were obliged to
sell property to pay for care. Traditional safety nets, which contribute to food security
in times of need, are breaking down in the worst affected communities, where families and
neighbours become too overburdened to help each other with food, loans, a hand in the
fields, or care of orphans.

Surviving adults have increased workloads, spend more time supervising and caring for
children.  Family productivity declines as productive members die, and remittances are
lost when non-resident members fall sick or die.  Along with loss in remittances from
income earning members, studies in 7 countries show that households affected by HIV/AIDS
suffer labour and output losses in subsistence agriculture.

Households cope by improving food security, increasing outside activities to supplement
incomes, and alleviating the loss of labour using strategies that do not require cash,
such as reallocating labour, removing children from school, planting crops that are less
labour intensive, and cutting back on cultivated area.  They also reduce farm inputs like
fertilisers and pesticides, and sell off capital goods, like land, livestock, and
equipment.

The proportion of female-headed household approaches one-third in many hard hit countries,
and is increasing.  These households are larger and poorer, and children in them are
significantly disadvantaged because the women have less access to property, work, and
external support.  Ironically, these are the households most likely to be providing care
to the sick and orphaned children, and they are most likely to be victimised in the event
of an AIDS death.

Communities are confronted with a generation of children raised without adequate adult
role models and without adult support and protection - children and adolescents who are
malnourished, undereducated and marginalised.  While the challenge of ensuring and
promoting their safety, well-being and development is paramount, the risks to society of a
generation without family support and proper education are too great to be ignored.

* What can be done?

Various relevant global instruments/conventions/platforms have been ratified by many
countries. In 2001 alone, for example, there were two related special sessions of the UN
General Assembly: one on HIV/AIDS and one on Children. Despite the existence of these
frameworks, there is little tangible international or national action being taken to
protect children affected by HIV/AIDS. The response continues to be at local community
level. Effective responses recognize the importance of keeping families and communities at
the front line by empowering and supporting them. Families, including extended families
and communities have done a heroic job in responding to the crisis. Several examples of
such efforts have been documented. For example:

 - Malawi, COPE (Community-based Options for Protection and Empowerment) supported the
formation of community care coalitions that united concerned community leaders and members
to respond to the needs of children and families affected by AIDS. These community
coalitions mobilise internal resources, access external resources and organise village
care committees to assist AIDS-affected children and families.

 - Community-based schools, as seen in Zambia, have provided models for expanding
education opportunities of children, especially, orphans and vulnerable children.

 - Another strategy for effective responses aims at mobilising and strengthening
community-based responses. Successful initiatives mounted by NGOs in Zimbabwe, Malawi and
Uganda mobilised communities and local volunteers to identify vulnerable families,
different needs of children, existing services and threats to affected children including
stigma and discrimination. However, direct support to families to alleviate the burden of
caring for the sick and orphaned children is still limited.

 - Initiatives aiming at increasing the capacities of children and young people to meet
their own needs are essential. In Uganda, the AIDS Support Organisation - or TASO - has
initiated a skills training program for TASO clients' children whose do not succeed in
progressing through the academic schooling system. These adolescents are placed with
artisans who teach them a skill or trade. TASO then provides the youngsters with a
"starter kit" of tools with which they begin the relevant trade.

Each of the above and more impressive efforts need to be taken to a larger scale and
formally integrated within the national HIV/AIDS response frameworks.

By Noerine Kaleeba
---

**About the author:

Noerine Kaleeba is from Uganda. She founded the AIDS Support Organization (TASO) in Uganda
in 1987. The organization offers counseling to those with HIV/AIDS as well as working with
government and NGOs to combat the spread of HIV.
Noerine is currently the Community Mobilization Adviser in the Department of Policy,
Strategy & Research at UNAIDS (Geneva).

She can be contacted at:
Email: kaleeban@unaids.org
Geneva

--
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