Children of the Storm (on AIDS orphans)

By: Bawa Yamba, Swedish Researcher at the Nordic Africa Institute

The end of the year epidemiological figures on HIV/AIDS released by UNAIDS show that Sub-Saharan Africa continues to be the worst affected region of the world. Of the present global estimates of 42 million people living with HIV/AIDS, Africa is the home to more than 29 million. About 3.5 million HIV infections occurred in the continent during 2002, and more than 2.4 million Africans died of AIDS in the past year. Prevalence figures for several African countries continue to reflect this alarming rate of increase. The success stories in AIDS prevention are still very few and far between indeed. Yet each modicum of progress needs to be highlighted and encouraged. Apart from continued evidence from Uganda that some reduction has occurred, even though some sceptics continue to question the veracity of this assumption, some populations in South Africa and Ethiopia show some reduction.

One example is South Africa where there is a drop in prevalence figures among pregnant women from 21 per cent in 1998 to 15 per cent in 2002. Yet small steps are nothing to diminish the gloom of countries with general prevalence figures, such as Botswana with about 38.8 per cent, Lesotho (31 per cent), Swaziland (34.4 per cent) and Zimbabwe (33.7 per cent). Relate this state of affairs to the current food crises in the southern African sub-region, and the picture is very bleak indeed. A worse scenario could not be imagined than one that situates famine in the context of HIV/AIDS; two mutually reinforcing catastrophes at once interrelated and self-propelling.

Orphans and vulnerable children
Undoubtedly the heaviest impact of HIV/AIDS is on children. They are the innocent victims of the pandemic. Through no fault of their own they become infected in parent-to-child transmissions. They also become infected through sexual contact with adults—sometimes even before they reach puberty. Such contacts are often the result of various kinds of coercion: such as in instances of seduction with money and presents, and rape by men who are afraid of sex workers whom they regard as likely to be infected with Sexually Transmitted Infections (STIs). Worse still is the fact that many children, whether infected or not, may eventually become orphaned, without the love and care of parents, and left to fend for themselves in a harsh and cruel world. Children who belong to the former category, that is, those who are infected, would appear to constitute no problem for those who find time to grapple with how to define ‘AIDS orphans’. Such children would be neatly slotted into the category ‘Persons Living with HIV/AIDS’. When that occurs, their problems are treated as similar to persons with AIDS rather than those of a particularly vulnerable group that requires special attention.

AIDS orphans, as we all know, are defined by UNAIDS as children under the age of 15 who are HIV negative and have lost their mother or both their parents due to AIDS. There is some sense to the logic of this categorisation. For one thing, problems of orphaned children seem much more acute with loss of the mother, and it may not only be trivial to point out that while the mother is always determinable, we can never be absolutely certain as to who the genitor is.

The phenomenon of the protracted absence of husbands, or mothers’ partners to look for jobs elsewhere, under conditions that do not allow for co-habitation of spouses, is very common in many societies in Africa. And, perhaps, this is why the demise of such a person would not impact heavily on the ordinary life situation of the family. Father-hood is a social role, something that might easily be provided by any close male relative of the mother. Such is, perhaps, the logic underlying this definition. But empirical facts show cases in which the death of the male spouse has a momentous impact on children. Property grabbing and disinheritance of children are just two of the consequences of the death of the father in Africa. For such reasons some countries have resorted to their own working definitions of AIDS orphans, while others have consciously eschewed the use of the term ‘AIDS orphans’. In Uganda, orphans are children below the age of eighteen who have lost one or both parents, thus sidestepping the issue of AIDS. Malawi does not accept the label AIDS orphans. Both countries would accept as more appropriate the label ‘Orphans and Vulnerable Children’ (OVC), an appropriate label that covers a very important category that ought to be the focus of attention.

Be that as it may, whether infected or not, all children are vulnerable. But children who have been affected by HIV/AIDS are not only vulnerable but also potentially susceptible to the pandemic. Indeed, it is this vulnerability that fuels susceptibility to the disease, be it through rape, coercion, or finding oneself compelled to resort to sex work to survive.

