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close this bookCall to Action for 'Children Left Behind' by AIDS: A plea for communities, governments, civil society, the private sector and international partners to vigorously address the plight of children who are affected by the AIDS epidemic (UNAIDS, 1999, 5 p.)
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The new millennium dawns on a world facing an unprecedented human tragedy - the loss of millions of people to the AIDS epidemic. More than 16.3 million people have died. By the end of the year 2000, a cumulative total of 13 million children will have lost their mother or both parents to AIDS, and 10.4 million of them will still be under the age of 15.

More than 90 per cent of children orphaned by AIDS are in sub-Saharan Africa, and the numbers are increasing daily. In the next decade, the numbers of orphans are also expected to increase in Asia, the Americas, Central and Eastern Europe and the countries of the Commonwealth of Independent States. In industrialized countries, deaths have declined significantly, but AIDS remains a deadly menace in the absence of an effective cure.

The onslaught of AIDS on people of reproductive age is increasing the numbers of orphans at such a rate that communities cannot rely on traditional means of caring for these children. This is particularly true in many sub-Saharan African countries lacking adequate basic social welfare services. The inability of communities to respond adequately and appropriately to the situation has resulted in social, psychological and economic deprivation for the children, and this is likely to continue for the long term. Such deprivation is worse for girls whose parents have died, as these girls often have to care for their siblings and take on extra work, thereby reducing their opportunities for schooling.

Of course, AIDS affects children long before their parents die. The toll taken by the disease begins during the period of illness, continues through death and bereavement and will likely persist into adulthood if adequate support and protection are lacking. These extremely vulnerable children can suffer myriad problems and human rights abuses: the terrible stress of watching parents fall ill and die, grief for lost family members; a decline in nutritional status; loss of health care; increased demands for their labour; reduced opportunities for education; loss of inheritance; homelessness; discrimination; physical abuse; and sexual abuse, which in turn exposes them to HIV infection.

The absence of parental protection and care, combined with HIV-related illnesses, has contributed significantly to the increase in deaths of children under five in the countries most affected. AIDS has undermined the capacity of communities and households to cope and is hindering efforts to achieve goals for the survival and development of children, including the year 2000 goals agreed to by world leaders at the 1990 World Summit for Children.

Specific needs of children and families affected by HIV/AIDS

The onset of AIDS, in many developing countries, marks the beginning of a transition from poverty to complete destitution. The reality is most bleak in the worst-affected areas of sub-Saharan Africa, where over 50 per cent of the population lives below the poverty line.

Despite many obstacles, however, threatened communities around the world are struggling to support orphans and families affected by HIV and AIDS. However, among the constraints are the sheer numbers of orphans, which have the potential to overwhelm these efforts, the urban focus of many programmes, which therefore reach relatively few people, and limited coordination with government. These constraints have prevented the needs and rights of many children and families from being addressed.

With the relentless toll of AIDS reducing the ability of families and communities to support and care for children, we now face troubling scenarios: grandmothers struggling to care for orphans; households headed by children, many of them primary-school age, who are caring for younger siblings; and worse, children with nowhere at all to turn. Often compounding the devastation caused by AIDS is armed conflict, which poses the additional challenges of forced migration, displaced populations and further violations of rights.

These multiple crises surrounding AIDS call for the urgent and full engagement of all levels of society, which have a guide for action in two key international conventions: the Convention on the Rights of the Child (CRC), ratified by 191 countries, and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), ratified by 165 countries as of November 1999. By ratifying, countries have made themselves accountable for addressing the rights and needs of children and women, including those affected by HIV or AIDS.