This chapter describes the plight of children who have been affected by the AIDS epidemic in South Africa and examines participants' concerns about the welfare of children. Several participants spoke on the subject of children (both their own as well as the children of the deceased). Their concerns revolved around two issues: the fate of the deceased's children and fears of what would happen to their own children once they died (in the case of participants who were HIV-positive).
Children Bereaved by AIDS
A total of six participants spoke about the loss of a loved/s to AIDS who left behind children who were now orphans. Zanele, Sizakele, Tuli, and Nomzamo all lost sisters who had children, and Delarise and Felicity both lost a best friend who had children. In each case, the fathers were out of the picture. In one case, the children witnessed the loss of both parents to AIDS. At the time of death, the priority was for family members to take in the children and to keep them together. Participants noted how much of a struggle it was for these families to accommodate the deceased's children into already overburdened households and how it strained material resources. But only two participants knew first-hand what the experience was like. Besta took in her brother's son and Ragani took in her three nieces after her brother and his wife died.
In South Africa, AIDS has left many children without parents. At the end of 2001, there were approximately 666,000 children under the age of 15 years orphaned by AIDS in South Africa (UNAIDS, 2002). This is compared to 420,000 at the end of 1999 (UNAIDS, 2000). Considerably more children have been orphaned by AIDS in South Africa than in the US for instance which has a total population about six times that of South Africa. A recent report indicated that through 1998 there were 97,376 children left motherless by AIDS in the US (Lee & Fleming, 2003). On the other hand, in South Africa, it is projected that there will be more than 2.5 million children orphaned by AIDS by 2010 (ReWe & Shisana, 2003). A lower estimate was projected by Johnson and Dorrington (2001) who indicated that without ARV treatment the number of children
who will lose a parent to AIDS will peak at 1.85 million in 2015. The vast majority of these children are Black and this trend will likely continue into the future. Johnson and Dorrington (2001) asserted that national implementation of ARV treatment programmes could significantly reduce the number of orphans in the next 15 years. We can only hope.
Recently, the Human Sciences Research Council published a report using data collected for the 2002 National Household Survey (Brookes, Shisana, & Richter, 2004) that highlighted the vulnerability of children in South African society. The report included information on orphanhood and risk factors for HIV infection among a sample of 3,988 children. The following findings were reported:
• 15% of children had lost a parent/caregiver by the age of 14 years.
• 25% of children 15-18 years of age had lost at least one parent/caregiver.
• Children of African descent, children in poor households, and children living in informal settlements were more impacted by AIDS.
• 0.5 % of households were headed by a child between 4 and 18 years of age.
• 45% of children lived in homes where there was not enough money for food and clothing.
• Almost one third of children were exposed to someone in the household and neighbourhood who got drunk regularly.
The authors of the report recommended that further research be conducted to assess orphanhood and to examine child-headed households due to HIV/AIDS. In the interim, they concluded that care and protection of children at home and in school was inadequate and this together with the combination of poverty and exposure to alcohol was creating an environment where children could be at considerable risk for sexual abuse and consequently HIV infection. For example, one third of children were left at home in the care of a person 15 years or younger, most children traveled on foot to school with little adult protection, and 50% of children 2 to 11 years of age were sent out of the home alone on errands (Brookes, Shisana, & Richter, 2004).
The plight of children orphaned by AIDS in Africa has received quite a good deal of attention in the popular press, and to some extent in scholarly journals. But, to date, there has been little systematic, empirical research to investigate the experiences of these
children (Wild, 2001, Bray, 2003). Journal articles have tended to be either reviews, prevalence studies of orphanhood due to AIDS, or discussions of policy implications.
Barnett, Whiteside, and Desmond (2001) noted that Susan Hunter was one of the first scholars to conduct empirical research in African countries on children orphaned by AIDS. Few books have been published on this subject, but two books deserve mention and they are Emma Guest's Children ofAIDS (2001) which focuses on Africa's orphan crisis and describes the experiences of orphans, caregivers and health workers in, and the other is by Jeff Gow and Coos Desmond titled Impacts and Interventions: The HIVIAIDS Epidemic and the Children of South Africa (2002) which describes the impacts of the HIV/AIDS epidemic on children in South Africa as well as the various responses to this crisis. Both books were published by the University of Natal Press, incidentally.
Let me focus briefly on Guest's book. This was one of the first books to record the experiences of children orphaned by AIDS in Africa. To the uninitiated, it offers a glimpse into their lives and their struggle to survive amidst extreme poverty and this is done through a collection of true stories of families, children, caregivers, social workers, and international workers. The author focused on three countries: South Africa, Uganda, and Zambia. In the introduction, the author presents a realistic and critical assessment of the state of AIDS in Africa and the way it is being addressed. The book is divided into four sections. The first section contains stories of a grandmother, an aunt, and a white couple who battle the bureaucracy to become foster parents to a Black AIDS orphan. The story ofMrs Banda, the grandmother, is heart-wrenching. She is quoted as saying:
I nursed my children until the illness got really bad and I couldn't cope any more. Then I took them to the hospital where they died. They were dying - one, two, three, four, five - in the order they were born. But, you know, I can't remember how old they were when they died. I keep forgetting things. (p. 19)
She is caring for eight grandchildren and her biggest problem is getting enough food for them. One wonders how anyone can survive after shouldering this amount of grief let alone also having to care for so many young lives with no resources or support. The
next section of the book focuses on community workers and social workers and their efforts to help these children. One chapter describes the difficulties facing workers in the child welfare system in South Africa (mainly lack of funds and nonsensical government policies). Other noteworthy chapters in this section of the book describe a "cluster' foster home for orphaned and abandoned children in KwaZulu-Natal and an orphanage for HIV-positive children in Crossroads, a township outside Cape Town. The third section of the book briefly focuses on the roles of international donors. The final section consists of two chapters that poignantly illustrate the lives of children who are going it alone.