Until a cure or an effective vaccine for the disease is found—a prospect still as distant as ever—or until most of those infected have access to anti-retrovirals that can arrest the progress of the disease, all those infected will continue to die. When they do they will leave orphans and vulnerable children behind. It is sometimes easy to forget this fact: a current reduction in prevalence figures does not immediately result in a reduction in the prevailing number of orphans. This is partly the reason why Uganda has about 2 million orphans, one of the highest in the wake of the AIDS pandemic, although it is, by any measure, one of the few success stories in AIDS prevention.

Intergenerational spread
Intergenerational spread is still one of the gravest problems that HIV/AIDS prevention has to address. By this I do not mean cases resulting from, say, disparity in age between spouses, but the conscious targeting of younger girls for sex by older men who rationalise that younger girls are less likely to be infected. Orphans and vulnerable children, particularly females, are often the easy prey of such targeting. My research data contains scores of instances where children have become infected through inter-generational sexual contact. Avoiding sex workers and pursuing younger girls might perhaps constitute the rational end of a behavioural spectrum that ranges from targeting younger girls for fear of sex workers, through to behaviour where it is not only young girls who are targeted, but also virgins and babies.

The far end of this spectrum is further propelled by the belief that sex with virgins cleanses the diseased male body. There is little doubt that such belief exists, my research data affirms this. It is, however, not easy to determine the extent to which such belief underlies the actions of men who rape babies. Several cases have emerged in recent years in which children have been raped. This is truly one of the sinister sides of the HIV/AIDS pandemic: the rape of babies. How do we go about protecting children from such trafficking and targeting? Would there be a point in, for example, putting such men through sensitisation programmes in which they would be made to see how unacceptable their behaviour is? Could one start with an ethical injunction, similar to that of Kantian categorical imperative (even if that was predicated on the assumption that all people were as rational and good as the venerable professor himself; one that assumes that there is some form of a universal good that is also good for all mankind?). For some brief deluded moment, I had thought that that was the answer to ‘virgin rapes’ when I pondered on men who force themselves on young girls in the belief that they would get rid of their infections. Make such men see the whole issue from the point of view of a similar imperative, by framing it as one in which they were made to consider the prospect of another raping their own daughters to rid himself of a venereal infection. Would the outrage of such a reflection conjure up a picture so abhorrent that it would cure them of any such inclination?

The impact of poverty
But reality is more complex than that. A case recently reported from South Africa suggests that the answer is not so simple. A mother had sold her own baby daughter to some men to be raped. She explained her action in terms of the need for money to feed her remaining children so that they might survive. She had several children who were on the verge of starvation. Selling her own baby was as rational and, perhaps, as ethical a choice as any we might envisage. Poverty is thus also one of the spectres that drive the AIDS pandemic. But would an improvement in economic standards for the worst hit countries result in a reduction of the infection? Would this result in an immediate ability to manage and survive the pandemic? The answers to these questions would vary even among the experts who work with HIV/AIDS prevention. But they would all agree that poverty is a great friend of the HIV/AIDS pandemic. It is partly poverty that drives people to resort to behaviours that are risky. It is not true to say that poverty is the cause of AIDS, or even that it is only among the poor that the worst impact is found. Nonetheless the impact of HIV/AIDS on children who find themselves in abject poverty is greater than on those who live in relatively wealthy circumstances.

Current figures tell us that there are about 14 million children orphaned by HIV/AIDS worldwide. Such figures are too horrendous for us to be able to comprehend their impact. We need to go down to the micro level to see what might well epitomise the fate of many of the children who are buried in such statistics. The following is the fate of three children that I became acquainted with in July 1993. Their mother died while we were interviewing on the quality of care for HIV/AIDS patients. The father had left the family six years earlier to work in South Africa and lost contact with his family. We helped transport the children to their grandparents’ home about fifty kilometres away, in accordance with the last wishes of their mother. Meeting the grandparents conveyed the sad fact that the new home of the children would be short-lived. They were frail and weak and we knew that the children would soon be going through yet another bereavement within a short period of time.

