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Children Orphaned by HIV and AIDS
An 'orphan' is defined by the United Nations as a child who has 'lost one or both parents'. Worldwide, it is estimated that 17.8 million children under 18 have been orphaned by AIDS and that this will rise to 25 million by 2015. 1
Around 15.1 million, or 85 percent of these children live in sub-Saharan Africa. 2 In some countries which are badly affected by the epidemic, a large percentage of all orphaned children - for example 74 percent in Zimbabwe, and 63 percent in South Africa - are orphaned due to AIDS. 3
In some countries, a larger proportion of orphans have lost their parents to AIDS than to any other cause of death - meaning that, were it not for the HIV epidemic, these children would not have been orphaned.
How many children have been orphaned by AIDS?
As the tables below show, the number of children orphaned by AIDS in some sub-Saharan African countries exceeds two million each, and, in some countries children who have been orphaned by AIDS comprise half or more of all orphans nationally. 4
The table below shows the countries with the largest numbers of children orphaned by AIDS, and what percentage of all orphans are those orphaned by AIDS. 5
|COUNTRY||NUMBER OF CHILDREN WHO HAVE LOST ONE OR BOTH PARENTS DUE TO AIDS, 2012||CHILDREN ORPHANED BY AIDS AS A PERCENTAGE OF ALL ORPHANS, 2012|
|South Africa||2,500,000||63 %|
Most of the children orphaned by AIDS who live outside of Africa live in Asia, where the total number of children orphaned by AIDS exceeds 1.1 million. 6 There is, however, insufficient information available to provide figures for the number of children orphaned by AIDS in individual Asian countries. The rest of this page concentrates on children orphaned by AIDS in Africa, although the issues described here are present to some extent in many countries around the world.
Variations within countries
As the number of orphans varies between countries, so it varies between different regions within those countries. Particular areas may have higher or lower percentages of orphans, largely depending on the local HIV prevalence rates. There can also be substantial differences between rural and urban areas.
An increasing problem
The scale of the orphan crisis is somewhat masked by the time lag between when parents become infected and when they die. As adults continue to die from AIDS-related illnesses over the next decade, an increasing number of children will grow up without parental care.
The problems faced by children orphaned by AIDS
Children whose parents are living with HIV often experience many negative changes in their lives and can start to suffer neglect, including emotional neglect, long before they are orphaned. Eventually, they may suffer the death of their parent(s) and the emotional trauma that results. In this case, they may then have to adjust to a new situation, with little or no support, and may suffer exploitation and abuse. 7 8
In one study carried out in rural Uganda, high levels of psychological distress were found in children who had been orphaned by AIDS. Anxiety, depression and anger were more found to be more common among children orphaned by AIDS than other children. 12 percent of children orphaned by AIDS affirmed that they wished they were dead, compared to 3 percent of other children interviewed. 9
These psychological problems can become more severe if a child is forced to separate from their siblings upon becoming orphaned. In some regions this occurs regularly: a 2002 survey in Zambia showed that more than half of orphaned children no longer lived with all of their siblings. 10
The loss of a parent to AIDS can have serious consequences for a child’s access to basic necessities such as shelter, food, clothing, health and education. Orphans are more likely than non-orphans to live in large, female-headed households where more people are dependent on fewer income earners. 11 This lack of income puts extra pressure on children orphaned by AIDS to contribute financially to the household, in some cases driving them to the streets to work, beg or seek food. 12
The majority of children who have lost a parent continue to live in the care of a surviving parent or family member, but often have to take on the responsibility of doing the housework, looking after siblings and caring for ill or dying parent(s). Children who have lost one parent to AIDS may be at risk of losing the other parent as well, since unprotected heterosexual sex is a major route of HIV transmission in Africa.
Children orphaned by AIDS may miss out on school enrolment, have their schooling interrupted or perform poorly in school as a result of their situation. Expenses such as school fees and school uniforms present barriers to school attendance if orphans’ caregivers struggle to afford these costs. 13
A multi-country study released in 2010 found that orphanhood itself was not directly associated with lower school attendance (when measuring school attendance orphans are defined as children who have lost both parents while non-orphans are defined as children both of whose parents are alive). 14 Instead, other factors such as greater household wealth were more likely to result in increased school attendance for both orphans and non-orphans.
