Worldwide, it is estimated that more than 15 million children under 18 have been orphaned as a result of AIDS. Around 11.6 million of these children live in sub-Saharan Africa.¹ In countries badly affected by the epidemic such as Zambia and Botswana, it is estimated that 20 percent of children under 17 are orphans - most of whom have lost one or both parents to AIDS.² 

Even with the expansion of antiretroviral treatment access, it is estimated that by 2015, the number of orphaned children will still be overwhelmingly high.³

How many children have been orphaned by AIDS?

As the tables below show, the number of orphans in some sub-Saharan African countries exceeds half a million, and, in some countries, children who have been orphaned by AIDS comprise half or more of all orphans nationally.⁴ 

Number of orphans due to AIDS, alive in 2007
South Africa	1,400,000
Uganda	1,200,000
Nigeria	1,200,000
Zimbabwe	1,000,000
Tanzania	970,000
Ethiopia	650,000
Zambia	600,000
Malawi	560,000
Côte d'Ivoire	420,000

AIDS orphans as a percentage of all orphans, 2005
Zimbabwe	77%
Botswana	76%
Swaziland	66%
Lesotho	64%
Malawi	57%
Zambia	57%
South Africa	49%
Kenya	46%
Uganda	45%

AIDS is responsible for leaving vast numbers of children across Africa without one or both parents. The first table above shows the countries with the largest numbers of AIDS orphans.

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 AIDS epidemic, these children would not have been orphaned. The second table shows the countries in which the children who lost their parents to AIDS make up the highest proportion of the total national number of orphans.⁵

Most of the AIDS orphans who live outside of Africa live in Asia, where the total number of orphans - orphaned for all reasons - exceeds 73 million.⁶ There is, however, insufficient information available to provide figures for the number of AIDS orphans in individual Asian countries. The rest of this page concentrates on AIDS orphans 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.

The age of orphans, however, is fairly consistent across countries. Surveys suggest that overall about 15% of orphans are 0-4 years old, 35% are 5-9 years old, and 50% are 10-14 years old.⁷

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. If, as expected, the number of adults dying from AIDS rises over the next decade, an increasing number of orphans will grow up without parental care and love.

“The increased spiral of adult deaths in so many countries means that the number of children orphaned each day is expanding exponentially. Africa is staggering under the load.“ Stephen Lewis, UN Special Envoy for AIDS in Africa⁸

The problems faced by AIDS orphans

Emotional impact

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 suffer the death of their parent(s) and the emotional trauma that results. They may then have to adjust to a new situation, with little or no support, and may suffer exploitation and abuse.^{9 10}

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 AIDS orphans than other children. 12% of AIDS orphans affirmed that they wished they were dead, compared to 3% of other children interviewed.¹¹

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 survey in Zambia showed that 56% of orphaned children no longer lived with all of their siblings.¹²

Household impact

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.¹³ This lack of income puts extra pressure on AIDS orphans to contribute financially to the household, in some cases driving them to the streets to work, beg or seek food.¹⁴

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 are often at risk of losing the other parent as well, since HIV may have been transmitted between the couple through sex.

Education

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 major barriers, since many orphans’ caregivers cannot afford these costs.¹⁵ Extended families sometimes see school fees as a major factor in deciding not to take on additional children orphaned by AIDS.¹⁶

AIDS orphans may also leave school to attend to ill family members, work or to look after young siblings. Even before the death of a parent, children may miss out on educational opportunities; research in Kenya suggests that children of HIV-positive parents are significantly less likely to attend school than other children.¹⁷

Outside of school, AIDS orphans 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.¹⁸

Stigmatisation

Children grieving for dying or dead parents are often stigmatised by society through association with AIDS. The distress and social isolation experienced by these children, both before and after the death of their parent(s), is strongly exacerbated by the shame, fear, and rejection that often surrounds people affected by HIV and AIDS. Because of this stigma, children may be denied access to schooling and health care. Once a parent dies children may also be denied their inheritance and property. Often children who have lost their parents to AIDS are assumed to be HIV positive themselves, adding to the likelihood that they will face discrimination and damaging their future prospects. In this situation children may also be denied access to healthcare that they need. Sometimes this occurs because it is assumed that they are infected with HIV and their illnesses are untreatable.

“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 Ljunqvist¹⁹

Family structures

In African countries that have already suffered long, severe epidemics, AIDS is generating orphans so quickly that family structures can no longer cope. Traditional safety nets are unravelling as increasing numbers of adults die from HIV-related illnesses. Families and communities can barely fend for themselves, let alone take care of orphans. Typically, half of all people with HIV become infected before they are aged 25, developing AIDS and dying by the time they are 35, leaving behind a generation of children to be raised by their grandparents, other adult relatives or left on their own in child-headed households.

Traditional systems of taking care of children who lose their parents, for whatever reason, have been in place throughout Sub-Saharan Africa for generations. But HIV and AIDS are eroding such practices by creating larger numbers of orphans than have ever been known before. The demand for care and support is simply overwhelming in many areas. HIV reduces the caring capacity of families and communities by deepening poverty, through medical and funeral costs as well as the loss of labour.²⁰

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 AIDS orphans in Africa, but it is also important that HIV prevention is not forgotten. The situation of AIDS orphans 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 AIDS orphan crisis, there was a rush by well meaning non-governmental organisations to build orphanages. Given the scale of the problem, though, 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 be cared for in family units through extended family networks, foster families and adoption, and that siblings should not be separated. Studies in sub-Saharan Africa have repeatedly demonstrated that growing up in a family environment is more beneficial to a child than institutional care, which should be considered a temporary option or a last resort.

