AIDS orphans 

AIDS orphans1 - the facts

By 2003 15 million children under 18 had been orphaned by HIV/AIDS worldwide.2 About 12 million of these live in sub-Saharan Africa, and it is expected that this number will have risen to more than 18 million by 2010.3 Most of the AIDS orphans who live outside of Africa live in Asia, where the total number of orphans - orphaned for all reasons - exceeds 87 million. There is however insufficient information in Asia to provide figures for the number of AIDS orphans in individual countries.

In sub-Saharan Africa, the number of orphans in some 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

Total number of orphans due to AIDS, 2003  
Nigeria 1,800,000
South Africa 1,100,000
Tanzania 980,000
Zimbabwe 980,000
Uganda 940,000
DR Congo 770,000
Ethiopia 720,000
Zambia 630,000
Orphans due to AIDS as a percentage of all orphans, 2003  
Zimbabwe 78%
Botswana 77%
Swaziland 63%
Zambia 60%
Lesotho 56%
Malawi 48%
Namibia 48%
Uganda 48%

AIDS is responsible for leaving vast numbers of children across Africa without one or both parents. The first table 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

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

Different areas in a country will not necessarily have the same concentrations of orphans. Particular areas may have higher or lower percentages of orphans, largely depending on the local prevalence rates. There can also be substantial differences between rural and urban areas.6

The Age of Orphans

The age of orphans 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 AIDS 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 of 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 Lewis8

Affecting Family Structures

In African countries that have already had long, severe epidemics, AIDS is generating orphans so quickly that family structures can no longer cope. Traditional safety nets are unravelling as more young adults die of AIDS related illnesses. Families and communities can barely fend for themselves, let alone take care of the orphans. Typically, half of all people with HIV become infected before they are aged 25, developing AIDS and dying by the time they are aged 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.

"Almost throughout sub-Saharan Africa, there have been traditional systems in place to take care of children who lose their parents for various reasons. But the onslaught of HIV slowly but surely erodes this good traditional practise by simply overloading its caring capacity by the sheer number of orphaned children needing support and care. HIV also undermines the caring capacity of families and communities by deepening poverty due to loss of labour and the high cost of medical treatment and funerals."9

The vulnerability of orphans

The vulnerability of AIDS orphans starts well before the death of a parent. Children living with caregivers who have HIV/AIDS will often experience many negative changes in their lives and can start to suffer neglect, including emotional neglect, long before the death of the parent or caregiver.

The economic impact of HIV/AIDS illness and death has serious consequences for an orphan's access to basic necessities such as shelter, food, clothing, health and education. Orphans run greater risks of being malnourished than children who have parents to look after them.

In addition there is the emotional suffering of the children which usually begins with their parents' distress and progressive illness. Eventually, the children suffer the death of their parent(s) and the emotional trauma that results. They then may have to adjust to a new situation, with little or no support, and they may suffer exploitation and abuse.1011

Since HIV can spread sexually between father and mother, once AIDS has claimed the mother or father, children are far more likely to lose the remaining parent. Children often then find themselves taking the role of mother or father or both - doing the housework, looking after siblings and caring for ill or dying parent(s).12

Children grieving for dying or dead parents are often stigmatised by society through association with HIV/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/AIDS. Because of this stigma and often-irrational fear surrounding AIDS, children may be denied access to schooling and health care. And 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 infected with HIV themselves. This further stigmatises the children, reduces their opportunities in the future, and they may also not receive the health care they need, and sometimes this is because it is assumed 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." Statement by UNICEF representative Bjorn Ljunqvist13

The Way Forward

The way forward is prevention and care. The rest of this page is devoted to issues around the care of AIDS orphans in Africa, but it is also important to remember HIV prevention. Preventing more adults from becoming infected with HIV in the future, and providing treatment and care, will prevent even more children from becoming orphans in the future.

Grandmother with her AIDS-orphaned grandchildren Grandmother with her AIDS-orphaned grandchildren

Care in the Extended Family

In the early days of the AIDS orphan crisis, there was a rush by well meaning non-governmental organisations to build orphanages. But this response was unsustainable given the scale of the problem, as the cost of maintaining a child in such an institution is many times that of 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.14

Support for Communities

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

The community needs to be supportive of children when they are orphaned. Orphans need to be accepted as part of the community and to 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 they are not stigmatised and denied the services they need.

Keeping Children in School

Keeping orphans at school is crucial for their future. It can provide education that can work as a safety net in the child's life. Schooling can also help to break the cycle of poverty. But orphans may be the first to be denied education when extended families cannot afford to educate all the children of the household.

In many African countries school fees result in many poor children being excluded from school, and extended families sometimes see school fees as a major factor in deciding not to take on additional children orphaned by AIDS.15

Empowerment for Children

Children can be empowered by regarding them as active members of a community rather than just victims. 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 HIV/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 (an adult attempting to rob orphans of their property once the children 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."16

Meeting Emotional Needs

Orphans will often have many physical needs such as nutrition and health care, and these can often appear to be the most urgent. But they will have significant emotional needs as well as the sickness and death of a parent is clearly a major trauma for any child. The emotional needs of the children must 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 1317

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

In many HIV high prevalence countries efforts to provide care and support for the orphans have been underway for many years. Although there have been encouraging initiatives, many of these are small scale and are struggling with the increasing number of children. Three of the 10 worst affected countries in terms of HIV prevalence are Botswana, Malawi, and Zambia.

