In the countries most affected by HIV/AIDS, there has been
growing concern over the number of orphans, a problem that has increased largely
as a result of the pandemic. It has been difficult to track this trend because
there are few estimates of the number of orphans caused by AIDS and because
those estimates that do exist often are not comparable from one country to
another. However, the needs of these children and their growing numbers mean
that governments, donors, nongovernmental organizations, religious bodies, and
others concerned about child welfare must take this trend seriously.
According to the U.S. Census Bureau, 15.6 million children
will have lost their mothers or both of their parents by 2000 in 23 countries
heavily affected by HIV/AIDS. That number will increase to 22.9 million by 2010,
largely as a result of the HIV/AIDS pandemic. Nineteen of these countries are in
Sub-Saharan Africa, where by 2010 these orphans will comprise up to 8.9 percent
of children under age 15. The sheer size of the population at risk for HIV/AIDS
in Asia means that the problem of orphaning there will eventually eclipse that
of Sub-Saharan Africa. The number of orphans will continue to grow in Latin
America and the Caribbean, where the pandemic started later.
The
Census Bureau has estimated the number of maternal orphans (children who have
lost their mothers) and double orphans (those who have lost both parents) in 23
countries hard-hit by HIV/AIDS.
The number of orphans in these countries is projected to grow sharply, largely
as a result of the epidemic. However, these figures do not convey the full
impact of HIV/AIDS on children and families in these countries. In order to
develop a fuller picture of this impact, the U.S. Agency for International
Development (USAID) contracted two independent researchers to expand the Census
Bureau estimates of maternal and double orphans to include the number of
paternal orphans (children who have lost their fathers).
Tracking
the projected growth in the number of paternal orphans provides a better
understanding of the impact of HIV/AIDS on children, for several reasons. The
loss of a parent has profound significance for a child. The death of a mother,
in particular, has dramatic psychosocial consequences. Children lose love and
nurturing, and their households may break up, with siblings sent to live with
different members of the extended family. Loss of a father often means the loss
of income and results in economic deprivation. When a father dies of AIDS, the
children often lose their mother as well, to illness or for social reasons.
When paternal orphans are included, the total number of
orphans from all causes is projected to increase from 34.7 million in 2000 to
41.6 million in 2010 in these 23 countries.
Orphans
are classified into three types:
Maternal orphans are children
under age 15 whose mothers have died.
Paternal orphans are children
under age 15 whose fathers have died.
Double orphans are children under
age 15 whose mothers and fathers have both died.
The
total number of orphans is the sum of the numbers in each
category. |
Source:
Paternal orphans: S. Hunter, 1997; Double and maternal orphans: U.S.
Bureau of the
Census. |
The growing number of orphans will have a profound impact on
the societies in which they live. Orphans may suffer the loss of their families,
depression, increased malnutrition, lack of immunizations or health care,
increased demands for labor, lack of schooling, loss of inheritance, forced
migration, homelessness, vagrancy, starvation, crime, and exposure to HIV
infection. With orphans eventually comprising up to a third of the population
under age 15 in some countries, this outgrowth of the HIV/AIDS pandemic may
create a lost generation — a large cohort of disadvantaged, undereducated, and
less-than-healthy youths. The threat to the prospects for economic growth and
development in the most seriously affected areas is considerable.
The vulnerabilities of these children are increased by the
geographic concentration of the HIV/AIDS pandemic — vulnerable children are
cared for by vulnerable families and reside in vulnerable communities. Many of
the communities most affected by HIV/AIDS are impoverished and isolated. Left
with little or no outside assistance, some have devised creative programs to
identify and assist the needy families in their midst, and there are
similarities among these community-based responses. For example, many include
mechanisms for assessing the needs of families and for monitoring the welfare of
affected children. Many also include labor-sharing arrangements for day care and
nutrition centers, agricultural work and other income-generating projects, home
repair, and home care for the ill and for orphans. Paradoxically, these
community-based support systems may be the least visible but most cost-effective
ways to help families affected by HIV/AIDS.
Our experience with orphaning as a social problem is limited.
Historically, orphaning on a large scale has been a sporadic, short-term
problem, caused by war, famine, and disease. HIV/AIDS has transformed orphaning
into a long-term, chronic problem that will extend into the next century. The
serious social and economic dislocation that will result from the large and
growing proportion of children who are orphaned will require comprehensive,
creative, and long-term solutions.
In addition, we know that the impact of HIV/AIDS will vary
widely from country to country, even within regions of high seroprevalence. For
example, on average 16.2 percent of children under the age of 15 will be
orphaned from all causes in the 19 African study countries by 2010, but that
proportion will be over 25 percent in eight of these countries (Rwanda,
Tanzania, Uganda, Botswana, Malawi, Zambia, Zimbabwe, and Burkina Faso).
|
HIV/AIDS
and Orphans |
|
Orphanhood
peaks seven to ten years after seroprevalence. |
|
Orphan
populations in Sub-Saharan Africa will continue to grow until at least
2010 and may not peak in some countries until after 2020. |
|
The
problem, already serious, will become much worse. |
|
By
2010, about 13.5 percent of children under age 15 in the study countries
will lose one or both of their parents to AIDS and other causes. |
|
In
the four non-African study countries, the number of orphans peaks earlier
because of declining fertility rates and decreases in the number of
children born, rather than to declining HIV-infection rates. |
|
Initial
seroprevalence is lower in West Africa, and therefore the epidemic may
peak at a lower level and later than in other parts of Sub-Saharan
Africa. |
The problems of children affected by HIV/AIDS begin long
before their parents die and extend beyond their individual households to affect
relatives, neighbors, and whole communities. Interventions to respond to AIDS
orphaning therefore must target communities and must include all children affected by HIV/AIDS, not
just those whose parents have been infected with HIV or have died from
AIDS.
Coupled with the displacement of children from other causes,
including natural disasters, war, and genocide, the number of children without
parents promises to be extraordinary in some countries. Even if development
assistance were increased, which is unlikely, it will be inadequate to address
the problem. New approaches — including policy innovations for women and
children — must be developed within the next few years to nurture and develop
local efforts to assist families and communities.
This report was developed by two independent researchers
contracted by USAID to review the situation of AIDS orphans. The authors, who
have been engaged in assessing and addressing this problem for several years,
reviewed and synthesized a substantial amount of information available on
children affected by HIV/AIDS in developing countries.
