Focus on AIDS and Orphans

By 2003 develop and, by 2005, implement national policies and strategies to build and strengthen governmental, family and community capacities to provide a supportive environment for orphans and girls and boys infected and affected by HIV/AIDS, including by providing appropriate counseling and psychosocial support, ensuring their enrolment in school and access to shelter, good nutrition and health and social services on an equal basis with other children; and protect orphans and vulnerable children from all forms of abuse, violence, explanation, discrimination, trafficking and loss of inheritance.

Living today are an estimated 14 million children who have lost one or both parents due to AIDS. Approximately 80% of these children-11 million-live in sub-Saharan Africa.

However, the orphan crisis is not restricted to that region.

As the number of adults dying of AIDS rises over the next decade, increasing numbers of orphans will grow up without parental care and love, and be deprived of their basic rights to shelter, food, health and education. In the world, huge numbers of children have lost at least one parent to AIDS. Sadly orphans numbers will increase as the epidemic matures. Forecasts indicate that the number of children orphaned by AIDS will rise dramatically in the next 10-20 years, especially in southern Africa. In countries where epidemics are relatively new but growing rapidly, the impact of large numbers of orphans has yet to be felt. But the future cannot be ignored, and preparations must be made now.

Programmes should not single out children orphaned by AIDS, since targeting specific categories of children can result in increased stigmatization and discrimination. However, to be orphaned by AIDS does create unique circumstances, not least because these children are more likely than other orphans to lose both parents, often in relatively quick succession. (Once one parent has acquired HIV, the other is highly likely to also become infected.) Very young children orphaned by AIDS may have acquired AIDS themselves, and children orphaned by AIDS are more likely than other orphans to encounter stigma and ostracism. The vulnerability of children orphaned by AIDS and that of their family starts well before the death of a parent. The emotional anguish of the children begins with their parents distress and progressive illness. This is compounded as the disease causes drastic changes in family structure, taking a heavy economic toll, requiring children to become caretakers and breadwinners, and fueling conflict as a result of stigma, blame and rejection. Eventually, the children suffer the death of their parent(s), and the emotional trauma involved. They then have to adjust to a new situation, with little or no support, or they may suffer exploitation and abuse.

As AIDS tears at the family fabric, assisting ill parents to live longer by providing appropriate medicine, food and care at home is one of the best ways to benefit children, particularly as many parents die of opportunistic infections that are treatable with inexpensive drugs. Home-based care for people living with HIV/AIDS is a means of addressing not only the health of those who are ill, but also the economic and psychosocial needs of their children.

Recent findings show that orphans who have lost both parents are even more likely to drop out of school and to be drafted into child labour than children who have lost one parent. Since the family is likely to have become more impoverished before the death of the parents, the children are often left destitute one their parents are gone. A situation analysis of children orphaned by AIDS showed that family structures (which have proved capable of coping with many social and economic strains over the years) are facing serious problems with AIDS. Families find it harder to assign substitute parents to children orphaned by AIDS than to children orphaned by other causes, and to cover the costs of their education and upkeep. In addition, the children are less inclined to conditions.

Moreover, the ability to stay in school-so crucial to a childs future-suffers significantly when a child loses one or both parents. In the late 1990s, a survey of 646 orphaned and 1239 non-orphans. Among the orphaned children, 56% of girls and 47% of boys had dropped out of school within 12 months of a parents death. Girls often drop out of school because they assume the responsibility for caring for parents who are ill, or because they must look after household duties in the parents stead, including that of caring for younger siblings. Other children leave school because they are discriminated against, are psychologically distraught, or cannot pay the school fees.

Many children appear to be slipped through social safety nets entirely, ending up in households with no resident adult, or as children might come to constitute a lost generation of young people who have been marginalized and excluded for much of their lives.

The best solutions are close to home

In order to counter the stigma often direct at children orphaned by AIDS, efforts should address the needs of all vulnerable children in a community affected by the epidemic. Areas made vulnerable by HIV/AIDS can and should be targeted but, within these communities, residents and local government should provide assistance to the most vulnerable children and house holds, regardless of the specific causes of vulnerability. Experience shows that successful programmes are those that focused, and respect and protect the rights of the child.