Botswana

In Botswana, it is estimated that 110,000 children had lost their parent(s) to AIDS by the end of 2003.18

A National Orphan Programme was established in April 1999 to respond to the immediate needs of orphaned children. The programme is run by various government departments, NGOs, CBOs and the private sector. The programme's objectives are to review and develop policies, build and strengthen institutional capacity, provide social welfare services, support community-based initiatives and monitor & evaluate activities. A major goal of the Programme is to develop a comprehensive National Orphan Policy, based on the Convention on the Rights of the Child.19

An example of the programme in action, is that in the rural district of Bobirwa district authorities have contracted out to the Bobirwa Orphan Trust the delivery of essential government services to orphans in the area. The Trust is made up of community volunteers and local extension staff - government paid employees, including social workers and family welfare educators. The members of the Trust identify and register orphans in the district, and through home visits, schools and churches, screen orphans using established criteria to identify the type of assistance they need. They also initiate community-placed foster placement, and identify local groups who purchase food and clothing and distribute them to orphans. Needy orphans are assisted with food, clothing, blankets, counselling, toys, bus fares to and from school, school uniforms and other educational needs.20

House of Hope Day Care Centre House of Hope Day Care Centre

Traditionally in Botswana orphaned children have been cared by the extended family. However, it has been found in Botswana that sometimes people are no longer willing or indeed no longer are able to do this. It has been found in Botswana that the level of care the orphans receive is sometimes unacceptable and sometimes the family members use the orphans to benefit from the government orphan packages.21

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. Started 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.22 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.23, 24

AVERT.org has more about HIV & AIDS in Botswana.

Malawi

Malawi has been struggling with high levels of HIV infection which is made worst by extreme poverty. By the end of 2003, it was estimated that Malawi had 500,000 children orphaned by AIDS.25

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 focus sub-national 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.26

An important aspect of the government's strategy has been to promote and support community based programmes, and 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.

The Madalito Orphan Vulnerable Care Centre in Mtsinje was set up in 2002 to serve children between 2 and 9 years and provide them with food education, support and counselling. The Thokanzani Hope Community Orphan Care Centre in Bilila was also set up in 2002 and provides assistance to 15 different villages in the area. Currently it supports 1300 orphans and their caregivers.

The AIDS orphan crisis in Malawi is a daunting challenge for the country and its government and resources are lacking in Malawi to handle the HIV/AIDS epidemic as a whole.

"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."27

AVERT.org has more about HIV & AIDS in Malawi.

Zambia

UNAIDS worker with a child orphaned by AIDS UNAIDS worker with a child orphaned by AIDS

In Zambia the estimated number of children orphaned because of AIDS is 630,000.28

In Zambia, one of the countries hit hardest by the HIV/AIDS epidemic, the traditional mechanism for the care of vulnerable children, the extended family, has started to break down under the twin pressures of poverty and disease.29

"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

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

Zambia's financial difficulties do not allow the government to provide free education. The government pays teachers' salaries, but local school management committees must cover operating costs by charging enrolment fees and setting requirements for uniforms. As a result, an end to education is often an early consequence of orphanhood and the loss of family income. In an effort to keep children in school, communities have developed three types of response. The first is to lobby local school management committees to not claim fees from the most vulnerable children. A second community strategy is to raise money for orphans' school fees. A third way is the Open Community Schools programme - community run schools without fees or dress codes using volunteer teachers, donated space and a curriculum that compresses the first six years into three.

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). In 2002 the project offered life-sustaining care and support services for over 137,000 orphans and other vulnerable 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.30

The Need for Urgent & Sustained Action

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, as well as preventing more children from becoming orphans in the future. In many countries a variety of initiatives are now taking place to help AIDS orphans, but the number of children is increasing rapidly, and in many instances the increase in response is not keeping up with the increase in need. There is an urgent need to scale up responses and this is going to need both increased 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." 31

and 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"32

General information about HIV and AIDS in Africa can be found in our Africa section.

More information about HIV and AIDS orphans statistics can be found in our HIV and AIDS Statistics section.

This page was written by Jenni Fredriksson and Annabel Kanabus, updated by Jane Penninngton and Annabel Kanabus, May 2005.

References

  1. There has been considerable discussion among some organisations about how to refer to children affected by HIV/AIDS in developing countries. 'AIDS Orphans', 'Children Affected by AIDS' (CABA) and 'Orphans and Vulnerable Children' (OVC) are some of the terms that are used. OVC is a term used by many international development agencies to describe all children who are judged to be vulnerable and at risk, including children affected by poverty and conflict as well as HIV/AIDS. The use of terms changes over time to avoid being stigmatising, discriminatory or misleading. For example some organisations no longer use the term 'AIDS Orphan' as they feel it implies children orphaned by AIDS are themselves HIV positive, and it increases stigma.