The study includes Bureau of Census estimates of maternal and
double orphans caused by AIDS and by other causes in 23 countries, as well as
complementary estimates of the population of paternal orphans, developed by one
of the authors using census data from developing countries and previous large-
and small-scale studies of orphans. The report also describes how the burden of
increased orphaning is affecting individuals, families, and communities and
what the response has been by those affected as well as by governments and aid
organizations. The authors identify issues that need to be discussed and
considered by organizations that seek to address development, child welfare, or
HIV/AIDS issues. Finally, the authors provide their perspective on guidelines
for assisting children, families, and communities affected by HIV/AIDS and
outline six intervention strategies.
The
Demographic Effects of HIV/AIDS
In 1994, the U.S. Census Bureau estimated the impact of AIDS
deaths on the populations of 14 countries that had seroprevalence levels in
urban areas above 5 percent.
In 1996, 19 countries had reached this seroprevalence threshold, all but two of
which are in Sub-Saharan Africa. This study focuses on these 19 countries, as
well as two countries where seroprevalence is approaching 5 percent and two
additional countries for which sufficient data are available to accurately
estimate the impact of HIV/AIDS. (See Annex Figure A–1 for the projected impact
of HIV/AIDS in these 23 countries.)
|
The
Demogrpahic Effects of HIV/AIDS |
|
Crude
death rates may double or triple, and life expectancy may fall. |
|
Population
growth may flatten or become negative. |
|
Infant
and child mortality may increase to levels that are two to five times
those that would be expected without HIV/AIDS. |
|
Dependency
ratios may worsen due to AIDS-related illnesses among adults. |
|
The
age distribution of the population in some areas will be affected by
HIV/AIDS, which has a greater impact on young people. |
|
Gender
ratios may shift in some age groups because of higher infection rates and
mortality in women. |
|
The
number of widows may increase, and their socioeconomic condition may
worsen. |
|
Household
composition will change as middle-aged parents die, and grandparents are
left to raise young children. |
Countries may experience the most severe demographic effects
of HIV/ AIDS years after the height of the epidemic. For example, the
number of orphans peaks seven to ten years after seroprevalence. These
demographic effects are now apparent and are expected to increase in
Sub-Saharan Africa, where the epidemic began early. They will become
increasingly evident in the next decade for countries in Latin America and Asia,
where the epidemic began later.
n
Total
Population Loss. By 2010, the total population loss resulting from AIDS in
these 23 countries is expected to be 76.2 million. The six East African
countries in this group are expected to lose 28.6 million people, the six
Southern African countries are expected to lose 17.3 million people, and the
seven Central and West African countries are expected to lose 18.9 million
people. The population loss in the four non-African countries is projected to
total 11.4 million. These losses will be the result both of very large increases
in adult and child mortality and from low fertility rates, as well as to some
reduction in births caused by the premature death of women of childbearing
age.
n
Population growth rates. AIDS is
expected to reduce population growth rates to less than half of their expected
levels by 2010, and they may remain low or negative for many years. In most
countries, total population growth will remain positive because fertility rates
will remain high. However, in three countries — Botswana, Guyana, and Zimbabwe —
fertility rates may drop sufficiently to result in negative population growth by
2010. Growth rates may near zero in Malawi and may slow to about 1 percent in
the Central African Republic, Kenya, Lesotho, Rwanda, South Africa, Zambia, and
Tanzania.
n
Crude
death rates. Crude death rates may be more than 1.5 times their present
levels for these countries overall, but the effects will vary by country. For
example, crude death rates are projected to increase by half in Ethiopia but to
more than double in Tanzania and Uganda. In the hardest-hit countries, including
Zambia, Zimbabwe, and Malawi, crude death rates may increase by three to six
times. The social costs of the rising number of AIDS deaths will be numerous,
including disruption of family and social structures and the omnipresence of
anxiety and grief.
n
Fertility
rates. Based on current trends, fertility rates can be expected to decline
only gradually in Sub-Saharan Africa, resulting in sustained increases in the
total population despite the increased mortality. Most simulation models assume
that HIV/AIDS will have no direct effects on fertility, which means that
seroprevalence levels would have to reach about 50 percent to offset the high
natural rates of population increase in most countries. However, a recent survey
in the Kagera Region of Tanzania suggests that increased adult mortality
reduces people’s desire for additional children. This effect is evident at the
community and household levels and is most pronounced when there have been
recent female deaths, presumably because of the added burden of orphans on the
surviving females. Other studies suggest that HIV has lowered pregnancy rates.
Increases in child mortality — another result of HIV/AIDS — generally increase people’s desire for
more children, but this effect has not been sufficient to balance the decreases
in the number of births caused by adult deaths. More data are needed in this
vital area because of the strong implications for future birth rates.
n
Life
expectancy. Since AIDS kills proportionately more young adults and children,
it will have a pronounced effect on life expectancy at birth in many countries.
Life expectancy will drop to 40 years or less in nine Sub-Saharan African
countries by 2010. Botswana, Kenya, South Africa, Zambia, and Zimbabwe would
have had life expectancies of 60–70 years without HIV/AIDS but will suffer
severe setbacks. Other countries that were making more modest but significant
improvements in life expectancy will also see severe reductions, including
Burkina Faso, Central African Republic, Malawi, Tanzania, and Uganda.
n
Age
distribution. HIV/AIDS also affects the age distribution of a population.
Currently, in all areas of the world except North America, Europe, the former
Soviet Union, and Oceania, the number of children under age 4 is greater than
the number of the adults over age 59. In Asia, the Near East, Northern Africa,
and Latin America and the Caribbean, this situation will change, and the
elderly will begin to outnumber the very young within the next decade. In
Sub-Saharan Africa, however, children under age 5 will continue to
outnumber adults over age 44. According to the Census Bureau, there will be
12 times as many children under age 15 as adults over age 64 in Sub-Saharan
Africa.
The proportion of the world’s children under age 15 who live in
developing countries will near 90 percent in 2020. As a consequence,
the impact of the epidemic on children and their families will be more
substantial in those countries.
