HIV/Aids is having a devastating effect on the world’s children, especially those in the developing world, and especially those in Africa. The disease strikes children directly through infection, creates orphans and places a heavy burden on young shoulders when family members fall ill.
Worldwide, approximately three million children under age 15 have been infected with HIV and 600 000 are newly infected annually. The majority of these children live in sub-Saharan Africa, where between 25-40% die before their fifth birthday.
The majority of infections in babies and young children occur through mother to child transmission: the baby is infected either perinatally (via the mother’s blood in the womb or during birth), or through breastfeeding. Sexual abuse also accounts for a relatively small number of infections in children. Some children become infected when they become sexually active at a very young age.
Although HIV may progress more rapidly in children than in adults, they may still enjoy years of good quality life, especially if they receive good supportive care.
Children affected by HIV/Aids
Thirteen million children under age 15 have lost one or both parents to Aids, most of them in sub-Saharan Africa. This figure is expected to rise above 25 million by 2010. In South Africa, an estimated 660 000 children have been orphaned by Aids. With infection rates still rising and adults continuing to fall ill, HIV/Aids will continue to impact on children for at least the next two decades.
Children orphaned by Aids are at greater risk of abuse, exploitation, discrimination, developmental problems and illness than those orphaned by other causes. Other children are also affected: increasing numbers are living with sick family members, or in households that are struggling because they have taken in orphans.
The burden of HIV/Aids therefore affects children in many ways, including the following:
Taking on adult responsibilities. As parents and other family members fall ill, children increasingly take over care of the sick, care of younger siblings, household chores and income generation. The eldest child may take on the role of head of the household.
Child labour. Children may have to work to supplement the household income, reduced when ill adults cannot work and savings are spent on medical treatment. Children who cannot find work may be forced into early marriage, prostitution, crime or begging on the streets.
Psychological stress. Children who watch their parents suffer and die undergo severe emotional distress. The psychological impact of witnessing a parent dying of Aids can be greater than for children whose parents die from more sudden causes. With Aids, there may be long periods of stress, suffering and uncertainty before the parent dies. In poor communities, effective pain or symptom relief to ease the parent’s suffering is often unavailable. Worries about future survival can add to a child’s already high stress levels. Ongoing emotional distress can lead to problems such as depression and aggressive behaviour.
Loss of parenting. Growing up under stress without adequate parental guidance and support, and poorly supervised by relatives and welfare organisations, children orphaned by Aids are at higher risk of developing antisocial behaviour (such as criminal activity and drug abuse) and failing to become productive members of society.
Societal discrimination and stigma. People in the community may discriminate against children who have HIV, who have family members with HIV, or who have been orphaned by Aids. This puts them at higher risk of abuse and social exclusion, and they may be denied basic needs such as education and housing. Orphans taken in by a new family may be expected to work harder than the other children, and may be the last to receive benefits such as having their school fees paid. In some communities, families will not take in orphans, because of the stigma of caring for non-related children – particularly those associated with Aids. The stigma still often attached to HIV/Aids makes it harder for children to deal with the illness and death of their parents.
Growing up in impoverished conditions. HIV/Aids has put great pressure on the traditional extended family system; the ability of poor communities to support children orphaned by Aids is increasingly strained, particularly in countries lacking adequate social welfare services. With the increase of mortality among adults, the burden of caring for children is often taken up by grandparents, who may find it hard to cope physically and economically. The result is that many children orphaned by Aids grow up in impoverished conditions; some will become homeless and be forced to live on the streets.
Poor nutrition and health care. Families struck by HIV/Aids may have less money available for nutritious food. Poor childhood nutrition results in developmental problems and poor school performance.
Negative impact on education: Children, especially girls, may drop out of school to care for ill parents, work, or tend the household. Orphans may leave school because of discrimination or emotional distress, or because they cannot afford school fees. Early school-leavers have an increased risk of HIV infection in that they are less likely to gain the skills needed to avoid unsafe sex, and will become economically vulnerable and open to sexual exploitation. School performance is affected by the psychological and physical stress of living with HIV/Aids. Education is also negatively impacted by teachers lost to the disease: Aids-related deaths among South African teachers rose by over 40% in 2000–2001.
Loss of inheritance. Sometimes parents die without making financial provisions for their children, or with unsettled financial debts. In some cases, wills are disregarded by relatives or customary law, with resulting loss of inheritance for the children. Sometimes children lose the house they were living in.
Physical and sexual abuse. Children without parental or family protection are more vulnerable to physical and sexual abuse, which increases their risk to HIV infection. Absence of parental protection and care, combined with HIV infection, contributes significantly to the increase in deaths of young children in the countries most affected by HIV/Aids.