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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


The Growth of AIDS Orphans and Policy Solutions

from Pediatric Nursing
Posted 03/03/2003

Eileen Meier, JD, MPH, BSN, RN


The global AIDS epidemic is causing not only high numbers of adult deaths but also creating high numbers of orphans that will increase dramatically within the next 10 years. During the XIV International AIDS Conference held late this summer, "Children on the Brink" was released outlining this growing problem. The report was issued by the United Nations program on AIDS, the United Nations Children's Fund (UNICEF), and the United Nations Agency for International Development with statistical evidence from the Census Bureau. By 2010, AIDS will leave 20 million children in Africa without one or both parents, nearly double the current 11 million orphaned children (Altman, 2002) Additionally, 5 million children will be orphaned elsewhere in the world due to the parent's death(s) from AIDS. By the end of 2002 (in 88 countries studied for the report), 13.4 million children currently under age 15 will have lost a mother, father, or both parents to AIDS (UNICEF, 2002a). This number will increase to 25 million by 2010. Currently, sub-Saharan Africa has the largest number of orphans: 12.5% of all children in this region are orphans compared with 6.5% in Asia and 5% in Latin America and the Caribbean. Translated into real numbers, there are 34 million orphans in sub-Saharan Africa, and 11 million are due to AIDS. By 2010, it is estimated that 42 million orphans will exist in sub-Saharan Africa due to all causes, of whom 20 million will be AIDS-related deaths of parents or caregivers (UNICEF, 2002a).

The Growth of AIDS Orphans and Policy Solutions

from Pediatric Nursing

HIV Rate Increasing Globally and Increasing Orphan Numbers

Currently, 33.6 million people are infected with HIV (UNICEF, Children orphaned by AIDS). The HIV virus is spreading rapidly, and 45 million people will become infected by 2010 if anti-HIV therapy is not available soon on a global scale (UNICEF, Children orphaned by AIDS). Forty million people around the world are currently infected with HIV, and an estimated 20 million people have died of AIDS-related causes. Due to the typical 10-year lag between infection and death, the number of orphans will continue to rise for a decade even if new HIV infections ceased. Parents who are infected will continue to die for the next 10 to 20 years. In Uganda, HIV prevalence peaked in the 1980s around 14%, then declined dramatically to 5% in 2001 due to government programs (UNICEF, 2002a). The number of orphans in Uganda continued to increase for 10 years after Uganda's epidemic had peaked and is only now declining from 14.6% to a probable 9.6% in 2010. In South Africa, HIV has rapidly escalated from 1% in 1990 to 20% in 2001. The number of orphans in South Africa is expected to rise from 1.5 million in 2001 to 2.3 million in 2010. In Lusaka, the capital of Zambia, the population of street children more than doubled from 1991 to 1999. This increase was largely due to AIDS orphans (Human Rights Watch, 2001).

Sadly, if AIDS had not occurred, orphan rates would be declining in Africa today and around the globe because of improvement in mortality rates in adults in the child-rearing years (UNICEF, 2002a). Because of the nature of HIV, if one parent dies of AIDS, there is a high probability that the other parent/spouse is HIV-infected and will die in the future. In the study Children on the Brink, there are a reported 9.5 million orphans that had lost both parents, and 3.8 million had lost at least one parent (UNICEF, 2002a).

The Growth of AIDS Orphans and Policy Solutions


from Pediatric Nursing

AIDS Orphans May Increase in Asia

Africa will not be alone in struggling with the problems of AIDS orphans. In fact, while the proportion of orphans due to AIDS in Asia is much less than Africa, the absolute number of orphans in Asia is much larger (UNICEF, 2002a). In 2001, there were more than 65.5 million orphans in Asia - nearly double Africa's 34 million. The percentage of children orphaned by AIDS was much lower at 1.8 million (2.8%), but the populations in many Asian countries are so large that even if AIDS prevalence remains low, the number of people with HIV/AIDS threatens to surpass that of the most severely affected African countries. In India, 3.8 million people (1%) are living with AIDS. This places India second to South Africa in absolute number of adult infections. HIV is spreading rapidly in India, so even a small increase in HIV prevalence could cause a tremendous increase in AIDS orphans in India. In addition, there is an increasing rate of sexual trafficking of children and women from Nepal into India, many of whom become HIV-infected and have children during forced prostitution.