    At AVERT we recognise and do not wish to minimise the needs of children who have been orphaned for other reasons. However, as a result of the AIDS epidemic there are now, as has been explained above, a very large and increasing number of children orphaned by AIDS some of whom have specific needs. There are some circumstances, such as the likelihood of being a double orphan, that are particularly likely to affect children orphaned by AIDS. So this page is focusing on AIDS orphans and we leave it to others to discuss the needs of orphans more generally. AVERT.org also has another page which discusses how children are affected by HIV/AIDS in a number of different ways, including the many children who are HIV positive.
  2. Orphan usually refers to a child under the age of 18 (or in some instances 15) whose mother (maternal orphan) or father (paternal orphan) or both (double orphan) are dead.
  3. UNAIDS/WHO 2004 Report on the global AIDS epidemic
  4. UNAIDS, UNICEF, USAID 'Children on the Brink 2004: A joint report of new orphan estimates and a framework for action' www.unicef.org/publications/index_22212.html
  5. UNAIDS, UNICEF, USAID 'Children on the Brink 2004: A joint report of new orphan estimates and a framework for action' www.unicef.org/publications/index_22212.html
  6. UNICEF (2003), Africa's Orphaned Generations, www.unicef.org/publications/index_16271.html
  7. Monasch, R and J T Boerma 'Orphanhood and childcare patterns in sub-Saharan Africa: An analysis of national surveys from 40 countries AIDS 2004, 18 (suppl 2): S55-S65
  8. http://www.aidsuganda.org/pdf/...
  9. United Nations Children's Fund (2003) 'Statement by Unicef representative Bjorn Ljungqvist, HIV/AIDS orphans survey findings conference', April 8
  10. Jo Stein Sorrow makes Children of us all: A literature review on the psycho-social impact of HIV/AIDS on Children CSSR Working Paper No. 47
  11. Reaching out to Africa's Orphans A Framework for Public Action 2004
  12. UNICEF, Children Orphaned by AIDS: Front Line responses from eastern and southern Africa, New York, 1999 www.unicef.org/publications/index_4379.html.
  13. United Nations Children's Fund (2003) 'Statement by Unicef representative Bjorn Ljungqvist, HIV/AIDS orphans survey findings conference', April 8
  14. Mass Orphanhood in the era of HIV/AIDS BMJ 2002;324:185-186
  15. Mass Orphanhood in the era of HIV/AIDS BMJ 2002;324:185-186
  16. IRIN News (2002) 'Botswana: AIDS orphans exploited', October 8 www.irinnews.org/AIDSreport.asp?ReportID=1477
  17. IRIN News (2004) Southern Africa: Special Report - New thinking needed on "AIDS Orphans"
  18. UNAIDS, UNICEF, USAID 'Children on the Brink 2004: A joint report of new orphan estimates and a framework for action' www.unicef.org/publications/index_22212.html
  19. UNICEF, Children Orphaned by AIDS: Front Line responses from eastern and southern Africa, New York, 1999 www.unicef.org/publications/index_4379.html.
  20. UNICEF, Children Orphaned by AIDS: Front Line responses from eastern and southern Africa, New York, 1999 www.unicef.org/publications/index_4379.html.
  21. IRIN News (2002) 'Botswana: AIDS orphans exploited', October 8 www.irinnews.org/AIDSreport.asp?ReportID=1477
  22. www.yesweb.org/gkr/project_factsheet.html?pid=1013
  23. www.unbotswana.org.bw/undp/news_220604.html June 2004
  24. House of Hope, www.achap.org/Househope.htm
  25. UNAIDS, UNICEF, USAID 'Children on the Brink 2004: A joint report of new orphan estimates and a framework for action' www.unicef.org/publications/index_22212.html
  26. UNICEF, Children Orphaned by AIDS: Front Line responses from eastern and southern Africa, New York, 1999 www.unicef.org/publications/index_4379.html.
  27. IRIN News (2002) Malawi: More action needed to support orphans', October 24 www.irinnews.org/AIDSreport.asp?ReportID=1492
  28. UNAIDS, UNICEF, USAID 'Children on the Brink 2004: A joint report of new orphan estimates and a framework for action' www.unicef.org/publications/index_22212.html
  29. Online Newshour (2002) 'Orphaned by AIDS', May 9 www.pbs.org/newshour/bb/health/jan-june02/aids_zambia_5-9.html
  30. USAID (2003) 'Building community-based partnerships to support AIDS orphans and vulnerable children', May
  31. Address by Stephen Lewis at the Official Opening of the XIIIth International Conference on AIDS and STIs in Africa, Nairobi, 21 September 2003 stephenlewisfoundation.org/docs/20030921-ICASAOpeningCeremonies.html
  32. Speech : 'Urgent Action for Children on the Brink', Carol Belllamy, www.unicef.org/media/media_9403.html

Last updated October 2, 2006