The Growth of AIDS Orphans and Policy Solutions

[Guest guest]

Do you realize what this disease has done in a little over 20 years time.

 

Why do we not hear about it in our media?

 

Frank

 

 

 

http://www.medscape.com/viewarticle/449677?mpid=10649

Legislative and Policy UpdateThe Growth of AIDS Orphans and Policy Solutions

 

 

Meier, JD, MPH, BSN, RN

Pediatr Nurs 29(1):75-76, 2003. © 2003 Jannetti Publications, Inc.

Posted 03/03/2003Introduction

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).

 

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).

 

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.

 

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.

 

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.

 

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.

 

References

Alagari, P., Summers, T., & Kates, J. (2002). Spending on the HIV/AIDS epidemic:

Global spending on HIV/AIDS in resource poorsettings. Menlo Park, CA: The Henry

J. Kaiser Family Foundation.

 

Altman, L. (2002, July 11). AIDS may leave 20 million African orphans. New York

Times,A12.

 

Human Rights Watch. (2001). Findings on AIDS-affected children in Kenya.

Retrieved November 25, 2002 from www.hrw.org/reports/2001/kenya United Nations

Children's Fund (UNICEF). (2002a, July). Children on the brink: A joint report

on orphan estimates and program studies.New York: UNICEF.

 

United Nations Children's Fund (UNICEF). (2002b, July). Orphans and other

children affected by HIV/AIDS fact sheet. New York: UNICEF.

 

United Nations Children's Fund (UNICEF). Children orphaned by AIDS: Front-line

responses from eastern and southern Africa.New York: UNICEF.

 

 

 

 

Meier, JD, MPH, RN, has 20 years of professional experience as nurse,

U.S. Senate staffer, health attorney, and health lobbyist. Ms. Meier is

currently the director of a health-policy consulting firm and represents several

health care advocacy groups.

 

 

 

 

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