Following are some of the common placement options HIV/AIDS Orphans. • HIV/AIDS on recourse to Informal Care Informal fostering and kinship care, already a common response to temporary or permanent inability of parents to care for their children, has become increasingly common. In Sub-Saharan Africa, where HIV is a major, and often the most noteworthy, cause of orphaning, over 90% of orphans live with a relative (UNICEF, 2004). Certainly, these arrangements are usually preferable to other choices, since children keep a sense of family feelings and may continue to reside in their original community.
There is also evidence from Sub-Saharan Africa to suggest that close relatives are expected to provide better care than more distant ones or than non-related foster carers, at least concerning access to education (Case et al, 2004), food provision and domestic chore allocation. Though kinship care is therefore often the best option, there are several ways in which HIV may have an impact on the care children receive in their extended family.
In highly affected communities, fewer adults are available to care for a growing number of orphaned children, and many of them are older and beyond their most economically productive years. For example, in many of the most affected countries in Eastern and Southern Africa, over 50% of all orphaned children are cared for by their grandparents (UNICEF, 2004). Similar findings have been reported in Thailand (Paul, 2001). Informal foster care by unrelated families is a less common, although not unimportant form of response to children orphaned by AIDS, particularly in Sub-Saharan Africa.
In Cameroon, Nigeria, Ethiopia and Kenya, for instance, over 5% of orphans are not related to the head of the family in which they live, and an equal or larger number are also described as foster children (UNICEF, 2004). Nevertheless the pressures on these informal foster families are much the same as those described for the extended family above. Besides, in some societies informal fostering is already a common practice, but often “based on a tradition of exchange between families” and not essentially on “perceptions of the child’s best interests” (Mann, 2001).
Concerns over exploitation of the children, abuse and unfavorable treatment or neglect in comparison to the caregivers’ biological children are frequently reported. Such risks may be increased in the presence of HIV, when families placing children in the care of others have less to offer in return, and as a result of stigma. • HIV/AIDS on Recourse to Institutions The use of institutional care is increasing in some high HIV prevalence countries.
Even in countries where the use of institutions is not a conventional response, growing concern about the HIV orphaning crisis and the availability of external support is leading to their increase. Both child rights frameworks and child development literature make clear that institutional care is seldom the most popular response; and should usually be used as a substitute rather than permanent measure, while working towards reunification or family placement. Institutional care is also costly, and as a result concentrates funds available for the care of orphans and other susceptible children on a small group.
In Tanzania for example, it has been recognized that the cost per child in residential care is six times the cost of supporting a child in a foster family. Concerns about conditions in residential care institutions, such as poor health and hygiene standards, lack of attention to the needs of individual children, lack of review of placements, as well as violence and abuse are common in many settings and discussed in detail in the UNICEF/ISS Working Paper. Recognition of these concerns has led to declining use of institutional care all over the industrialized world.
Important efforts are in progress to develop alternatives in many countries of the former Soviet Union and Eastern Europe, where residential placements had earlier been used as a first-line social welfare response, in addition to in several sub-Saharan African countries. In some of the most HIV-affected countries, on the other hand, the trend now appears to be reversing. In Uganda, for example, the number of children in residential care declined as of the early 1990s but then increased by 66% between 1998 and 2001 (Ugandan Ministry of Labour, Gender and Social Development, 2003).
A study on the response of faith-based organizations to the impact of HIV/AIDS on children in Sub-Saharan Africa found that support for orphanages was becoming gradually more popular among particular denominational groups, with over half of the institutions identified by the study having been established since 1997. Institutional care is often driven by external donors and the local private sector who are seeking real and visible ways to assist. Lack of guidance and regulation from government, which remains liable for responding to children in need of care, helps effect these responses.
Moreover, in regions where institutional care is already an established response, such as Eastern Europe, parts of Asia and Latin America, there is a risk that the gains of de-institutionalization efforts may be lost if residential placements are viewed as the most suitable response to HIV/AIDS affected children. At the same time as resources grow ever scarcer in poverty- and HIV-stressed families and communities, institutions serve as magnets when other care and family support options are unavailable.
In fact, this trend may explain why the majority of children in residential care in many countries do, in effect, have a living parent or other relatives. At present few services are available to support original and extended families to care for HIV-affected and other helpless children, nor are regulations in place in many countries to guarantee that institutional care is used only in proper situations and in tandem with ongoing efforts to reunify children with their families.
Yet, experience has shown that institutional care need not be an expected outcome of large-scale orphaning crises. In Rwanda 12,704 orphaned or separated children were in institutional care in the year following the genocide; with a much larger number having been orphaned or otherwise separated from their families. A policy of family tracing, reunification and fostering led to a swift reduction of the numbers of children being cared for this way, and a successful reintegration of children back into the community.
By 2000 less than 5,000 children remained in institutional care (Diona et al, 2001). Despite the fact that Rwanda is now also suffering from the effects of a widespread HIV pandemic, the number of children in institutional care has not increased significantly, because of the continued application of the policies developed in the mid- to late 1990s. In some cases, institutional care may include the setting up of orphanages and hospitals for children living with HIV/AIDS.
State intervention to remove children from their families is usually based on therapeutic concerns, however does not appear to take into consideration the preference for family nurture nor the possibility of efficiently supporting children living with HIV within their families. The isolation of HIV positive children from other children in out-of-home care settings also bring about stigma and increase their marginalization from others. • HIV/AIDS On Child-headed Families
In communities where AIDS and/or conflict have already taken the lives of many adults, there is greater chances of older children taking responsibility for younger siblings, so as to keep their family together. This response may also be common where government social services are not well developed, where community structure is weak, and where stigma contributes to the hesitation of the extended family and others in the community to care for orphaned children.
It may also grow because of knowledge that support for such initiatives is available from welfare agencies. The suitability of child-headed households as a lawful form of care for children without parental care is a matter of existing debate. Many advantages and disadvantages are linked with this form of care. On the one hand, it allows sibling groups to remain together and hold on to their family home.
Some children see it as preferable to fostering, or to being placed in a family where they may experience inequity, and all fear immediate or subsequent separation from siblings in such alternative situations. In contrast, child-headed households face difficulties in earning a adequate livelihood, are likely to lack experience in dealing with problems, and are particularly susceptible to abuse and mistreatment (Tolfree, 2003) (Luzze, 2002).
In some settings on the other hand, both informal and formal efforts have been made to support, rather than separate, child-headed households. In South Africa, for instance, the Law Reform Commission has proposed their legal recognition “as a placement option for orphaned children in need of care” and as a result for provision to be made to ensure sufficient supervision and support by persons or entities selected or approved by an official body and directly or indirectly accountable to that body (South African Law Reform Commission, 2002).
What seems clear, at least under present conditions, is that spontaneously-established child-headed households need to be supported and protected and certainly not arbitrarily dismantled – however at the same time should not be regarded as a “care option” to be promoted as such.