AIDS mortality is less concentrated in specific age
groups than, for example, deaths caused by war. Nonetheless, the populations of
countries severely impacted by HIV/AIDS will be considerably
different than they would have been without HIV/AIDS. In general, population
pyramids, which chart the age breakdown of a population and show the
youngest segments at the bottom, will be less broad at the bottom reflecting a
decrease in the number of people in younger age groups. As with other population
effects of HIV/AIDS, the impact will vary by country depending on the age and
severity of the epidemic.
n
Infant
and child mortality. HIV/AIDS has a profound effect on the mortality of
infants (under 1 year of age) and children (under age 5), as a result of
interuterine infection and perinatal transmission. In all 23 countries included
in this study, AIDS–related mortality will eliminate the gains made in child
survival over the past 20 years. The effects will be most pronounced in those
countries that have made the greatest progress in reducing infant and child
mortality. In Zambia and Zimbabwe, infant mortality rates may nearly double, and
child mortality rates may triple. In Kenya and Uganda, infant mortality rates
are projected to increase by 50 percent, and child mortality rates are projected
to double. The effects may actually be more severe, however, because there may
also be increased mortality among HIV–negative children who live with an
HIV–infected parent because their nutrition, health, and survival rates may be
poorer than for other children. The number of children living with an
HIV–infected parent in Thailand, for example, are expected to be more than twice
the number of orphans by 2005, although this group will diminish as more
infected parents die of AIDS.
n
Dependency ratios. Overall, HIV/AIDS
will have only a slight impact on dependency ratios — the ratio of dependents to
economically active adults — because the epidemic kills children as well as
adults. However, dependency ratios can vary considerably in the short-term and
in particular areas according to the age of the epidemic and geographic
variations in seroprevalence. These short-run changes may require considerable
social adjustment. Moreover, dependency ratios may mask the economic
effects of the increased dependency of adults sickened by HIV/AIDS and the
fact that young people affected by HIV/AIDS often leave school or enter the
labor force at earlier ages.
n
Gender
ratios. Women face a higher risk of HIV infection than men. If HIV/AIDS
mortality is more concentrated in women, there may be fewer economically active
females. Because women are much more likely than men to be family caretakers,
this will affect the well-being of children and families. There may also be a
change in the gender ratios in certain age categories — for example, there could
be 1.5 men for every woman in some Sub-Saharan African countries within the next
20 years.
n
Widow(er)hood. The proportion of women
who are widowed increases in earlier years of the epidemic, although the
duration of widowhood will decrease if women are infected and die as a result.
Older people will experience economic setbacks because of the loss of support
from their children who die from HIV/AIDS. Those who will lose the most are
elderly women, who not only will be burdened by caring for the very young but
will also experience a drastic deterioration in their social and material
resources for coping with this burden. The vulnerability of grandmothers will
ultimately affect the grandchildren in their care.
n
Household
composition and/or co-residence. With increased mortality among adults aged
19 to 49, those in older age groups will assume more responsibility for
providing care for the family and for the ill. The proportion of households with
three resident generations will decrease, as middle-aged parents die and
grandparents are left with children. The number of households with orphans,
which is already a substantial proportion of the total, will increase. A
Ministry of Health study in Zambia estimated that 40 percent of households may
have one or more orphans in the future and that 16 percent may be headed by
widows. The 1995 Uganda Demographic and Health Study found that 25 percent of
all households included foster children under age 15.
The
Socioeconomic effects of HIV/AIDS
|
The
Socioeconomic Effects of HIV/AIDS |
|
Growth
of GDP per capita will decline slowly by steadily. |
|
Labor
shortages may arise, affecting household production and production in
commercial agriculture and industry/ |
|
More
households will be impoverished because of lost productivity and lost
access to markets. |
|
Child
labor will increase inside and outside the home because of the scarcity of
adult labor. |
|
Nutritional
status may suffer because of the decline of household labor for
subsistence agricultural production. |
|
Social
services will be stressed. |
|
Health
care will become less accessible as conditions related to HIV/AIDS stress
hospital and home care systems. |
|
School
enrollment will decline due to increased mortality of children under age 5
and increasing demands for child labor. |
In addition to reversing gains in infant and child mortality,
adult longevity, and general health, HIV/AIDS threatens to reverse the
socioeconomic gains made by many developing countries. The relationship is
bidirectional. On one hand, many of the patterns of recent social and economic
development created the conditions that have allowed the spread of HIV/AIDS,
including male labor migration, underemployment of women, civil strife, refugee
movements, urbanization, structural adjustment, and increasing poverty. On the
other, HIV/AIDS will cause fundamental social and economic changes in countries
with high seroprevalence levels that will affect the demand for labor, the
availability of social services, access to health care, educational
opportunities, and the rates of poverty at the household level.
The World Bank’s 1993 World Development Report noted that HIV
infections were a leading cause of disability and death and predicted an annual
slowing of growth of income per capita by 0.6 percent in the 10 worst-affected
countries in Sub-Saharan Africa. Others argue that net effects may not be
visible on the aggregate level. But, as one observer commented about the Asian
epidemic,
that doesn’t mean...countries
aren’t paying a price; it’s just being exacted at the local level. The economic
effects of HIV/AIDS...are felt most strongly by families, communities and
[small-scale] industries such as fishing and trucking.
The effects of HIV/AIDS will be uneven among households and
communities but will encompass the following areas:
n
Social
Services. The added strain and pressure that coping with HIV/AIDS places on
families and households may result in increased child abuse and neglect. In many
of the countries most heavily affected by HIV/AIDS, social service and welfare
agencies are the most understaffed and underfunded parts of the government, and
the safety net for impoverished and stressed families is nearly nonexistent. If
these types of agencies are strengthened, they can play an important role in
assisting children, families, and communities; preventing abuse; and fostering
cooperation among nongovernmental and community-based organizations.
n
The
well-being of individuals and households. The costs of HIV/AIDS– related
illness and death can be enough to send a household into permanent poverty or
from poverty into destitution. Per capita and household income will decline as
more families are thrown into poverty by costs of illness, health and hospital
care, and support of orphans. The loss of women’s labor in the home and in
agriculture will create critical deficits in food supplies and potentially in
exports. The loss of female caretakers for sick adults and children will lower
the overall welfare of families and communities and reduce their ability to
provide mutual assistance. As a consequence, children will have weaker household
systems of care and protection and will be forced to assume adult roles in the
home and in external labor markets.
n
Demand
for labor. HIV/AIDS causes illness and death among adults in the most
productive age groups. The costs of absenteeism and reduced
productivity may be higher than the costs of eventual deaths. HIV/AIDS
will significantly slow the growth of the labor force and will create labor
shortages in certain markets. For example, the growth of the number of workers
in Thailand is projected to be 12 percent less than anticipated in the 1990s due
to HIV/AIDS mortality, which has led some businessmen to pay for HIV/AIDS
prevention programs. In many areas of Sub-Saharan Africa, companies are
contributing not only to HIV/AIDS prevention programs but also to vocational
training and educational programs to develop replacement labor. A study in
Uganda estimated there would be 2 million fewer people in the working age groups
by 2010, 12 percent less than without HIV/AIDS.
n
Urban
poverty. Higher seroprevalence in urban areas will aggravate the situation
of the urban poor more than the rural poor, who have broader household and
community support systems and can fall back, to some extent, on household food
production as their incomes decline. Reverse migration of urban dwellers to
rural farms may provide a safety valve, particularly for HIV–infected people and
HIV/AIDS orphans, but large influxes may overwhelm the resources of rural
relatives, particularly if they add to the burden of caring for those ill from
HIV/AIDS.
n
Agricultural production. Household food
production will become less labor-intensive and probably less nutritious.
