|Investing in Our Future: Psychological support for children affected by HIV/AIDS. A case study in Zimbabwe and The United Republic of Tanzania (UNAIDS, 2001, 77 p.)|
|HIV/AIDS and children in Africa|
FACT: The number of people living with HIV/AIDS globally is 36.1 million, of whom 25.3 million reside in sub-Saharan Africa.
FACT: Current UNAIDS figures estimate that globally, 21.8 million adults have died of AIDS since the beginning of the epidemic, leaving an enormous number of children as orphans.
FACT: It is estimated that there are 1.4 million children living with HIV/AIDS globally.
FACT: 95% of the worlds orphans live in Africa
FACT: Africa is home to 70% of the adults and 80% of the children living with HIV globally.
FACT: UNAIDS and WHO estimate that in the year 2000, 3.8 million adults and children became infected with HIV and 2.4 million people at advanced stages of infection died of AIDS-related illnesses.
FACT: Before the advent of AIDS, approximately 2% of all children in developing counties were orphans. It is estimated that by 1997, this proportion increased to 7% and has today reached 11% in some countries.
FACT: There are 13.2 million children under the age of 15 whose mothers have died of HIV/AIDS since the beginning of the epidemic.
Source: AIDS Epidemic Update: December 2000, UNAIDS & WHO
The HIV/AIDS epidemic has had an enormous impact on the world, especially in sub-Saharan Africa. The increasing rate of HIV infection affects African children in countless ways and in nearly every aspect of their lives. The number of children living with HIV/AIDS continues to grow daily, as children are born to HIVinfected mothers, contracting the virus from their mothers during pregnancy.
In addition, there are millions of orphans who have lost at least one parent to an AIDS-related illness. Although the number of orphans is staggering, its effects are only just beginning. HIV/AIDS has seriously impacted upon children whose siblings, relatives or friends have HIV; children who are suffering from or have died of AIDS-related diseases, such as tuberculosis; and children whose homes are stressed with additional related orphans.
Girls are especially vulnerable to HIV/AIDS and the negative effects of the virus. They face the possibility of both physical abuse and the exploitation of their labour. When a family cannot pay school fees or there is sick parent who needs caring for, it is the girl child who is usually the first to drop out of school or to be given additional responsibilities.
The Effects of HIV/AIDS on Childrens Lives: Adapted from HUMULIZAS Manual for Psychosocial Support for Orphans
· Savings are used for medication/treatment and children must work to supplement the familys income.
· Illness reduces the economic performance of the household.
· Economic hardships make it necessary to look for alternative sources of income, for example through prostitution, street children, or early marriage.
· When both parents have died or are unable to care for their children, they are shifted into the homes of the extended family, often taxing the financial stability of those households.
· Inability to maintain or repair the home.
· Lower nutritional status in households with less income and many children.
· The presence of AIDS in the household, and the additional responsibilities and burden it brings on the family, may cause children to drop out of school.
· Due to unresolved psychological trauma, the school performance of children is negatively affected by HIV/AIDS.
· Traditional skills, passed through the generations, die with the parent before being taught to the children.
· Orphans face stigmatization by other children, including at school.
· In some communities it is taboo to take non-related children into ones home, especially if the children are sick.
· Dying is not talked about to children so they often do not understand what is happening in the household until the parent actually dies.
· Many times when a will is written it is disregarded by greedy relatives who leave nothing for the orphaned children.
· Medical concerns with opportunistic infections, such as tuberculosis, to other family members.
· Children and elderly people become the head of household.
· Poor families are more affected by losing a family member and may become impoverished forever, moving from poverty to destitution.
· This is the least visible effect because it is not tangibly seen.
· Emotional suffering appears in various forms for everyone (e.g. depression, aggression, drug abuse, insomnia, failure to thrive, malnutrition, etc).
· Children with sick parents worry about the future, where they will go and who will take care of them.
· Loss of consistent nurture, which can lead to serious development problems, and loss of guidance, which makes it more difficult for the child to reach maturity and to be integrated into society.
· Psychological damage can arise at any time after the event (months, days, and even years).
· Children may not understand the situation and therefore cannot express their grief effectively. Even if they want to express their feelings, there is often no one to listen.