Four months later I returned to Zambia and decided to visit the children together with a medical colleague. The grandparents had died of malaria and the children had now moved to their maternal uncle and aunt. I once again visited them in their new home. To my despair I knew immediately that the new caregivers were most probably living with HIV/AIDS: obvious loss of weight, recurrent diarrhoea during our two-hour visit, and lesions that my medical colleague suspected were a form of kaposis sarcoma and which were quite apparent, led to this conclusion. The children had then been living in the new home for two months. They seemed happy and received much love and tenderness from their aunt and uncle. Three months later and within an interval of two weeks both the new caregivers had died.

The children now live in their original home where they are described as a ‘child-headed household’. They fend for themselves with the support of the local community. Within the span of just nine months these children had gone through three bereavements. They had moved from home to home and lost their caregivers, just as they were getting settled emotionally and spatially. Movement from home to home also meant dropping out of school. What such repeated trauma does to children, is for psychologists to speculate upon. The child-headed household I have described encapsulates some, but not all, of what orphans have to live through. They are the true orphans of the storm; caught in an existence that forebodes an almost inevitable disaster.

Literature on children affected by HIV/AIDS
Bandawe, C.R. and J. Louw, ‘The experience of foster care in Malawi: A preliminary investigation.’ In Child Welfare, LXXVI, 1997.
Barnett, T. and A. Whiteside, AIDS in the Twenty-First Century. London: Palgrave, 2002.

Bennell, P., K. Hyde, and N. Swainson, The Impact of the HIV/AIDS Epidemic on the Education Sector in Sub-Saharan Africa. Centre for International Education, Sussex, 2002.

Bourdillon, Michael (Ed.), Earning a Life: Working Children in Zimbabwe. Harare: Weaver Press, 2000.

Burman, S., ‘Intergenerational family care: Legacy of the past, implications for the future.’ In Journal of Southern African Studies, no. 22, 1996.

Connolly, Mark, Principles to Guide Programming for Orphans and Other Children Affected by HIV/AIDS. New York: UNICEF, 2001.

Dane, B. and C. Levine (Eds), AIDS and the New Orphans: Coping with Death. Auburn House, 1994.

Drew, R.S., C. Makufa and G. Foster, Strategies for providing care and support to children orphaned by AIDS. Mutare, Zimbabwe: Family AIDS Caring Trust, 1998.

Foster, G., C. Makufa, R. Drew and E. Kralovec, ‘Factors leading to the establishment of child-headed households—the case of Zimbabwe’. In Health Transitions Review no. 7 (Suppl 2), 1997.

Foster, G. and J. Williamson, ‘A review of the current literature on the impact of HIV/AIDS on children in sub-Saharan Africa’. In AIDS, no. 14(3), 2000.

Hunter, S. and J. Williamson, Children on the Brink: Strategies to support a generation isolated by HIV/AIDS. New York: UNICEF/USAID, 2000.

James, Allison, C. Jenks and A. Prout, Theorizing Childhood. Cambridge: Polity Press, 1998.

Matshalaga, Neddy, Sustainability of the Community Based Orphan/Children in Difficult Circumstances Care Programme in Masvingo and Mwenezi through Community Income Generating Projects. A Consultancy Report for UNICEF, July 1997.

Parry, Sue, ‘Community care of orphans in Zimbabwe: The Farm Orphans Support Trust (FOST)’. Paper presented to a conference on Raising the Orphan Generation: Organised by Children in Distress, held in Pieter-maritzburg, 9–12 June 1998.

Tout, Ken, ‘Grandparents as parents in developing Countries’. In Ageing International, vol. XXI, no. 1, 1994.

Webb, D., ‘Orphans in Zambia; Nature and extent of demographic change, AIDS Analysis Africa.’ In Southern Africa Edition, vol. 6, no. 2, 1995.