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close this bookThe Status and Trends of the HIV/AIDS Epidemics in the World MAP Provisional Report (UNAIDS, 1998, 32 p.)
View the document(introduction...)
View the documentMonitoring the AIDS Pandemic (MAP) Network
View the documentPrevious Reports Produced by MAP
View the documentAcknowledgments
View the document1. Introduction
View the document2. The State of the HIV/AIDS Epidemic
View the document3. Migration and HIV
View the document4. Inequities in Care and Support for Those Infected With and Affected by HIV
View the document5. Mother to Child HIV Transmission: The Potential Global Impact
View the document6. HIV Transmission in the Health Care Setting
View the document7. Orphans
View the document8. Interactions Between TB and HIV programmes
View the document9. The Global Map of Neglected Behaviours: Knowledge and Action Gaps
View the document10. General Recommendations
View the document11. List of Participants

7. Orphans

It is generally accepted that children born to HIV-infected mothers have about a 33 percent chance of being infected through maternal transmission. This means that two-thirds will not be infected. However given that the incubation period is approximately 6-8 years, those children not infected will be orphaned. Orphans continue to be considered orphans until they reach the age of 15. The importance of orphaning resulting from the epidemic has not been fully appreciated nor planned for, although there has been some consideration of this in certain countries and from certain agencies.

The MAP meeting reviewed the state of knowledge regarding orphans and examined alternative estimates on the numbers of orphans and likely future trends. A number of critical issues are at work which emphasise the importance of this issue. The number of orphans resulting from AIDS mortality is large and is expected to increase rapidly in the near future. UNAIDS estimates that already over 8 million children have lost their mother due to AIDS. As the peak in the incidence of orphaning will occur only once the peak in AIDS cases is past, the orphan issue is bound to be a long-term one, requiring increased attention and long-term solutions.

Furthermore, most analyses have not addressed the fact that estimates of the number of orphans due to AIDS are in addition to the number due to non-AIDS causes. This means that whatever the magnitude of orphans due to AIDS, the real problem will be much greater. In addition, due to technical difficulties, most analyses have only estimated the number of children whose mother has died. Some research has shown that the total number of orphans may be two to three times the number of maternal orphans.

Orphanhood impacts on children in a variety of ways. The following areas were discussed:

· Loss of family and identity;
· Psychosocial distress;
· Increased malnutrition;
· Loss of health care, including immunisation;
· Increased demands for labour;
· Fewer opportunities for schooling and education;
· Loss of inheritance;
· Forced migration;
· Homelessness, vagrancy, starvation, crime;
· Exposure to HIV infection;
· Exploitation and exposure to violence; and
· Gender differentials in impact.

Based on recent estimation efforts, the number of orphans created by current epidemics is reasonably well known. What is not known are the age patterns, gender differences, or the situation of these orphans in the households and communities in which they live.

The numbers of orphans in countries with severe HIV/AIDS epidemics is already straining the ability of extended families and communities to absorb and provide for these children’s needs. It is unclear how much coping can be expected of families and communities. How much of the inevitable gap in support will be taken up by the state? And what can civil society, with the support of government and the international community, do to help? These are questions that must be faced in the next decade, and there are no easy answers.

In the countries of Eastern Europe and the CIS the numbers of AIDS cases and hence orphans may be small in absolute numbers, but may represent a significant increase in percentage terms. In addition, the effects may be exacerbated in this region, where there is a history of relying on the state for support, while the current state system is contracting and its capacity to provide care decreasing. Some examples of innovative community response include selected programmes in Uganda, the Child-Headed Household programme in Zimbabwe, and programmes in Zambia. Despite these examples of effective programs, none has been replicated even nation-wide, nor has there been any attempt to document “best practices” for global application.

Directions for action

There is an urgent need for information of what has worked and what has not in terms of care and support for affected children in diverse cultural settings. Best practices need to be identified for use by communities and programme planners.

Additional research on the circumstances of orphans must be undertaken, including studies of their characteristics and circumstances and the differential impact of maternal, paternal, and double orphaning.

Policy makers should ensure policies and programmes address the different needs of girls and boys as well as adolescents versus younger children.

Governments and communities should incorporate the care and support offered by traditional institutions (religious, social and grassroots) into their overall programme planning.

Finally, all those involved need to recognise the right of children’s voices to be heard, considered and given due weight in determining their care and support needs.

Orphans: A Looming Crisis

Already more than eight million children have been orphaned by AIDS in sub-Saharan Africa. It is projected there will be three million orphans in South Africa in the next 10 years. This issue was the focus of the Raising the Orphan Generation Conference” held in June 1998 in Pietermaritzburg.

In this conference, a number of orphan estimates were presented. The reported number of orphaned children under 18 years of age in Tanzania was 6 percent in 1991 and 26 percent in the Rakai district in Uganda. In Manicaland Province of Zimbabwe, 6.4 percent of children under 14 years of age had been orphaned by 1991, and in Zambia, 17 percent of children under 16 had lost their mother by 1996. A 1994 survey in the KwaZulu-Natal Midlands region in South Africa showed that 6 percent of children under 16 had lost their mother (due to various causes, including AIDS).

The Children in Distress Project has prepared estimated numbers of orphans through 2001 in Kwazulu-Natal. The numbers, shown below, indicate 150 thousand cumulative orphans in 1998 and over 300 thousand by 2001 (Source: CINDI Website).

Cumulative Orphans from AIDS - Kwazulu-Natal: 1991-2001

It is clear that AIDS will continue to orphan many thousands of children in KwaZulu-Natal. The state, the society, and the community are in no way prepared for the care and support which will need to be extended to these children. AZT treatment will reduce the number of paediatric AIDS cases, at an estimated cost of dollars 380 per patient, but will also serve to increase the number of orphans.