A comprehensive case study of the public school system in South Africa provides an overview of educator attrition and mortality trends, stratified by age and gender (Figure 5). (Badcock-Walthers et al, 2005). Data from about 90% of South Africa’s teaching force tracked over seven years (1997/8 – 2003/4) showed that there are alarming number of orphans in households of public school teachers. The fast increasing number of AIDS orphans now commands the attention of a large number of researchers concerned with their care.
As said by the UN, the disease has resulted in more than14 million AIDS orphans since the epidemic began (Hagen, 2002) and this number is expected to increase to some 40 million in Africa by the year 2010 (Foster and Williamson, 2000). Nevertheless, these numbers are thought to underestimate the problem as they are based on a restricted definition of orphanhood. The United Nations and other analysts normally define an orphan as a child under 15 years old whose mother has died of AIDS, thus excluding children from 15 to 17 years old and those who have lost a father to AIDS.
However many community programs intended for helping children in difficult circumstances in addition to those promoting rights of the child often define orphans as those under 18 years old who have lost one or both of their parents. Limited definitions of orphans hide particular problems, such as the specific needs of young adolescents and the differences between losing a mother, a father, or both (Hagen 2002). Consequently, major questions remain about how large the orphan crisis is and how fast it is growing.
Analysts who attempted to answer these questions in the early 1990s tended to use theoretical mathematical models, since there was inadequate census or morbidity data in most African countries (Gregson et al, 1994). More recent studies have been able to use demographic and health surveys and or other sources of empirical evidence to more strongly track orphan prevalence rates and developments in different countries, although they cannot establish the cause of death of parents.
Nevertheless, some researchers have deduced that, since HIV/AIDS death rates have gone up in relationship with the rise of the number of orphans, AIDS has been the cause of death of many of the parents. Using demographic and health survey data in 17 countries in sub-Saharan Africa from 1995-2000, Bicego et al (2003) found that prevalence of orphanhood change according to country and whether the epidemic in the area is at a “mature” stage or not. For instance, more than one-third of all families in Uganda are hosting an orphan (Deininger et al, 2003).
This high level is to a certain extent as a result of the fact that the epidemic began comparatively early in Uganda compared to other African countries, extending the period that children have been exposed to the risk of orphanhood. On the contrary, Niger and Ghana in Western Africa, which have had low HIV prevalence levels, showed a decrease in orphans over time (Bicego et al, 2003). More empirically based studies such as these have highlighted the AIDS orphan issue as a growing problem and pointed to the need for more and better data to evaluate its scale (Bicego et al, 2003).
Most research deal with questions of the impact on the child of losing one or both parents, in terms of their educational, nutritional, health and emotional status. Some research has looked at further effects on orphans such as their migration into cities, becoming street children, and the need to engage in sexual activities so as to secure food and shelter, which puts them at increased risk of HIV infection and transmission among other problems. Modern research has focused on the caregivers and surviving household heads, who are often female and elderly grandparents, and sometimes even siblings who are children themselves.
Generally, children who have lost one or both parents to AIDS are at risk of leaving school or falling behind their age group in school. The main concern is that families pull children out of school when the financial burden increases as a result of HIV/AIDS. Moreover, even before the parent dies, the child is needed more in the household to help with domestic work. After becoming an orphan, some children stay home to look after their siblings, and hence do not go to school.
Some studies have found that when a mother dies, younger children are less likely to go to primary school, and when a father dies, children in upper grades are less likely to go to school. Nevertheless, other studies have found little disadvantage in educational opportunities for orphans (Bicego G. et al, 2003). Uganda provides one model for improving the problem by making it possible for all children to go to primary school without fees through the Universal Primary Education Program implemented in 1997.
The effect is that educational opportunities for orphans were found to be same as for non-orphans (Deininger and Subbarao, 2003). Besides, the program seems to have helped all children go to school, whether they are orphans due to AIDS or not. Another concern is that children’s mal-nutrition if they are orphans as a result of AIDS, although empirical studies have found inconsistent results. In Uganda, evidence suggests that orphans’ nutrition and health are risk when they are brought into a family that lacks adequate resources to care for them (Preble, 1990).