· Population: 12
AIDS in Zimbabwe, end of 1999:
· HIV-positive adults: 1.4
Source: AIDS in Africa: Country by Country, UNAIDS, 200
A number of factors have contributed to the difficulties facing Zimbabwe today. These include the effects of the present political impasse, the declining value of the Zimbabwean dollar, rapid inflation, lack of investment, rising unemployment, escalating costs of living, the effects of frequent droughts and the emergence of HIV/AIDS.
The present political, economic and HIV/AIDS situation in Zimbabwe presents a number of challenges to individuals, families, communities, and especially children living with HIV/AIDS.
On an individual level, the income of HIV/AIDSaffected families dwindles, usually because the breadwinner is ill or the familys savings are spent on medical treatment. Children in these situations are often forced to drop out of school and to work. The situation is exacerbated when the prices of food and household goods increase.
Inflation has severely impacted upon the countrys health care system, more specifically on the diagnosis of HIV infection and the care of HIV/AIDS patients. Even diagnosing opportunistic infections is too costly for the majority of the population. For example, while treatment for tuberculosis is free, it costs a minimum of Zim$800 (US$16) to reach a diagnosis before treatment can begin. This excludes the cost of transportation and other expenses.
The fuel crisis in Zimbabwe has impaired the ability of AIDS organizations to care for families in need. In Harare, Mashambanzou is one nongovernmental organization (NGO) that provides food for HIV/AIDS-affected families. The scarcity of petrol inhibits volunteers for Mashambanzou and around the country from regularly reaching families with counselling, food, and blankets.
At the community level HIV/AIDS has placed an additional burden on the extended family system. This structure has provided security for children and families for generations. Traditionally in Zimbabwe, family elders would meet and assign a family member, usually the fathers eldest brother, to care for an orphaned child and raise the child as part of his own family.
Recently the capacity of families to cope with additional children has become more and more strained. Relatives are starting to look at their familial responsibility towards related children as more of a financial burden. There are additional problems for orphaned children without relatives owing to the stigma attached to caring for non-related children. In this emergency, additional support from outside sources is required to assist these children to cope.
Early marriage is regarded as an option for households absorbing extra children. A man may marry to obtain assistance in taking care of his dependants. A woman may marry to reduce the number of dependants in her familys household, as well as to obtain additional income through the bride price, i.e. money or goods given to the brides family by that of the bridegroom.
The death of a mother or father can leave unsettled debts which impact negatively on the future care and resources left for the remaining children. In severe cases, the family of a deceased woman may refuse to allow her burial until the surviving husband and his family have settled the outstanding debts.
We are four staying with our uncle. He is old. Our father died in 1998 and our mother died last year. I am the oldest girl. I am afraid what will happen to us if we all have to leave. Where will we go? Will we still be able to stay together? Will I have to care for my sisters and brother? I dont want to be a prostitute.
H.F., age 15, quoted in a FOST survey, September 1999
The majority of the population reside in the rural areas. It is estimated that there are presently two million people living on large-scale commercial farms in Zimbabwe, nearly 20% of the population. They help to produce major items of the countrys economy: tobacco, maize, cotton, sugar, groundnuts, horticultural produce and beef. One million children live on these farms.
A survey carried out in September 2000 by the Farm Orphans Support Trust (FOST) found that the average number of orphans at each farm was 12, as compared with 2 in 1994. The average age of orphans was 11 years and most of the children were not infected with HIV/AIDS.
Children living on farms face some challenges that are unknown to children living in towns. The livelihood and accommodation of families living on commercial farms is tied to their fathers employment, as workers do not own the land they reside on. Families affected by HIV/AIDS therefore face the prospect of losing their homes once their fathers or breadwinners pass away from HIV/AIDS, often resulting in young boys having to become the breadwinner to prevent this from occurring.
Stanley, 22 years old, works on a farm outside of Harare. His mother died in 1995 and his father, who also worked on the farm, died in 1998. Stanley is part of FOSTs programme.
After his parents died, Stanley became the head of his household, working on the farm to support his three younger brothers and sisters, aged 15, 11 and 9. He married a 15-yearold in May 1999, so someone would be at home to take care of his siblings while he is at work.