Commercial production by smallholders and plantations will be jeopardized
as labor is diverted to the immediate demands of food crop production.
Farming systems where labor is already scarce, overall or on a seasonal basis,
will be most vulnerable.
n
Health
care. HIV/AIDS–related illnesses are swamping hospital beds and budgets in
all countries in the region. Home care systems are being developed, but they
require external resources, which continue to be scarce.
n
School
Enrollment. Increases in HIV/AIDS–related illness and death will likely
cause a decline in school attendance as declining household incomes put pressure
on children to help meet the need for labor and income. A World Bank study in
Tanzania suggested that HIV/AIDS may reduce the number of primary schoolchildren
by 22 percent and secondary schoolchildren by 14 percent as a result of
increased infant and child mortality as well as lower attendance. HIV/AIDS also
will reduce the number of teachers available, just as it will reduce the number
of skilled workers in other sectors.
The
Impact of HIV/AIDS on Children
The demographic effect of HIV/AIDS that has received the most
attention is the increase in the number of orphans — perhaps because of our
natural sympathies for the suffering of children. Increased numbers of orphaned
children certainly will be the most visible demographic shift caused by the
pandemic.
In many of the Sub-Saharan African countries included here,
the HIV/AIDS pandemic began early and is now severe, with seroprevalence rates
in some urban areas above 30 percent. Because of its severity, the epidemic has
been closely monitored in these countries, which include Botswana, Kenya,
Malawi, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. In Sub-Saharan Africa,
the epidemic is expected to peak before 2010, and orphan populations will peak
seven to ten years later. This means that orphan populations are projected to
increase in Sub-Saharan Africa through at least 2010. However, the Asian
countries that are most seriously affected by HIV/AIDS are home to over 20
percent of the world’s population, and so it is likely that by 2020 the largest
number of HIV/AIDS orphans will be in South and South East Asia. Unfortunately,
data is unavailable to make accurate projections of the number of HIV/AIDS
orphans in most Asian countries where epidemic impact is likely to be severe,
including India, Burma, Cambodia, and Vietnam. This underscores the importance
of developing effective interventions in Sub-Saharan Africa that can be applied
when the problem of HIV/AIDS orphans becomes severe in Asia and other areas of
the world.
|
The
Impact of HIV/AIDS on Children |
|
Loss
of family and identity |
|
Psychosocial
distress |
|
Increased
malnutrition |
|
Loss
of health care, including immunization |
|
Increased
demands for labor |
|
Fewer
opportunities for schooling and education |
|
Loss
of inheritance |
|
Forced
migration |
|
Homelessness,
vagrancy, starvation, crime |
|
Exposure
to HIV infection |
Yet, the problems children face as a result of HIV/AIDS begin
long before their parents die, because they live with sick relatives
in households stressed by the
drain on their resources. In countries with only moderately
severe HIV–infection rates, up to 25 percent of children born to healthy women
may have at least one parent infected with HIV by their fifth birthdays.
Children in households affected by HIV/AIDS face loss of
their family and their identity, psychosocial distress, increased malnutrition,
loss of health care (including immunization), increased demands for labor,
reduced opportunities for schooling and education, the loss of their
inheritance, forced migration, homelessness, and exposure to HIV infection.
In estimating the total number of children orphaned by AIDS,
the Census Bureau subtracts the number of children born HIV–positive — some 39
percent of children born to HIV–positive mothers. In Sub-Saharan Africa, most HIV–positive
children die before their second birthdays. They live longer in other parts of
the world, due to better nutrition and health care.
Unfortunately, there is no good methodology for estimating
the number of HIV– positive children. We do know, however, that for every 10
orphans who survive to age 15, there are three or four children infected with
HIV who die much sooner. These children are often quite sickly and require
special care and attention from their mothers, their families, and the health
care system. Information, education, and communications campaigns can be used to
help mothers understand that not all of their children are necessarily
HIV–positive so that they seek appropriate medical attention and immunization
for HIV–negative children.
Governments and relief agencies need to know more about these
children — who they are, where they live, who is taking care of them, and what
can be done to help them. We need this knowledge for their benefit and for our
own. Not only do these children deserve our humanitarian concern, but the
potential social impact of their presence in large numbers demands our immediate
attention. The presence of large numbers of undereducated, impoverished, and
less-than-healthy children in underdeveloped social structures may have negative
effects on social organizations and societal stability.
HIV/AIDS causes serious problems for children. But singling
out for assistance those children whose parents have died of AIDS stigmatizes
the intended beneficiaries. The needs of individual children are not
necessarily greater than those of children orphaned by other causes or
vulnerable for other reasons, and the problems may begin long before their
parents become ill or die from HIV/AIDS. Because of increased economic stress on
households, many children who are not themselves orphans also will experience
these problems.
For these reasons, interventions should be targeted in two
stages. They should be directed to the communities where the impact of HIV/AIDS
is greatest and where it significantly affects the ability of families to meet
their children’s needs. Within these communities, assistance should be targeted
to the children and families identified by residents as the most
vulnerable (without making HIV/AIDS a criterion).
The Impact of
HIV/AIDS on Families
The problems caused by HIV/AIDS are shared by all members of
the household. The locus of care for HIV/AIDS patients is the family because of
poverty or a lack of access to institutional care, personal preference, and
cultural norms. Changes in family composition and increased poverty limit the
ability of many families to provide care for sick family members. Most HIV/AIDS
patients now care for themselves or are assisted by female relatives.
Households often cannot afford even basic medicines to treat
opportunistic infections or to make patients more comfortable. The demands of
caring for sick family members may lead caretakers to neglect their own needs or
those of others in the household. Caretakers can benefit from the support of
members of their extended families or communities and from counseling to address
the stigma, isolation, and uncertainty they often feel about the future.