Another study found that adding a foster child to a family had the effect of reducing per capita consumption in addition to investment of household resources, which in turn negatively affected nutrition and medical services (Deininger and Subbarao, 2003). It has also been found that with the loss of the mother as caregiver, the health of orphans often deteriorates, as elderly and adolescent caregivers may be less educated about good child health practices (Foster, 1998).
On the other hand, other studies have found little difference in the effect on orphans. Health and nutritional status compared to non-orphans in the same household. In a longitudinal case study in Malawi, from the 1980s to 2000, researchers found no evidence of increased morbidity (particularly stunting and wasting) in surviving children of mothers who were HIV-positive (Crampin et al, 2003). The authors suggest that extended families have not victimized children whose parents have been ill or died from HIV/AIDS.
A study in Kinshasa, Zaire (DR Congo) found that morbidity and socioeconomic consequences were not appreciably different between 1) AIDS orphans whose mother had died 2) children with HIV-1-seropositive mothers and 3) children with HIV-1-seronegative mothers. This was true particularly when a concerned family or extended family member was present. Nevertheless, it is pointed out that in areas such as Uganda, where the HIV prevalence rates are much higher than in Zaire (DR Congo), the situation is likely to be more severe (Ryder et al, 1994).
However, there is some evidence that HIV infection is higher among AIDS orphans. Looking at 15 villages in rural Uganda, one study found that seroprevalence of HIV was higher among orphans and widows/widowers of a spouse who died from HIV-1 than among the remaining population (Kamali et al, 1996). A new complicating factor is that by the time a child has become an orphan of one or both parents due to AIDS, he or she has lived through the illness of this parent, and this has its own effects upon the well being of the child with the economic situation of the family.
AIDS can have a greater impact on children than other diseases as the surviving parent is likely to die too if also infected, and as a consequence of the enormous economic burden as a result of a lengthy period of illness (Crampin et al, 2003). Obviously, the emotional impact of losing one or more parents to HIV/AIDS is painful, and can be intensified if a child is abandoned (for example, when the cause of death of the parent is discovered). Stigmatization is a problem for AIDS orphans, as death from AIDS is often related with promiscuity, prostitution, or other improper behavior (Preble, 1990; Crampin et al, 2003).
This problem, together with economic difficulties, may force orphans to migrate to cities, joining the ranks of the already large number of street children, who in turn become more at risk of HIV infection and further transmission through sexual work and sexual exploitation to secure their basic needs (Preble, 1990, Danziger, 1994). In general, orphanages are seen as improper systems for childcare in Africa. Customarily in Africa, if children are orphaned, kinship groups, including grandparents, aunts, uncles, and other extended family, have absorbed them (Carballo et al, 2002).
This is called fostering in the literature, but is not equal to “foster parenting” in the United States, in which the government or other institution places children in homes of non-relatives. Fostering in Sub-Saharan Africa is managed within the family or community. In most of the cases in the literature, children whose mothers die sometimes live with their father and their stepmother, who may have been the second wife in a polygamous marriage, or who may have married the father after the death of the mother. Many children live with their grandmothers or in child-headed households, taken care of by older siblings.
In Zimbabwe, studies have shown that care giving is increasingly provided by grandparents, with an average age of 62, while a small minority of households is headed by siblings who are children themselves (Foster, 1998). Matshalaga (2002) studies the impact of orphans on the extended family system, showing that in Zimbabwe grandmothers who had conventionally “retired” from active life were drawn back into family and community dynamics through their new child-rearing responsibilities. Few programs have created “children’s villages” in Uganda (Hunter, 1991), and there are also a few Western-style orphanages.
The costs of these programs are exorbitantly high, however, and it is improbable that either children’s villages or orphanages will become common in Sub-Saharan Africa. Despite the fact that the extended family has been the focus of care for orphans and has usually been able to effectively absorb orphans within communities, particularly in rural areas where extended families are more intact (Walraven et al, 1996; Kamali et al, 1996), there are signs that the extended family system is being stretched as the number of AIDS orphans rises (Preble, 1990; Hunter, 1991; Danziger, 1994; Nyambedha et al, 2003).
One qualitative study in western Kenya found that the traditional patterns of fostering of orphaned children are not satisfactory for the care of the rising numbers of children orphaned by HIV/AIDS. More and more grandparents, generally grandmothers, are caring for numerous grandchildren, even though their own incomes are not high (Nyambedha et al, 2003) and they sometimes appear to have no alternative in the matter.