However, the loss of a productive family member is likely to be a financial burden and might push a family into poverty, increasing the likelihood that a child orphaned by AIDS will miss out on school. Ensuring that households where a child has been orphaned by AIDS receive external care and support is therefore essential to ensure that they attend school. 15
Figures released in 2013 revealed that in most countries in sub-Saharan Africa, the gap between school attendance by orphans and non-orphans has significantly narrowed, although progress varies across the region. Most countries with the greatest HIV epidemics have orphan school attendance rates of at least 90 percent of non-orphan school attendance rates. 16
Outside of school, children orphaned by AIDS may also miss out on valuable life-skills and practical knowledge that would have been passed on to them by their parents. Without this knowledge and a basic school education, children may be more likely to face social, economic and health problems as they grow up. 17
Children grieving for dying or dead parents are often stigmatised by society through association with AIDS, leading to shame, fear, and rejection. This stigma often denies orphaned children access to schooling and health care because it is assumed that they are infected with HIV and their illnesses are untreatable. Once a parent dies children may also be denied their inheritance and property.
“We should remember that the process of losing parents to HIV/AIDS for the children often includes the pain and the shame of the stigma and the fear that the disease carries in most our societies.” - UNICEF representative Bjorn Ljunqvist 18
Traditional systems of taking care of children who lose their parents, have been in place throughout sub-Saharan Africa for generations. Most commonly, this is kinship care, where a grandparent(s) or close family friend becomes the child's main caregiver, keeping a family based-structure, as opposed to institutional forms of care. Kinship care is often the preferred choice for the carer, the child, and community based organisations, due to better opportunities for children if they stay within a family home that is known to them, and the cheaper costs than an orphanage. 19
However the demand for care and support is simply overwhelming in many areas, putting pressure on kinship carers. This can lead to deepening poverty, through medical and funeral costs as well as the loss of labour. 20 There is an urgent need for kinship carers to be given greater support, both financially and emotionally.
The way forward
The way forward is threefold: firstly new HIV infections must be prevented so that children do not lose their parents; secondly access to antiretroviral treatment needs to be stepped up; and finally care must be provided for those children who are already orphaned. The rest of this page is devoted to issues around the care of children orphaned by AIDS in Africa, but it is also important that HIV prevention is not forgotten. The situation of children orphaned by AIDS is ultimately generated by adult deaths; until this problem is addressed the orphan crisis will continue.
Support for carers
In the early days of the children orphaned by AIDS crisis, there was a rush by well meaning non-governmental organisations to build orphanages. This response was unsustainable, as the cost of maintaining a child in such an institution is much greater than other forms of care. Most people now believe that orphans should receive kinship care, and that siblings should not be separated. The community needs to be supportive of these kinship carers and children, making sure that they are accepted and have access to essential services, such as health care and education.
Keeping children in school
Schools can play a crucial role in improving the prospects of children orphaned by AIDS and securing their future. A good school education can give children a higher self-esteem, better job prospects and economic independence. As well as lifting children out of poverty, such an education can also give children a better understanding of HIV and AIDS, decreasing the risk that they will become infected. Schools can also offer benefits to children orphaned by AIDS outside of education, such as emotional support and care.
Empowerment for children
Many children already function as heads of households and as caregivers. They are a vital part of the solution and should be supported in planning and carrying out efforts to lessen the impact of AIDS in their families and communities.
Protection for the legal & human rights of orphans
Many communities are now writing wills to protect the inheritance rights of children and to prevent land and property grabbing, where adults attempt to rob orphans of their property once they have no parents to protect their rights.
“You find that the parents have been productive and have left assets for the children but immediately after their deaths, the relatives squander everything. Those that are left without anything are just being used for the food rations.” - Pelonomi Letshwiti, a social worker for Childline Botswana 21
Children orphaned due to AIDS may face exploitation in other areas of their lives as well. For instance, evidence suggests that there is a relationship between children orphaned by AIDS in sub-Saharan Africa and increased child-labour. 22
Meeting emotional needs
The physical needs of orphans, such as nutrition and health care, can often appear to be the most urgent. However, the emotional needs of children who have traumatically lost a parent should not be forgotten.
“My sister is six years old. There are no grown-ups living with us. I need a bathroom tap and clothes and shoes. And water also, inside the house. But especially, somebody to tuck me and my sister in at night-time.” - Apiwe aged 13 23
Country responses to the children orphaned by AIDS crisis: Botswana, Malawi, and Zambia
In many countries with a high prevalence of HIV, efforts to provide care and support for children orphaned by AIDS have been underway for many years. Although existing initiatives are encouraging, many of these are small scale and are struggling with the increasing number of children that require care. Three of the African countries that have been worst affected by HIV and AIDS are Botswana, Malawi, and Zambia.