HIV/AIDS places new demands on family resources and reduces
the time adults can spend on income-generating activities or subsistence
agriculture. Medicines, treatments, and other care often consume a significant
share of the family income. When HIV infection results in illness, adult family
members are less able to care for children and the elderly. The demands for
children’s labor for domestic chores, income-generating work, or care for an
ailing parent increase. Girls often face pressure to marry at younger ages.
Households with HIV/AIDS typically spend a full year’s income meeting treatment
and funeral costs. Many families are impoverished by HIV/AIDS, particularly
those with little savings or reserves. Female-headed households are especially
vulnerable.
Labor-intensive, small-holder farms generally decline as a
result of HIV/AIDS because it reduces the quality and quantity of household
labor and limits the amount of disposable income available for farm inputs.
HIV/AIDS deaths may result in changes in land ownership and utilization, food-
and cash-cropping patterns, reduced food stores, and the sale of livestock
holdings. The overall result may be diminished nutrition for adults and
children.
HIV/AIDS causes the dissolution of households. Children may
be fostered or adopted prior to the death of a parent. Orphans are cared for by
grandparents, uncles, aunts, or siblings. Female orphans are often preferred for
adoption over male orphans because they can provide domestic labor, sexual
diversion, and, in many countries, a bride price.
Children’s psychosocial distress begins with a parent’s
illness, and they are left emotionally and physically vulnerable by the death of
one or both parents. They may suffer lingering emotional problems from attending
to dying parents and seeing their parents die. Orphans are more likely to
be removed from school because of the loss of household income and labor. They
experience higher morbidity and mortality and decreased nutrition. Children
under age 2 who lose their mothers are most likely to suffer additional
morbidity and mortality.
AIDS deaths lead to a redistribution of household assets,
often with the disenfranchisement of women and children. (However,
redistribution according to customary law that favors relatives of the male head
of household is sometimes blocked by family members or the community, which
indicates a considerable
|
The
Impact of HIV/AIDS on Families |
|
Loss
of family members (death, fostering, adoption) |
|
Changes
in household and family structure |
|
Family
dissolution |
|
Lost
income |
|
Impoverishment |
|
Lost
labor |
|
Forced
migration |
|
Grief |
|
Stress |
|
Reduced
ability to care for children and elderly household
members |
change in attitudes and beliefs.) Widows may have difficulty
remarrying or find potential husbands reluctant to assume responsibility for
their children.
HIV/AIDS also affects the nature of households. There is an
increase in multigenerational households without the middle
(income-generating) generation. There is an increase in female-headed households
that have little access to family or external resources. The roles of family
members change. Children may care for ill adults and work to produce food and
generate income. Children also are marrying younger. With increased
mortality among adults, older people will provide more care for children and the
ill. This burden will fall disproportionately on elderly women, who are not only
burdened with care of the young, but also experience economic setbacks because
of loss of support of their children.
The proportion of households with orphans, already
substantial, will increase. A study by the Zambian Ministry of Health estimated
that 40 percent of households in the country have one or more orphans and that
16 percent of households are headed by widows. The 1995 Ugandan DHS found that
25 percent of all households included foster children under age 15.
HIV/AIDS often causes urban-to-rural migration, the opposite
of regular patterns. Illness forces some people to seek care or support from
extended families in rural areas. Also, orphaned children are often sent to live
with relatives in a parent’s home village. Other people leave cities because
they are afraid of contracting HIV/AIDS in urban settings.
The changes experienced by children, families, and
communities vary around the world. In Africa, despite their poverty, children
benefit from broad support mechanisms that may provide a stronger safety
net than in other regions. These include multigenerational families, single
mothers living in sub-households, customs for exchanging children among
kin, and the sharing of child support and child rearing. Many of these patterns
and customs differ in Asia or Latin America.
The Impact of
HIV/AIDS on Communities
The
vulnerabilities of children, families, and communities are compounded by the
geographic concentration of the pandemic. Vulnerable children are cared for by
vulnerable families and reside in vulnerable communities. Many communities
hardest hit by HIV/AIDS are already severely disadvantaged, with high poverty,
|
The
Impact of HIV/AIDS on Communities |
|
The
labor pool is reduced, particularly for agricultural labor and for skilled
labor, including health workers and teachers. |
|
Poverty
increases. |
|
Infrastructure
deteriorates. |
|
Access
to health care and education is reduced. |
|
Mortality
is elevated. |
|
The
community has fewer resources to marshal for mutual aid. |
|
Communities
suffer a general loss of resilience. |
poor
infrastructure, and little or no access to even the most rudimentary services.
In fact, communities with the highest infection rates are often the most
impoverished and marginal because these are the conditions conducive to
rapid HIV transmission.
The vulnerability of a particular community can be measured
along a number of dimensions, including HIV/ AIDS prevalence; the existing
orphan burden; the community’s economic strength, including the
availability of employment and subsistence food production; and the level
of infrastructure, especially the availability of health and education services.
HIV/AIDS stresses communities in a variety of ways. There may be reductions
in the labor pool, particularly for agricultural and skilled labor, increased
poverty, a reduced ability to maintain infrastructure, reduced access to health
care and education, elevated mortality, fewer resources to be marshalled for
mutual aid, and a general loss of resilience.
Community-Based
Responses to HIV/AIDS
In
many areas, communities have joined together spontaneously to support and assist
families and children affected by HIV/AIDS. Left on their own, with no external
assistance, some communities have devised identification and assistance programs
of varying sophistication to help needy children and families in their midst.
The paradox is that community-based responses may be the most cost-effective
interventions while being the least visible.
Many
of the community-based programs to assist those affected by HIV/AIDS are
developed and run by community-based organizations, or CBOs. These organizations
are generally democratic, representing the interests of their members and
accountable to them. They are formed as a response to shared experiences, and
they generally do not rely on outside sources for funding. They are usually
local but can spread and grow into networks of grassroots organizations.
