The New York Times - Thursday, December 2, 1999
Lawrence K. Altman

UNITED NATIONS - More than 11 million children have been orphaned by AIDS since the epidemic was recognized in 1981, and the number is expected to rise to 13 million by the end of 2000, the United Nations said today in a report to mark World AIDS Day.

The number of AIDS orphans is believed to far outstrip the number of children orphaned by other causes. The soaring number of AIDS deaths could eventually undermine the stability of affected countries, Dr. Peter Piot, the head of the United Nations program on AIDS, said in an interview here.

All but 5 percent of the world's children orphaned by AIDS live in countries below the Sahara, Unaids and Unicef said in the report. In the past, age-old networks of immediate and extended families would have assumed care of orphans. But, the report said, "the traditional African extended family is breaking down under the unprecedented burden of the pandemic."

Orphans are "the most forgotten aspect of the AIDS epidemic," Dr. Piot said, adding that for many of these children the future is bleak. Many end up as child laborers or "roaming the streets," he said, leaving them "prime targets for gangs, militia and creating more child armies like those that participated in massacres in Liberia and Sierra Leone in West Africa."

The result, the report said, "is a growing threat to stability, exacerbating inequalities within and between countries, undermining previous gains in development and harming children."

"These are enormous issues and a big challenge for tomorrow," Dr. Piot said.

Dr. Theo-Ben Gurirab, president of the United Nations General Assembly, said that had so many children been orphaned in wealthy parts of North America or Europe, "their fate would already have been declared a human tragedy."

The orphan issue affects people of all ages. In Africa in 1998, 200,000 people were killed in wars and conflicts while AIDS killed 2.2 million others, "and the worst is yet to come," the report said.

Children are growing up knowing little about their parents, and many orphans find themselves thrust in the role of parents, looking after their siblings. And Africans who were expecting their children to care for them in their advanced years now have to care for their grandchildren.

The United Nations defines AIDS orphans as children 15 and younger who lost either their mother or both parents to the viral disease. The statistics were reported this way in part because mothers are most important for care of surviving children but also because there is better information on women than on couples. Dr. Piot said the United Nations intends to do country-by-country surveys to determine the number of orphans according to a classic definition.

Under the United Nations definition, 11 percent of all children in Uganda and 9 percent in Zambia were orphans in 1997, the latest date for which information is available. In many other African countries, like Zimbabwe, it was 7 percent. The United Nations report did not provide a comparison with countries in other areas. Before AIDS, about 2 percent of all children in developing countries were orphans. No figure exists for orphans in African countries before AIDS, United Nations officials said.

AIDS orphans are at higher risk for malnutrition and its effects, illness, abuse and sexual exploitation than children orphaned by other causes, the report said. Also, AIDS orphans face the stigma and discrimination that often shadow the disease, leaving them socially isolated and often deprived of education and other basic social services.

And because many grandparents caring for their orphaned grandchildren have limited resources, "they cannot keep this up forever," Carol Bellamy, the executive director of Unicef, said.

The National Black Leadership Commission on AIDS, an American group, joined with the United Nations yesterday in urging African governments and communities to provide greater access to credit, income and property for women.

The groups also called for widespread counseling and voluntary testing for H.I.V., the virus that causes AIDS, support for the needs of orphans, and increased community protection of women's and children's rights.

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