Inter Press Service - July 30, 2000
Marwaan Macan-Markar

Last Wednesday, this legislative body approved a bill that authorised 600 million dollars to be spent over the next two years for AIDS prevention. According to Republican Senator Jessie Helms, a co-author of this bill, the US Treasury Department has been directed to set up a trust fund with the World Bank to facilitate programmes that help prevent the spread of AIDS (Acquired Immune Deficiency Syndrome) and treat those orphaned by it.

"Children are the hardest hit and they are the innocent victims of this sexually transmitted disease," Helms told the US media soon after the bill was passed on a voice vote.

But what is the best form of care for AIDS orphans? What environment is ideal to enhance and guarantee the rights of these children?

For health activists, such questions matter, given the circumstances these children find themselves in following the death of one or both parents to this pandemic. According to the United Nations department for AIDS (UNAIDS), studies have revealed, for instance, that AIDS orphans run greater risks of being malnourished and stunted.

Furthermore, such children are also victims of the stigma associated with the killer disease. As a result, says UNAIDS, they are often denied access to schools.

In some countries, it adds, they have even been deprived of basic health care needs since "it is assumed that they are infected with HIV (the Human Immunodeficiency Virus that causes AIDS) and their illnesses are untreatable."

According to a US-based health body, the National Pediatric and Family HIV Resource Center, these children need to be protected from sexual exploitation, too, because they are more likely to be abused and forced into "exploitative situations," such as prostitution, "as a means of survival."

What will help them, it argues, are skills that will include ways to make "sound decisions about relationships and sexual intercourse," advice on how to "resist pressure for unwanted sex or drugs," information about "youth-friendly health services," and assistance regarding "human rights, including legal rights such as inheritance".

So to whom should such children turn to for care? Orphanages?

No, says UNAIDS. What it has been arguing for, instead, are community-based initiatives in countries with AIDS orphans.

"Experts argue that orphanages are more expensive than community- based approaches and that orphanages can be culturally inappropriate if they cut children off from their social origins," says Dominique De Santis, spokeswoman for UNAIDS.

And this view has been given weight by successful programmes implemented in a number of African countries, ranging from Malawi and Zimbabwe to Uganda. In the case of Malawi, for instance, the government had decided as early as 1991 to support community-based programmes under its National Orphan Care Task Force.

Regards Uganda, on the other hand, a similar emphasis has been spearheaded by the Uganda Women's Effort to Save Orphans (UWESO), which currently has 35 branches nation-wide to care for AIDS orphans.

"It helps fund education and training for the children and runs a micro-finance programme to help the caretakers start up small businesses and trading activities," reveals De Santis.

Child rights activists have also come out in favour of this shift away from orphanages. "As with any child, AIDS orphaned children need a family environment in their own culture in which to live and grow," observes Bruce Harris, the executive director of Casa Alianza, the Latin American branch of Covenant House.

From his experience, the best environment for such a child is the comfort and home of a relative or, in the absence of one, the home of a foster family in the child's community. In Central America, he adds, this continues to be the norm, where the orphaned child is "being absorbed in a traditional manner by the extended family."

But the UN Children's Fund (UNICEF) feels that such responses need to be more broad-based, drawing on support from governments, the international community, the private sector and civil society organisations, since there is a "severe strain" on the traditional support system.

This is true, says Carol Bellamy, the head of UNICEF, if one looks at the pressure the major caregivers are under - grandparents. "The grandparents who in so many cases are taking care of their orphaned grandchildren have limited resources. They cannot keep this up forever."

Such concern, in fact, is not misplaced when one considers the alarm raised at the 13th International AIDS Conference, which was held early this month (Jul. 9- 14) in Durban, South Africa, about the rapidly rising number of AIDS orphans. In a report released during the conference, the US Agency for International Development (USAID) estimated that by 2010, "at least 44 million children will have lost one or both parents ... in the 34 countries most severely affected by the AIDS pandemic." Furthermore, it added, "Of these 44 million orphans, 68 percent of their parents will die of AIDS," representing a dramatic increase from 1990, when AIDS accounted for 16.4 percent of parental deaths.

According to the authors of this report, "Children on the Brink 2000," the orphan crisis is most acute in sub-Saharan Africa, currently the home of 12.1 million of the 13.2 million children worldwide orphaned by AIDS.

"In at least eight countries in this region, between 20 and 35 percent of children under 15 have lost one or both parents. By 2010, 11 countries will reach this rate," the report revealed.

For UNAIDS, such dismal predictions warrant a dramatic mobilisation of local and international resources to care for these children. "Although we have seen some progress made by several African governments in response to the orphan crisis, much more is needed," says De Santis.

What is required, she adds, are national policies that seek to reform the education sector to assist these orphans and their communities, in addition to changes in the health sector, which should guarantee quality care for the needs of the children and communities affected by AIDS.

Equally important for the orphans, she asserts, are laws. They need to be introduced and enforced to "protect the rights of these children."
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