Ultimately, though, the extended family can only serve as part of the solution to mass orphanhood if adequately supported by the state and the community, as well as other sectors of society.

The community needs to be supportive of children when they are orphaned, making sure that they are accepted and have access to essential services, such as health care and education. This means improving existing services and reducing the stigma surrounding children affected by AIDS so that they do not face discrimination when trying to access these services.

Keeping children in school

“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 13²¹

Schools can play a crucial role in improving the prospects of AIDS orphans 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 AIDS orphans outside of education, such as emotional support and care.

Unfortunately orphans may be the first to be denied education when extended families cannot afford to educate all the children of the household.

Empowerment for children

If AIDS orphans are as active members of the community rather than just victims, their lives can be given purpose and dignity. 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

Much can be done to ensure the legal and human rights of AIDS 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 Botswana²²

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 AIDS orphans in sub-Saharan Africa and increased child-labour.²³

Meeting emotional needs

The physical needs of orphans, such as nutrition and health care, can often appear to be the most urgent. But the emotional needs of children who have lost a parent should not be forgotten. Having a parent become sick and die is clearly a major trauma for any child, and may affect them for the rest of their life.

“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 13²⁴

Country responses to the AIDS orphan crisis: Botswana, Malawi, and Zambia

In many countries with a high prevalence of HIV, efforts to provide care and support for AIDS orphans 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 Africa countries that have been worst affected by HIV and AIDS are Botswana, Malawi, and Zambia.

Botswana

In Botswana, it is estimated that 95,000 children had lost their parent(s) to AIDS by the end of 2007.²⁵

A National Orphan Programme was established in April 1999 to respond to the immediate needs of orphaned children, and a comprehensive policy for helping AIDS orphans was established under this programme.²⁶ 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.²⁷ By December 2005, 50,557 orphans were registered to receive support from the government.²⁸

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. On top of this, needy orphans are assisted with blankets, counselling, toys, bus fares to and from school, school uniforms and other educational needs.²⁹

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. Even when they are, the level of care orphans receive is sometimes unacceptable. In some cases, families have been known to take on orphans merely to benefit from government orphan packages.³⁰

A variety of different community organisations do now provide support for orphans, and the government does encourage communities to provide care for orphans within the community, and to rely on institutional care only as a last resort.

The Kgaitsadi Society in Gabarone is an example of a community organisation set up to care for and educate AIDS orphans. Established in 2002, it assists with their basic needs and provides basic and primary school level education through a flexible school programme. It also provides support for children caring for family members and for those that are working. Other examples of community organisations are the Maun Counselling Centre, and the House of Hope in Palapye both of which provide day care support for orphans.^{31 32}

Read more about HIV & AIDS in Botswana.

Malawi

AIDS, extreme poverty and food shortages have all taken their toll on Malawi in recent years. By the end of 2007, it was estimated that Malawi had over half a million children orphaned by AIDS.³³

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.³⁴

An important aspect of the government's strategy has been to promote and support community based programmes. In both rural and urban areas across Malawi, communities are developing a variety of ways to cope with the growing crisis of AIDS orphans. In many villages orphan committees have been established to monitor the local situation and to take collective action to assist those in need.³⁵

The Government furthered its commitment to AIDS orphans in June 2005 when President Mutharika launched The National Plan of Action for Orphans and Vulnerable Children. This plan, which is due to run until 2009, aims to increase access to essential services - such as education, health, nutrition, water and sanitation - amongst AIDS orphans and other vulnerable children. It also aims to help families and communities provide support for such children.³⁶

The large number of children losing parents to AIDS in Malawi presents a daunting challenge to both the government and regional communities. A severe lack of human and financial resources continues to hold back Malawi’s fight against AIDS, including efforts to support AIDS orphans.

“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.”³⁷

Read more about HIV & AIDS in Malawi.

Zambia

In Zambia the estimated number of children orphaned because of AIDS is 600,000.³⁸

The AIDS epidemic in Zambia is among the worst in the world. Under the twin pressures of poverty and disease, many extended families (which traditionally care for vulnerable children in Zambia) are breaking down.

“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 representative³⁹

Child-headed households, once a rarity in Zambia, are now increasingly common. Unfortunately, formal and traditional inheritance, land ownership and health policies have not kept up with their needs.

In July 2006, Zambia’s Health Minister, Ronnie Shikapwasha, revealed that 6% of the country’s AIDS orphans are homeless and that less than 1% lives in orphanages. He stressed that more needs to be done to support AIDS orphans, through better access to education, health care, nutrition, and food, among other things.⁴⁰

One multi-sectoral project in Zambia is Strengthening Community Partnerships for the Empowerment of Orphans and Vulnerable Children (Scope-OVC). This support programme is implemented by CARE/Zambia with help from Family Health International (FHI) and funding from the U.S. Agency for International Development (USAID). Between 2003 and 2004, this project offered life-sustaining care and support services for over 81,709 children. The project works to keep siblings together and children within extended families and communities. Scope develops district and community level capacity and resources to respond to the needs of orphans and vulnerable children. Scope also tries to build partnerships and networks and sustain old ones with community-based organisations that provide care and support for children.⁴¹

Read more about HIV and AIDS in Zambia.

The need for urgent & sustained action

“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.”

Carol Bellamy

Millions of children have already lost at least one parent as a result of the AIDS 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. In many countries a variety of initiatives are now taking place to help AIDS orphans. The number of children requiring support is increasing rapidly, though, 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, the UN Secretary-General's Special Envoy for HIV/AIDS in Africa spoke about the AIDS orphan 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.”⁴²

Additionally, the Executive Director of UNICEF, Carol Bellamy 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.”⁴³

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References

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