In
1993, the United Nations Development Program (UNDP) estimated that there were at
least 100,000 CBOs worldwide. These groups form a powerful constituency for
governments, nongovernmental organizations (NGOs), and donors.
|
Shared
Elements of Community-Based
Interventions |
|
Enumeration
and needs assessments |
|
Targeting
assistance to the most needy |
|
Monitoring
vulnerable children and families |
|
Labor-sharing |
|
Savings
and credit schemes |
|
Protection
of property and inheritance rights of widows and children |
|
Vocational
training |
|
Changes
in local laws and practices |
Many
of the communities hardest hit by HIV/AIDS have fashioned similar responses to
increased illness and death from HIV/AIDS and the resulting needs of families
and children, including the following:
n
Systems to enumerate and assess the needs of
families and children to determine the extent of problems, to raise awareness,
and to promote informed decision-making
n
Targeting assistance to families and children
most in need
n
Monitoring systems, which are often ad hoc, to
maintain contact with children, supervise their activities, and prevent child
labor abuses
n
Voluntary labor sharing for a variety of
purposes, including:
§
cooperative daycare and nutrition centers to free
women burdened with HIV/AIDS patients and additional foster children to work in
or outside the home
§
agricultural projects at various levels to
increase output
§
income-generating projects to produce food and
cash
§
repair of deteriorating houses
§
home care and visitation of orphans and HIV/AIDS
patients
§
preparation and distribution of school
uniforms
§
Credit schemes for funeral benefits or
income-generating projects
n
Efforts to protect the property and inheritances
of widows and children from being appropriated by the family of a deceased
spouse
n
Apprenticeships to teach orphaned adolescents
marketable skills
n
Efforts to change local laws and practices that
burden needy families and children, such as restrictions on and fees for school
and health services.
Helping
Children, Families, and Communities Affected by HIV/AIDS
It is impossible to overemphasize or exaggerate the scope and
complexity of the challenges faced
by children affected by HIV/AIDS and by the families, communities, and
governments responsible for their well-being. The coordination, effectiveness,
and impact of HIV/AIDS programs must be improved. Appropriate programs must be
effective, cost-effective, and sustainable over the long term.
Four fundamental priorities should guide responses to the
needs of these children.
n
Urgency: The problems of children
affected by HIV/AIDS are not new, but they have taken on a new urgency. The
number of orphans has grown since HIV began to spread in the 1970s, and they now
demand our immediate attention. Some 30 million children have already lost one
or both parents to all causes, including AIDS, in the 23 study countries
included in this report. The numbers of orphans will swell in the near future as
the epidemic grows in Asia and in Latin America and the Caribbean. In short, the
estimates for the 23 countries in this study, as large as they are, reflect only
a portion of the total number of children affected by HIV/AIDS worldwide.
Solutions have been developed — especially by the families and communities most
affected — but these need to be strengthened, expanded, and combined to
adequately address the current and future needs of these children.
n
Realism: The estimates in this
report of the number of HIV/AIDS orphans give us a perspective on the gravity
and enormity of the challenge we face. We must be realistic about the
feasibility of different types of interventions to assist those affected by
HIV/AIDS. Scarce resources cannot be used to develop costly institutional
programs or direct interventions by nongovernmental organizations (NGOs).
The resources available must immediately be devoted to building on the
innovative and effective approaches being developed by affected communities
themselves. These are the only interventions that will be sustainable over
the long term, both financially and morally.
n
Scale: Intervention programs must be
quickly brought to scale to achieve national coverage. This is no longer a
luxury but a necessity. Doing this will require dramatic initiatives. The
principal requirement is strong and visionary national leadership. National
leaders must develop alternative resources to finance such programs, including
community and voluntary resources and donor financing. They also must be
committed to policy interventions that increase the rights of women and
children, improve their ability to support themselves and obtain a reasonable
education, and protect their earnings and investments through equitable property
ownership and inheritance laws.
Most responses to children and families affected by
HIV/AIDS have been far too limited in scope and scale. Governments, donors,
NGOs, and others must coordinate their efforts to address the large and growing
problems that exist. A strategic, coordinated response at scale requires
programs that are:
§
targeted to the most vulnerable areas,
communities, and population groups
§
targeted by each community to the most vulnerable
children and households
§
effective in reducing the vulnerability of
orphans and other affected children
§
sustainable, with a low cost per beneficiary
§
integrated or coordinated with existing services
and development initiatives.
n
Appropriate Roles: In going to scale
to achieve national coverage, resources will be spread thin, and those involved
must assume appropriate and cost-effective roles. There must be a hierarchy of
responsibilities among key actors to improve the efficacy and cost-effectiveness
of programs. International organizations and donors should provide and
coordinate resources and serve as a resource to governments. They can identify
appropriate community-based responses, evaluate their effectiveness, and share
the lessons learned. National governments should provide leadership and develop
national strategies that target resources to the most needy, integrate
interventions with existing services, facilitate information-gathering and
-sharing, and generally improve the welfare of children and families.
Communities should identify and monitor vulnerable children and families and
develop and implement programs to assist them. NGOs should help communities
expand their capacities to address the needs of their members by helping them to
strengthen their response mechanisms and to identify and generate additional
resources.
The first and most important responses to the problems caused
by HIV/AIDS comes from the affected children, families, and communities
themselves. The efforts of governments, nongovernmental organizations, and
donors are significant largely to the extent that they help children,
families, and communities cope more easily with these problems.
Recent experience suggests that six basic intervention
strategies can help governments, NGOs, and donors to target their
efforts.
|
Intervention
Strategies to Assist Children, Families, and Communities Affected by
HIV/AIDS |
|
|
|
1. Strengthen the capacity of families to cope with their
problems. |
|
|
|
2. Stimulate and strengthen community-based
responses. |
|
|
|
3. Ensure that governments protect the most vulnerable
children and families. |
|
|
|
4. Build the capacities of children to support
themselves. |
|
|
|
5. Create an enabling environment for affected children and
families. |
|
|
|
6. Monitor the impact of HIV/AIDS on children and
families. |
1. Strengthen the capacity of families
to cope with their problems.
When a household begins to feel the effects of HIV/AIDS,
extended family relationships are its first safety net. Although families are
under great stress, the extended family has not collapsed under the weight of the
HIV/AIDS pandemic. Most families are still providing some level of care for the
overwhelming majority of affected children. Even in the most severely affected
countries, the vast majority of orphans are living within their extended family
networks. Typically, less that 1 percent of orphans live on the street, in
institutions, or in households headed by children.
|
Strengthening
the Capacity of Families to
Cope with Their Problems |
|
Improve
infrastructure |
|
Provide
access to credit |
|
Increase
their ability to generate income |
|
Reduce
demands on their labor |
|
Protect
women’s and children’s property and other legal rights |
|
Ensure
access to health services |
|
Respond
to their psychosocial needs |
However, the customs and reality of caregiving for HIV/AIDS
and trends in family structure in developing countries combine to place the
greatest stress and responsibility on females in the family, both adults
and children. Action is needed to empower women and maximize their access to
economic resources. In many of these countries, women have few legal rights —
for example, they may be unable to own or inherit property or to hold a job
without a man’s permission. In addition, building basic infrastructure that
reduces the demands on women’s labor can significantly alleviate their
vulnerability.