Molatela is a 17-year-old girl who lost both her parents to AIDS in one week in July, 1999. She cares for her four brothers, including the youngest who is three years old and HIV-positive. Her courage is moving yet one feels deep sadness for the loss of her childhood, amongst other things.
Having nursed her parents through terminal illness, she has become a substitute mother for her siblings. She is doing the best she can to wash, cook, and clean for a family of five, keep herself and her rebellious younger brothers in school, keep an HIV-positive three-year-old well, while dealing with her own grief at the loss of her parents. (p. 143)
The final chapter describes the tough lives of children of the street in Lusaka - those who are homeless and have no one to look after them. Their daily struggle to survive is described and the outlook for their future appears bleak. Overall, Guest's book provides insight into how poverty and grief overshadow the daily lives of children orphaned by AIDS in Africa.
Gow and Desmond's book has a more scholarly orientation than Guest's book and focuses on health, welfare and education issues as they relate to children and HIV/AIDS.
The book provides a good overview of the socio-economic consequences of the epidemic on children in South Africa. Inone chapter, Giese (2002) focused her discussion on the issue of health and well-being of children and asserted that the social and economic consequences of HIV/AIDS on children in affected households could lead to "reduced opportunity for growth and development creating a cycle of dependency, vulnerability,
and abuse" (p. 60). The economic burden of HIVIAIDS can lead to food insecurity and malnutrition. Even when food is available, a child may have difficulty eating because of
"a range of physical, emotional and psychosocial factors which play a role in appetite suppression" (p. 62). Orphaned children and children in affected households may have stunted growth and they are likely to be sicker than other children because of the environment in which they live. Besides not being able to afford to go to school, these children risk being abandoned. According to the 1999 annual report of the South African National Council for Child and Family Welfare, there was a 67% increase in the number of children abandoned over a 3-year period. Giese also indicated that children in affected households have to deal with "the double burden of prejudice related to HIV and prejudice related to poverty" (p. 62).
Two participants, Sizakele and Besta, brought up the subject of child-headed households within their community. Both had been moved by the plight of children who were left to fend for themselves after their parents died. And both tried to help out as much as they could by visiting these households and giving them food now and again.
Sizakele recalled one household she had helped where a 15 year old boy was taking care of several siblings on his own:
Itis so painful ... but there is nothing you can do. We do whatever possible which we can do to help, like I used to invite them for lunch ... I gave R200 to this boy. Now since I am not receiving money, I don't know ...Ihaven't said anything to him but I must call him and tell him I can't help.
When asked if this made her feel guilty, she said:
I am not feeling guilty... because I just committed myself out of love. I felt like, okay, we can share this money...I gave him RI00 for transport to school. Whenever I have some money, I will buy them polony so that they will be able to make some lunch for school. But it is so hard when it comes to money...Some people will say you are spoiling the child by
giving him money. 1 said, 'How can you expect the children to go to school?' Anyway, this is what 1 did it for.
1 asked Sizakele if people in the community were sometimes unsympathetic to child- headed households, and she remarked:
Ja. 1 think it is because he is a boy and people have fears of giving children money because they will end up using it wrongly - the issue of drugs. They feel that maybe it might just make him do other things. To me, it doesn't matter as long as 1 have given up something with the hope of making a difference. So far he hasn't embarrassed me. Every time he is at home, you will find the house nice and the children are bathed. Ja...it is so hard. And 1 am thinking that.. .we are heading· into the second week that 1 haven't given him anything...I am pretty sure he is taking no advantage.
Phurnzile's mother and stepfather died when she was 15 years old and she was left to care for her younger sister. No-one in her extended family offered to help her. Out of desperation, she said: "I used my body just to survive ...Iwould sleep with someone even if! didn't love that someone so long as he would give me money."
South Africa has seen a rise in the number of child-headed households and although this phenomenon has received a good deal of attention in the media, we still do not know much about the problem nor do we have reliable statistics on the number of children living in child-headed households. What is clear though is that child-headed households are extremely vulnerable. Giese (2002) indicated that these children are living on the margins of society, deprived of educational opportunities and recipients of few health and welfare services. In terms of the psychological impact, they have experienced the trauma of watching a parent die and they have to worry about who will care for them after the parent's death. Children in affected households also risk being sexually abused because they have no-one to care for them, though not much is known about this problem (Bray, 2003). Giese (2002) commented:
For children living in HN-infected households, children orphaned by HIV/AIDS and children who are HIV-positive, their basic rights to food, housing and healthcare are violated to the extent that their survival is threatened. (p. 74)