Orphans and HIV: A Tale of Two Epidemics
Those who live in resource rich countries benefit from the remarkable scientific advances in HIV. With over 20 drugs to treat HIV infection, the lives of those who are infected have been extended for several decades; with knowledge of how to prevent all means of HIV transmission, new HIV infections have decreased significantly. Not so for those in resource poor countries -- especially for children.
Never before have so many children been orphaned by a single disease. The HIV/AIDS epidemic has resulted in an estimated 15 million children who have lost one or both parents to AIDS. Every day, another 6,100 children are added to that number -- a situation unprecedented in recorded history. Whether children have lost one parent or both, they are considered orphans or vulnerable children because the remaining parent is usually too ill to work or support the family. Among the millions of orphans are many children who are themselves infected with HIV.
Treatment of HIV-exposed or infected children in resource-poor countries lags behind developed countries where virtually all HIV-infected infants receive combination antiretroviral drugs and prophylactic antibiotics. At the end of 2005, less than 5 percent of the 2.3 million children living with HIV in resource-poor countries received treatment. Even cotrimoxazole, a generic antibiotic capable of reducing death from infectious complications of HIV by 40 percent, and costing less than $3 per year per child, is not routinely used in most resource-poor countries. Yet the need to treat children is urgent, as HIV infection progresses to AIDS more rapidly in children than in adults. Without treatment, 30 percent of HIV-infected infants die within their first year of life and 60 percent die by age 5.
Children with HIV who live in rural areas or in foster parent/orphan care settings have minimal access to medical care or healthcare facilities. Healthcare workers often are not trained to recognize, diagnose and care for HIV-infected children. Even when healthcare workers are available, they are often overwhelmed with meeting basic needs and dealing with other serious and life-threatening diseases, such as malaria and tuberculosis. It would take 19 years in the US to reach the number of HIV infected infants born in one day in resource poor countries.
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Why Are There So Many Orphans and Vulnerable Children?
Increasing Numbers of HIV Infected Women of Child Bearing Age
The number of children orphaned by HIV/AIDS is increasing at an unprecedented rate -- 6,100 each day. The rapidly growing number of orphans reflects the dramatic increase in HIV infection of women of childbearing age. Women now represent 50 percent of the people living with HIV infection. While 70 percent to 80 percent of infants born to HIV infected mothers escape infection, all are likely to become orphaned as their parents die from HIV complications or become too ill to support the family.
Lack of Highly Visible International Advocacy
The geographic isolation of orphaned children in resource-poor countries has created a physical and intellectual distance between their suffering and an understanding of the extent of the epidemic. Their physical, psychosocial and spiritual needs are seldom heard, so we do not see their pain. Because children cannot advocate for themselves, others must speak for them. We are reminded of the words of Marion Wright Edelman, easily adapted to resource-poor countries:
"Having lobbied for children's rights issues in Washington, DC, over the past 18 years, I am convinced that the new direction will not come from inside the political process. Politicians love to make speeches about families and children, but when they get back to Washington and budget battles, kids are the last to cross their minds. Kids don't vote. And political leaders respond to three things: threats to their reelection, potential embarrassment in the media, and the promise of campaign contributions. Children don't make campaign contributions, and many of their parents are too busy struggling to make ends meet to get involved in campaigns. If change is to come, it will happen because people like you respond in an aggressive, sustained, and even outraged way."
Inattention to Physical, Psychosocial and Spiritual Needs of Orphans and Vulnerable Children (OVC)
Inattention leaves OVC vulnerable to exploitation. Gangs and rebel armies provide a substitute for families. Hamish Young from UNICEF described the plight of orphans as, "Putty in the hands of warlords." Orphaned children deal with their own mortality as they lose their parents and siblings, often suffering in grief alone without any psychosocial or spiritual support. Older orphans, as they approach adulthood, face an uncertain future. Often they lack the maturity needed to make decisions about romantic relationships, sexual activity, experimentation with drugs and alcohol, advanced education and their own health. The pain of dealing with complex feelings of guilt, depression, and loneliness creates psychological and spiritual confusion. Without help and hope the consequences often are homelessness, migration, illiteracy, poverty, child labor, and unemployment when they reach adult life.
Inadequate Infrastructure and Trained Healthcare Workers
Children with HIV who live in rural areas or in foster parent/orphan care settings have minimal access to medical care or healthcare facilities. Healthcare workers often are not trained to recognize, diagnose and care for HIV-infected children. Even when healthcare workers are available, they are often overwhelmed with meeting basic needs and dealing with other serious and life-threatening diseases, such as malaria and tuberculosis. Healthcare workers uneducated in HIV/AIDS may engage in discrimination and stigmatization that increases the suffering of orphan children.
Families Cannot Cope
The traditional extended family network, which normally cares for 90 percent of Africa's orphans and vulnerable children, is severely strained. Many households are headed by women only, grandparents or even children who are themselves orphans. Communities, once stable and able to provide for the needs of OVC find that they have lost many of their teachers, healthcare workers and leaders to HIV.
Stigma and Discrimination
Orphan children are easily stigmatized by their relatives, communities, schools and churches. HIV "blame" extends to the child, despite overwhelming evidence that HIV is not transmitted casually. Persistent mythology, due to lack of education, instills fear among potential caregivers, educators and even within orphan programs. Without protection, children are sometimes demonized and lose all of legal rights, including access to care and education. Education for those engaged in orphan care reduces the discrimination and stigma that needlessly increases an orphan's suffering.
Web Sites
Global Strategies for HIV Prevention
From Faith to Action on the Firelight Foundation
References
Ammann AJ The ongoing HIV epidemic. Student British Medical Journal 2002;10:441-484
Domek GJ. Social consequences of antiretroviral therapy: preparing for the unexpected futures of HIV-positive children. Lancet. 2006 Apr 22;367(9519):1367-9.
Foster G, Makufa C, Drew R, Kambeu S, Saurombe K. Supporting children in need through a community-based orphan visiting programme. AIDS Care. 1996 Aug;8(4):389-403.
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