Many of the problems faced by households affected by HIV/AIDS
are fundamentally economic. These households are generally struggling to
make ends meet and suffer setbacks when a member is sick with HIV/AIDS, when a
sick member dies, or when they take in orphans. Arranging access to formal or
informal credit mechanisms or ways to generate additional earning capacity
can help families overcome such setbacks. In addition, reducing the demands
on household members’ labor can free them to undertake other productive
activities. This might involve, for example, supporting community-based child
care, extending piped water to villages, or enabling artisans to produce
fuel-efficient stoves to reduce the time required to collect firewood.
Reducing “property grabbing” by protecting women’s and
children’s property and inheritance rights can reduce the vulnerability of
survivors. This can be done, for example, by informing HIV–infected parents and
women about laws that can protect their inheritance rights, by helping
people to prepare written wills, by supporting legal services for widows and
orphans to help them regain property, and by sensitizing traditional
leaders about the need to protect widows’ and orphans’ property rights through
traditional law and customs.
Support for home-based care of HIV/AIDS patients is an
important way to strengthen families’ capacity to cope. Family members learn to
provide more adequately for the needs and comfort of those who are ill.
This is also an opportunity to provide psychosocial support to those who are ill
and their family members.
Measures should be taken to reduce the health risks to
children in households affected by HIV/AIDS. These may include developing
home-based health services, supporting child nutrition programs, making
special efforts to include these children in immunization programs and other
health outreach efforts, incorporating training about HIV prevention
into programs that reach all children (i.e., in school) and that target
especially vulnerable children (e.g., street children), and improving access to
safe water.
Protracted illness and the eventual death of parents have
profound psychosocial effects on children, but these receive less attention than
the more visible problems they face. Most measures to address psychosocial needs
among children affected by HIV/AIDS do not require separate new programs but can
be incorporated into school, health, and other activities. Approaches include
helping infected parents play normal parental and social roles and giving
children opportunities to talk about their fears.
In addition to physical and material support, a vitally
important aspect of strengthening family coping capacities is providing
emotional support and encouragement. Friends, neighbors, families, members of
the families’ religious communities, or cooperative associations can help build
a sense of hope and possibility through periodic visits. This can also be an
important component of outreach programs that support home-based care.
2. Stimulate and strengthen
community-based responses.
|
Stimulating
and Strengthening Community-Based Responses |
|
Respect
community decision-making |
|
Enhance
the community’s ability to support vulnerable families |
|
Organize
orphan-visiting programs |
|
Protect
women’s and children’s property rights |
|
Provide
training |
|
Organize
cooperative day care and labor support |
For children whose families cannot adequately provide for
their basic needs, the community is the second safety net. The types of
spontaneous, community-based interventions discussed previously can help support
families under great stress to care for their children. They can also help
vulnerable children directly. Such efforts may involve helping communities
identify problems among vulnerable children and families and ways to support
them, encouraging leaders to protect the property and inheritance rights of
widows and orphans, organizing cooperative child care or labor support, training
community members to assess needs and provide support, organizing
orphan-visiting programs, or providing material or financial resources.
The most vulnerable children and
families are the least able to make their needs known. An active effort is
required to identify them and to mobilize local resources to respond to their
most urgent needs. Assisting communities in developing and implementing
assistance programs involves respecting communities’ decision-making
structures and enhancing communities’ ability to target assistance to vulnerable
families.
3. Ensure that governments protect the
most vulnerable children and provide essential services.
The most vulnerable children are those who fall through both
safety nets. They need a third line of response. Under national law and the
United Nations Convention on the Rights of the Child, national governments
have the ultimate responsibility to ensure that children are protected and
cared for if they are on their own or if those with whom they live are unable or
unwilling to care for them adequately.
This requires governments to intervene to protect abused or
neglected children. Children who lose both parents are especially vulnerable.
Many foster families provide the best care they can, but some have exploited or
abused orphans they have taken in.
Governments also have a responsibility to provide services on
many levels that improve the welfare of children, including ensuring access to
safe water and health services, enabling all children to attend school, and
empowering families to support themselves economically.
|
Ensuring
that Governments Protect the Most Vulnerable Children and Provide
Essential Services |
|
Intervene
to protect abused or neglected children |
|
Build
adoption and foster care mechanisms |
|
Protect
children’s property rights |
Adoption and foster care mechanisms are needed to help
children who require special placement. Building these mechanisms involves
strengthening and expanding governmental or NGO programs, supporting measures to
ensure rapid placement of abandoned infants, and, where institutional care
exists, supporting screening procedures to ensure that children are placed in
institutional care only when no better placement options are possible, that such
care meets appropriate standards, and that institutional care is used on an
interim basis until a family placement can be made.
Protecting children’s property rights can reduce their
vulnerability. Nonetheless, many children orphaned by AIDS have to work to
survive, and they often find themselves in harmful or abusive situations.
Measures that can benefit children who must work include sensitizing police to
the situation of children who work on the street and to any laws that protect
them; promoting enforcement of child labor laws; providing less harmful ways for
children to earn income; and working with employers to improve children’s work
conditions, shelter, education, and training.
4. Build the capacities of children to
support themselves.
Orphans often must support themselves and their younger
siblings earlier than other children. HIV/AIDS catches children in a double
bind. At a point where children face a premature need for education and training
that will help them support themselves, economic pressures and the need to
replace lost adult labor often force them to drop out of school. Girls are often
forced to drop out first, causing long-term losses for the society.
|
Building
the Capacities of Children To Support
Themselves |
|
Enable
children to stay in school |
|
Reduce
labor demands on households |
|
Protect
children from exploitation |
Enabling children to stay in school and to learn vocational
skills improves their ability to provide for their own needs, now and in the
future. Interventions to help children continue their education must address the
specific factors that cause them to drop out. Assistance may be used to pay
school expenses or vocational training fees, support apprenticeships
with local artisans, construct school facilities in exchange for guaranteed
admission of orphans, and develop informal education for part-time students.
It is also important to decrease households’ dependence on
children’s work. These could include initiatives to boost the income-generating
capacity of poor households in areas seriously affected by HIV/AIDS. They could
also include water, fuel, or other projects that reduce household work
requirements, or respite care for people with HIV/AIDS.
Children must also be protected from exploitation and abuse.