In Botswana, it is estimated that 120,000 children had lost one or both parents to AIDS by the end of 2012. 24
A National Orphan Programme was established in April 1999 to respond to the immediate needs of orphaned children. 25 The government currently runs a ‘food basket’ scheme, where a basket of food is provided to orphaned households once a month. Orphans are also provided with school uniforms and are subsidised for transportation fees to get to school, among other things. 26 However, by December 2012, just 26 percent of orphaned households were receiving external support. 27
An example of the programme in action is the rural district of Bobirwa, where district authorities have contracted the Bobirwa Orphan Trust to deliver essential services to orphans in the area. The Trust is made up of community volunteers and government paid employees, including social workers and family welfare educators. Members of the Trust register orphans in the district and identify their needs through home visits, schools and churches. They also initiate community-based foster placements, and support the provision of food and clothing to orphans through local groups, which may include blankets, counselling, toys, bus fares to and from school, school uniforms and other educational needs. 28
Traditionally, orphaned children in Botswana have been cared for by extended families. However, due to social and economic strain some families are no longer willing - or indeed able - to do this. In some cases, families have been known to take on orphans merely to benefit from government orphan packages. 29
Read more about HIV & AIDS in Botswana.
By the end of 2012, it was estimated that Malawi had 770,000 children orphaned by AIDS. 30
As early as 1991, the Government of Malawi established a National Orphan Care Task Force. The Task Force is made up of various representatives and organisations, which are responsible for planning, monitoring and revising all programmes on orphan care. One year later, in 1992, National Orphan Care Guidelines were established. The guidelines serve as a broad blueprint to encourage and co-ordinate regional and community efforts. The Task Force has also established a subcommittee that is reviewing existing laws and legal procedures to provide greater protection to vulnerable children. 31
An important aspect of the government's strategy has been to promote and support both rural and urban community based programmes. In many villages orphan committees have been established to monitor the local situation and to take collective action to assist those in need. 32
The Government furthered its commitment to children orphaned by AIDS in June 2005 when President Mutharika launched The National Plan of Action for Orphans and Vulnerable Children. This plan, which ran until 2009, aimed to increase access to essential services - such as education, health, nutrition, water and sanitation - amongst children orphaned by AIDS and other vulnerable children. It also aimed to help families and communities provide support for such children. 33
However, a severe lack of human and financial resources continues to hold back Malawi’s fight against AIDS, including efforts to support children orphaned by AIDS.
“Orphans have little food, few clothes, no bedding and no soap...and as a whole, community care because of HIV/AIDS is overwhelmed and breaking down.” 34
Read more about HIV & AIDS in Malawi.
In Zambia the estimated number of children orphaned because of AIDS is 670,000 as of 2012. 35
“It's very hard to find a family in Zambia that hasn't been personally touched. It's very hard to find a child that hasn't seen or witnessed a death related to HIV/AIDS. The extended family in the community structure, they've really broken under the weight of the HIV/AIDS epidemic and poverty, and when the burden becomes too great, families are unable to cope anymore, and so we're seeing tremendous numbers of orphans and children who are no longer able to be cared for by their extended family.”
“And in the midst of all that, we are seeing within the communities themselves and within extended families truly heroic efforts to absorb the children, to work with them, to give them the nurturing and caring in the environment, in their own communities that is so necessary for this next generation.” - Stella Goings, UNICEF representative 36
Child-headed households, once a rarity in Zambia, are now more common. Unfortunately, formal and traditional inheritance, land ownership and health policies have not kept up with their needs.
Zambia's Education Sector Plan (2012-2015) includes a strategy for enhancing early childhood development, which has a focus on increasing access to school for orphaned children. It is hoped that this will heighten not only learning abilities and employment prospects among orphans, but also HIV prevention information. 37
Strengthening Community Partnerships for the Empowerment of Orphans and Vulnerable Children (Scope-OVC) was a community mobilisation project that ran between 2000 and 2004. The project worked to keep siblings together and children within extended families and communities. 38 It also established District Orphan and Vulnerable Children's Committees (DOVCC) in all districts, with the aim of sustainably bringing all sectors of society together to respond to the needs of orphaned children. 39 More effort is needed to maintain projects like this.
Read more about HIV and AIDS in Zambia.
The need for urgent & sustained action
Millions of children have already lost at least one parent as a result of the HIV epidemic, and millions more are likely to over the next few years. There is an urgent need to help, care and protect these children. There is also a need to prevent people becoming infected with HIV so that the number of children orphaned in the future is minimised. The number of children requiring support is increasing and in many instances the increase in response is not keeping up with the increase in need. Responses need to be scaled up, and this is going to need increases in both financial resources and commitment over the next few years.
In September 2003, Stephen Lewis, then UN Secretary-General's Special Envoy for HIV/AIDS in Africa, spoke about the children orphaned by AIDS problem:
“... in Zambia, [we] were taken to a village where the orphan population was described as out of control. As a vivid example of that, we entered a home and encountered the following: to the immediate left of the door sat the 84-year-old patriarch, entirely blind. Inside the hut sat his two wives, visibly frail, one 76, the other 78. Between them they had given birth to nine children; eight were now dead and the ninth, alas, was clearly dying. On the floor of the hut, jammed together with barely room to move or breathe, were 32 orphaned children ranging in age from two to sixteen... It is now commonplace that grandmothers are the caregivers for orphans.”