Growing up in communities disrupted by the epidemic orphans are more likely to cope if they can live in surroundings that are as familiar, stable and nurturing as possible. The sensus is that orphans should be cared for in family units through extended family networks, foster families or adoption. At the very least, siblings should not be separated, and children should remain in, or close to, their communities. Even child-headed households be viable, although hardly ideal, options if given enough community and state support.

While Africa is still in the early stages of its orphan crisis, many children and many communities are coping, and their resilience and fortitude should not be underestimated. Millions of orphans have already been absorbed into extended family networks, even in the poorest communities. Formal and informal fostering arrangements are also common in some countries. Indeed, many societies in Africa have retained the structures and ethos of community-based orphan care-traditions that have helped them cope with previous calamities.

On the other hand, formal institutions, such as orphanages, have proved to be a tiny and inadequate part of a response. The financial costs of maintaining outstrip that of other forms of care, making orphanages an unsustainable option. Furthermore, such institutions often leave children without the social and cultural skills they need to function successfully as adults. However, orphanages can be a last resort, either with no other alternative as a temporary solution, or one for children with no other alternatives. Where orphanage do operate, there should be proper registration of children and monitoring of standards of care.

Supporting extended families and affected communities

The extended family can only serve as part of the solution to the mass orphanhood if adequately supported by the State, the private sector and the surrounding community. This need for support is desperate in the worst-hit regions where the capacities of families are being eroded by economic decline and dependents in a recent study of AIDS affected household needs following the death of a mother.

But it is also clear that families are willing to take in an orphan if support is made available. Support to orphans and other disadvantaged children is a State obligation under the Convention on the Rights of the Child. Such support can take many forms : free health care and education (or supplements, enhanced access to microcredit and other forms of financial support.

A part of the solution.

Empowering affected children first of all means regarding them as active participants, rather than the mere victims. Many children already function as heads of households and a caregivers. They are a vital part of the solution and should be supported in planning and carrying out efforts to mitigate the impact of HIV/AIDS in their families and communities. For instance, the community-based organizations which help orphans not only gain skills but also utilize such skills in order to empower themselves for the future.

Children in households with ill parents should also participate in decision making regarding their future foster care. This is crucial for succession planning, which helps parents (who know they are HIV-positive ) prepare for the future and provide their children with the necessary care and support. So-called memory books offer valuable psychological benefits; usually containing important are often jointly created by parents and children.

Much can be done to ensure the legal and human rights of orphans and vulnerable children. Many communities are now writing wills to protect the inheritance rights of women and children. Emphasis should be put on the children affected by HIV/AIDS, with special emphasis on psychosocial support. Many of the children have poor life skills and exhibit psychosomatic disturbances, depression, very low self-esteem, disturbed social behavior and hopelessness.

The experiences of these children confirm that the death of a parent (or, worse still, both parents, as is often the case with AIDS) causes severe trauma and can stunt childrens development.

However, the resilience and coping capacity of these children can be enhanced with relatively simple, direct and culturally appropriate psychosocial support.

More generally, it is communities that are at the forefront of creating the scores of orphan-care programmes to ensure that vulnerable children have access to care and support. Most of these projects and programmes exist thanks to the efforts of womens groups, church-based groups and non government organizations.

The Challenge ahead

The challenge of dealing with the rising numbers of orphans and vulnerable children (e.g providing care to their HIV-positive parents) is beginning to be addressed on a wide scale. Such initiatives must be carefully executed, with maximum regard for the best interests of the children and families concerned as well as for the needs of society.

To generate the rights of orphans and vulnerable children the following should be emphasized.

- Strengthen protection, care and coping capacities within extended families and communities.

- Build the capacity of children to meet their own needs;

- Reduce stigma and discrimination.

Caring and coping interventions for children and communities must take into account the long-term nature of AIDS-related problems and impacts. Millions of children have already lost at least one parent to the epidemic, and millions more will do so in the years to come. The challenge is to protect their rights ad enable them to realize their potential.

Source: UNAIDS 2003