Vulnerable children need encouragement and support from their extended families,
friends, teachers, neighbors, and members of their religious communities.
5. Create an enabling environment for
affected children and families.
The significance of efforts by governments, NGOs, donors,
religious bodies, and other entities will depend largely on the extent to which
they make it easier for children, families, and communities to cope with the
effects of HIV/AIDS. In addition to the strategies for direct intervention
described above, all parties must work together toward the overarching goal of
creating an enabling environment for those affected.
|
Creating
an Enabling Environment for Affected Children and
Families |
|
Promote
increased understanding and commitment |
|
Reduce
stigma and discrimination |
|
Advocate
and implement laws and policies that protect the safety and rights of
affected children and families |
|
Improve
the coordination, effectiveness, and impact of programs |
|
Mobilize
and allocate appropriate and sufficient financial
resources |
Policymakers,
community leaders, journalists, employers, and the public at large must develop
an increased understanding of the problems facing children affected by
HIV/AIDS and a stronger commitment to address those problems. This can be done
through conferences, efforts to attract media attention to the issues, and
public information campaigns about the impact of HIV/AIDS and about how
some communities are responding.
Stigma and discrimination impede efforts to prevent the
spread of HIV/AIDS, to improve care and support of those with HIV/AIDS, and to
reduce the effects on their family members. The process of reducing stigma and
discrimination is largely one of reducing fear, ensuring basic legal protection,
and transforming the public perception of HIV/AIDS from “their problem” to
“our problem.” Providing information and challenging myths can help reduce
fear. Laws to protect the rights of those with HIV and their families regarding
health services, employment, housing, and schools can directly enhance their
ability to cope.
In some countries, public attitudes have changed when
political leaders and popular public figures have spoken out openly on HIV/AIDS.
Some religious bodies have established ongoing programs to promote awareness and
compassionate action.
The coordination, effectiveness, and impact of programs must
be improved. Appropriate programs generally meet three criteria. The are
effective, making a significant impact on priority problems. They are
cost-effective, with a reasonable cost per beneficiary. And they are sustainable
over the long term.
Several mechanisms can be instituted to improve coordination
and increase the effectiveness of intervention programs. One is to establish a
regular forum for key actors to come together regularly to share information,
coordinate activities, and build partnerships. Another is to clearly define
roles for governmental and nongovernmental actors. A third is to develop
policies that define strategic approaches, programming priorities, and
geographic responsibilities.
Sufficient financial resources must be mobilized and
allocated to support essential policies and priorities. In many Sub-Saharan
African countries, responsibility for children’s welfare is often assigned to
the most understaffed and underfunded government agencies.
Resource-strapped governments also rely on funding and assistance from donors
and NGOs to provide many health, educational, and social services.
Collaboration among these agencies and organizations is essential to
improving the effectiveness and sustainability of community-based
responses to HIV/ AIDS. Such collaboration can create an environment that
ensures and improves the welfare of children and families. It can also help
ensure that program interventions are cost-effective and sustainable.
The private sector’s commitment to respond also should be
nurtured. Many countries have work-site HIV/AIDS prevention programs with
nascent care components. In some countries, concerned employers are
developing survivor support programs which include health, education, and
vocational training. Private philanthropy also can be a source of support for
local programs.
Laws and policies should be changed, where necessary, to
reduce the vulnerability of children and families. At a minimum, laws and
governmental policies and activities should promote women’s and children’s
rights and status, allow women to own land and hold jobs, encourage men to take
responsibility for and contribute to the support of their families, support
increased NGO activity and coordination, increase multi-sectoral responses to
HIV/AIDS, encourage private sector investment in HIV/AIDS prevention and
care, and redirect national investment to improve health care and educational
opportunities for those affected by HIV/AIDS.
6. Monitor the Impact of HIV/AIDS on
Children and Families
Because an HIV/AIDS epidemic is constantly evolving,
monitoring its effects provides essential information to guide policy and
program development. Systems that regularly collect and disseminate information
on the health and socioeconomic impact of HIV/AIDS on families and children
are particularly important.
|
Monitoring
the Impact of HIV/AIDS on Children and
Families |
|
Collect
and disseminate information on the health and socioeconomic impact on
children, families, and communities |
|
Enhance
mechanisms for collecting data |
|
Estimate
and project the number of orphans |
|
Involve
community members in data collection |
|
Update
data regularly to reflect the evolving nature of the epidemic and the
impact of interventions |
Accurate information is essential for targeting assistance to
children in the most seriously affected areas. There is a need to enhance
mechanisms for collecting and analyzing data on the impact of HIV/AIDS on
children, families, and communities; their coping strategies; the factors that
contribute to the spread of HIV/AIDS; and existing programs and services.
Estimates and projections of the number of orphans are particularly
valuable.
When community members assist in collecting such data, they
become more familiar with the scale and nature of the problems created by
HIV/AIDS and are usually motivated to take charge and find solutions.
This data must be updated regularly to reflect the changing
face of the epidemic and the impact of interventions.
Action
Steps
Governments must undertake a series of steps to assist
families, children, and communities affected by HIV/AIDS. Active community
participation is essential for any program to be effective in addressing the
needs of the most vulnerable children and families and for it to obtain
international support.
In
addition to undertaking interventions in the six strategic areas outlined above,
governments must mobilize and coordinate resources for an effective response.
Given the magnitude of the problems created of HIV/AIDS, even relatively
low-cost interventions will require significant resources to be implemented at
scale. Collaboration among governments, donors, and international organizations
is essential to ensure that resources are mobilized and directed to the most
cost-effective interventions in a coordinated way.
These
efforts could be focused on collecting and analyzing critical information,
including the costs of interventions, numbers and types of orphans and children
affected by HIV/AIDS, and children’s and women’s rights. A special effort will
be needed to gather this type of information on the impact of HIV/AIDS in Asian
countries, including India and Bangladesh, in order to anticipate the extent of
orphaning as soon as possible.
Individual
children, families, and communities have been principally responsible for caring
for individuals and families affected by HIV/AIDS. They have been affirmative in
their responses and have developed low-cost models that can be emulated.
Communities will flourish even while facing the challenges of this pandemic if
they are supported and enabled by the institutions that condition their
environment — the most important of which is government.
International organizations, donors, and NGOs can assist
governments in ensuring that policies and infrastructure are in place to support
community interventions and innovations. If we are serious about considering
communities as partners, then we must understand and value their contributions
and innovations. Community-based interventions are investments that can be
leveraged with properly targeted funds.