But the marriage that Stanley thought would solve his problems has only added to them. The children dont listen to his wife because they are nearly the same age. He still owes her parents a large amount of money for her bride price, for which he has had to borrow money to pay so far. A few months ago, they had a baby, so he must now support two additional people on his salary.
Stanley believes that if his parents had sent him to school his life today would be easier because he could get a better job. His father was a polygamist and couldnt afford to send all of his children from all of his wives to school.
Each month he gets Zim$1,100 (US$22) from the farmer to pay the younger childrens school fees and uniform expenses. He says that the youngest boys are very smart, always ranking first and second in their classes, so he hopes that they can complete school.
Stanley keeps hearing about the possibility of retrenchment from other workers on his farm and he is worried because he was born on the farm and doesnt have a birth certificate or an identity document, thus making it difficult for him to find work legally elsewhere. If he had money he would buy a bike and sell goods from farm to farm, but he doesnt have any capital to plan anything for the future. He feels like things are crumbling down on him.
The recent farm invasions have also affected the lives of children living on the farms, endangering their physical and psychological security. For example, there has been a reported increase in the instances of rape among young girls living on the farms, thus making young girls in these areas more susceptible to HIV infection.
· Population: 31
AIDS in Tanzania, end of 1999:
· HIV-positive adults: 1.3
Source: AIDS in Africa: Country by Country, UNAIDS, 2000
There are many traditional cultural similarities between Zimbabwe and the United Republic of Tanzania, such as early marriage and the bride price. However, more than 70% of Tanzanians live in rural areas and depend on subsistence farming. Living with HIV/AIDS in the rural areas is especially demanding for many reasons. Subsistence farming fulfils only the familys immediate needs, so when the breadwinner becomes ill, there are no food or monetary resources on which to draw.
The epidemic is most severe in Dar es Salaam and in the north-western part of the country, where there are a large numbers of refugees from neighbouring Rwanda, Burundi and the Democratic Republic of Congo.
AIDS education is part of the national school curriculum; however, there is little general knowledge about the virus, especially in isolated rural areas. Access to health care can be difficult because of the distance, the road infrastructure and the lack of vehicles for transportation. There is also the problem of finding available HIV tests and confirming an HIV-positive diagnosis, even within health care facilities.
The United Republic of Tanzania is a traditional society where even in the language youth respect their elders. This can be illustrated by the Swahili word for greeting an older person, shikamoo, which means, I am beneath you. This respect keeps order in society, but is a challenge to AIDS education. Breaking taboos, such as talking about sex or death with someone who is older and therefore more knowledgeable, is difficult. Writing a will also goes against tradition, and upon the death of a husband, his family generally takes as much of his property as possible, often leaving the widow and children with nothing.
Whenever a particular 15-yearold girl would attend a counselling session, she would cry and cry and say nothing else. When the counsellor asked her what was wrong, she would complain of headache and stomach problems. The counsellor went to her grandparents with whom she was living as both her parents had died when she was 6, but they said she cried every night and wouldnt say why.
In a discussion between the counsellor and the girl, she explained that she had been sick for a long time and was worried about her chest. Finally she admitted that she thought she was HIV-positive. When the counsellor asked her why she thought she was HIV-positive, the girl said that her mother and her father had died of AIDS when she was young. Her grandparents had told her that her mother had chest problems and flu, and the girl also had chest problems and flu, so she just knew she was going to die. The counsellor explained to her how HIV is transmitted until she understood that she probably had not contracted the virus from her parents, but that she could go for a test. She had been expecting to die ever since her parents died, because she had thought that if someones parent had died of AIDS, then no matter what, the child would also die of AIDS. A few months later, following an HIV/AIDS test that revealed she was negative, she had peace of mind again. Her pain was gone, both physically and psychologically. She stopped crying at night and was enjoying playing with the other children.
Anonymous, her story was taken from a HUMULIZA counselling session
It is projected that by the year 2010, there will be 4.2 million orphans in the United Republic of Tanzania. However, before this time, the countrys support systems need to be strengthened to be able to cope with the needs of these children and to promote HIV/AIDS awareness, especially in rural areas.
My parents are special,
My parents loved us,
They were great to us,
My parents enjoyed being with us,
Parents are special,