“The grandmothers are impoverished, their days are numbered, and the decimation of families is so complete that there’s often no one left in the generation coming up behind. We’re all struggling to find a viable response, and there are, of course, some superb projects and initiatives in all countries, but we can’t seem to take them to scale.” 40
Additionally, Carol Bellamy (a former Executive Director of UNICEF), stated that:
“The silence that surrounds children affected by HIV/AIDS and the inaction that results is morally reprehensible and unacceptable. If this situation is not addressed, and not addressed now with increased urgency, millions of children will continue to die, and tens of millions more will be further marginalised, stigmatised, malnourished, uneducated, and psychologically damaged.” 41
- 1. AIDS Orphan (2013) ' HIV and AIDS'
- 2. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 3. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 4. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 5. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 6. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 7. Jo Stein (2003), ‘ Sorrow makes Children of us all: A literature review of the psycho-social impact of HIV/AIDS on Children’ CSSR Working Paper No. 47
- 8. Subbarao K. and Coury D. (December 2004), ' Reaching out to Africa's Orphans: A Framework for Public Action', The World Bank.
- 9. Atwine B., Cantor-Graae E. and Banjunirwe F. (March 2005), ‘Psychological distress among children orphaned by AIDS in rural Uganda’, Social Science & Medicine 61 555-564.
- 10. USAID/SCOPE-OVC/FHI (2002), 'Results of the orphans and vulnerable children head of household baseline survey in four districts in Zambia', cited in UNICEF (2003, November) ' Africa's Orphaned Generation'
- 11. Monasch and J. Ties Boerma (2004), 'Orphanhood and childcare patterns in Sub-Saharan Africa: an analysis of national surveys from 40 countries', AIDS 18 (suppl. 2): S55-S65.
- 12. Salaam T., Congressional Research Service (2004, March), ' AIDS Orphans and Vulnerable Children (OVC): Problems, Responses, and Issues for Congress'
- 13. UNICEF (2006), ‘Africa’s Orphaned and Vulnerable Generations: Children Affected by AIDS’.
- 14. Akwara, P. et al, (2010) ' Who is the vulnerable child? Using data to identify children at risk in the era of HIV and AIDS' AIDS Care 22(9) 1066-1085
- 15. UNICEF/UNAIDS (2010) ' Children and AIDS: Fifth Stocktaking Report'
- 16. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 17. Salaam T., Congressional Research Service (2004, March), ' AIDS Orphans and Vulnerable Children (OVC): Problems, Responses, and Issues for Congress'
- 18. United Nations Children's Fund (2003) 'Statement by UNICEF representative Bjorn Ljungqvist, HIV/children orphaned by AIDS survey findings conference', April 8.
- 19. Every Child & HelpAge International (2012) ' Family first: Prioritising support to kinship carers, especially older carers'
- 20. United Nations Children's Fund (2003) 'Statement by UNICEF representative Bjorn Ljungqvist, HIV/children orphaned by AIDS survey findings conference', April 8.
- 21. IRIN News (October 2002), 'Botswana: children orphaned by AIDS exploited'.
- 22. UNAIDS (2006) ' Report on the global AIDS epidemic '.
- 23. IRIN News (October 2003), 'Southern Africa: Special Report - New thinking needed on "children orphaned by AIDS"'
- 24. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 25. UNAIDS (2006) 'Report on the global AIDS epidemic'.
- 26. US Social Security Online (2005), 'Social security programs throughout the world: Botswana'.
- 27. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 28. UNAIDS (2006) 'Report on the global AIDS epidemic'.
- 29. IRIN News (October 2002), 'Botswana: children orphaned by AIDS exploited'
- 30. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 31. International HIV/AIDS Alliance (2002), ' Expanding community-based support for orphans and vulnerable children'.
- 32. Phiri S. and Webb D. (2002), 'The impact of HIV/AIDS on orphans and programme and policy-responses', in UNICEF, Cornia G. (ed.) ' AIDS, public policy and well being'
- 33. IRIN News (June 2005), 'Malawi: new child welfare plan gives stakeholders common platform'.
- 34. IRIN News (October 2002), 'Malawi: More action needed to support orphans'.
- 35. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 36. Pbs.org (May 2002), 'Orphaned by AIDS'.
- 37. UNICEF (2013) ' Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
- 38. USAID (2005), ' USAID Project Profiles: Children Affected by HIV/AIDS'.
- 39. Family Health International, Zambia (2003) ' Final Project Review Report'
- 40. UN Secretary-General's envoy for HIV/AIDS in Africa, Stephen Lewis (2003), Opening Address of the XIIIth International Conference on AIDS and STIs in Africa.
- 41. Bellamy C. (2002), 'Urgent Action for Children on the Brink'.