The Growth of AIDS Orphans and Policy Solutions

from Pediatric Nursing

Medical, Social, and Economic Impact on Children

Children whose parents have AIDS and/or die with AIDS are impacted medically, socially, and economically. Children must take on greater responsibilities for generating income, obtaining food, and caring for sick family members or siblings. Many children are forced to live on the street after parents die, subjecting them to physical and sexual abuse or forced prostitution. Children who are sexually abused or forced into prostitution are vulnerable to contracting AIDS. Watching parents die without medical aid or in pain causes many children to become depressed. Fear of the future, HIV-related discrimination at home and school, economic worries, or forced prostitution by parents all add to the mental health problems of these children.

Increasingly, children and remaining family members lose their housing and inheritances. Children sent to foster families may cause families to stretch already inadequate resources. Caregivers of orphaned children through extended families are more likely to be poor women. Women typically have less access to property, housing, and employment. Women may also turn to prostitution, thus repeating a cycle of HIV, death, and loss of housing for an orphan. Food consumption was found to drop by 41% in orphaned children, increasing malnutrition rates (UNICEF, Children orphaned by AIDS).

One of the greatest problems these children will face is lack of education. In a UNICEF study of twenty sub-Saharan African countries, children aged 5-14 who had lost one or both parents were less likely to be in school and more likely to work 40 or more hours a week (UNICEF, 2002a). A survey of 646 orphaned and 1,239 non-orphaned children in Kenya found that 52% of orphaned children were not in school, but only 2% of non-orphaned children were not in school. Children may also be denied access to school and health care because of myths surrounding HIV. Once their parent becomes sick or dies, children and adults may be thrown out of homes and schools and denied support of the community out of fear.

The Growth of AIDS Orphans and Policy Solutions

from Pediatric Nursing

Funding for AIDS Programs

To date, the U.S. government has spent nearly $4 billion on AIDS programs (Alagari, Summers, & Kates, 2002). In the fiscal year (FY) 2001, the U.S. spent approximately $740 million on global AIDS/HIV programs. The budget for FY 2002 is $1 billion for global AIDS activities, which is nearly 7% of its total federal HIV/AIDS funding. Specifically, in FY 2002, $435 million was administered by the U.S. Agency for International Development (USAID) (Alagari et al., 2002). Spending allotments for FY 2003 have not yet been determined. The President's budget global fund request was $200 million, $50 million more than previously, although the need was budgeted at $1.2 billion

The Growth of AIDS Orphans and Policy Solutions

from Pediatric Nursing

Policy Solutions for the Problem

A number of recommendations have been made to address this growing problem. Families must be supported economically with access to health services and education. Community resources provided through the government can be helpful, such as the one discussed below in Botwana to assist orphans with needs in their community. Children must be able to meet their needs. School attendance is of utmost importance to do this. If children are not educated, future generations are undermined. Governments must develop legal and program policies to protect the most vulnerable. Child protective services must be strengthened. Stigma and discrimination against those with AIDS or whose relatives have AIDS must be eliminated. Orphanages are generally not considered appropriate as a first-line response to this crisis.

A number of sub-Saharan African countries have changed laws and child welfare systems. The HIV epidemic in Botswana is the largest social and economic crisis that the country faces. In 2000, 64% of deaths of children under aged 5 was due to AIDS, and in 1997, 4% of children under age 15 were orphaned due to AIDS. A National Orphan Program was established in 1999. Orphans are registered to assist with their foster care needs, AIDS counseling, home visits, the initiation of community-based foster placement, food and toiletries assistance, and bus fares to school.

AIDS education among young people is lacking and must be remedied. A 1998 Kenyan study found that 36% of girls aged 15-19 could not name a single way to protect against HIV infection, and 32% did not know a healthy-looking person could carry the HIV virus. Young girls become sexually active during their teens, and in sub-Saharan Africa, more than 50% of women give birth before age 20 (UNICEF, 2002b). In South Africa, 9.5% of girls in a small study were HIV-infected before age 15 (UNICEF, 2002b).

This problem will continue to grow and spread into new regions, such as China and Asia, and continue in sub-Saharan Africa if anti-retrovirus drugs to treat AIDS are not available. As more children become homeless, they may add to the increasing numbers of those with AIDS due to forced prostitution and sexual abuse. This problem requires a global response in order to address these children's growing needs.