Foreword

The magnitude of the epidemic has highlighted in stark colours the needs of orphans and vulnerable children. By the end of 2000 36.1 million people were estimated to be living with HIV/AIDS, of whom 34.7 million were adults. Africa is home to 70% of these adults. Many of these adults, because of the ages of those most vulnerable to HIV infections, are also parents. In one year alone, 2000, 2.5 million adults died of AIDS.

Coping with the cumulative impact of over 17 million AIDS deaths on orphans and other survivors, on communities, and on national development is an enormous challenge, especially in African countries with social and health services already reeling from lack of human and financial resources. To date in the world, 13.2 million children younger than 15 years of age have lost either their mother or both parents to AIDS, with 95% of these children living in sub-Saharan Africa.

In spite of all hardships and stigma, these children also have a right to education, affection and cultural identity, as well as to services for the care of children. They have a right to be heard and to be protected from abuse, neglect, maltreatment and exploitation. They have the usual needs of children, including economic, social, educational, medical and psychosocial needs.

Of these, the latter has probably been documented least in Africa. The psychological effects are the least tangible and the most difficult for adults to address. And yet they impinge on all aspects of a growing child. “The devastation wrought by HIV is very real, whether the impact is measured in terms of children’s future prospects or companies’ bottom line.”

Parents and organizations, religious leaders and counsellors are daily facing painful choices in relation to children: to disclose the parental HIV status; to involve children in home care of the sick; to talk about the dying and death of a parent or sibling; to find ways and means of postponing orphanhood; and to secure the best future possible for each child, even in the midst of massive constraints.

This case study, based on years of experiences in Zimbabwe and the United Republic of Tanzania where these situations are regularly confronted, describes efforts to address the tough questions related to the rights and needs of children affected by HIV/AIDS, with a focus on their psychosocial needs. We hope that the effect of listening and talking to these children affected by HIV/AIDS will be to make their perspective much better known to adults who are working with millions of vulnerable children, not only in these countries, but also beyond.

Bunmi Makinwa and Sandra Anderson
UNAIDS Intercountry Team for Eastern and Southern Africa
Pretoria, South Africa