AIDS orphans: 'when you die, how should I do this?'.

It's called a "memory book"--a parent dying from AIDS jots down facts and prepares her child for the grim reality of a parentless future. Following case studies in psychosocial support for children affected by HIV/AIDS in the United Republic of Tanzania and Uganda, the memory book has been part of the best practices of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in counselling children. In a sense, there should have been 11 million memory books in sub-Saharan Africa for the 11 million children orphaned by AIDS. And according to predictions in the World Health Organization's The World Health Report 2004, the number of double orphans--children who have lost both parents--in the region will nearly triple by 2010 due to the HIV/AIDS pandemic. Otherwise, the number of children losing both parents would have ideally declined if the 1990-2000 projections were to continue. Families, therefore, are under severe strain on account of the devastation caused by the disease. The developmental challenges of one of the poorest regions in the world now directly involve the future of 11 million orphaned by AIDS, out of 34 million orphans in the region.

"The world has never faced the prospect of tens of millions of orphan kids and societies so impoverished that it is difficult to absolve them", Stephen Lewis, the UN Secretary-General's Special Envoy for HIV/AIDS in Africa, emphasized. "It has been the most difficult dimension to respond to, because no one has ever encountered this phenomenon before." According to the Report, the number of orphan children could rise to 25 million under the age of eighteen by the year 2010. Mr. Lewis said: "It is a nightmare and it must be confronted."

Caught up in the circle of cause and effect of HIV/AIDS and harmed at both ends are women and children who suffer deeper implications than men. As women bear the brunt, children are left without any caretakers. According to The World Health Report, even though men and women are victims of AIDS in equal numbers, girls and women, who average 55 per cent of all people living with HIV/AIDS, are probably more susceptible to infection than men, due not just due to biological factors but more to "socially-defined gender differences". It further states that gender norms allow sexual freedom to men and encourage older men to take younger female sexual partners, while women are expected to be ignorant of their sexuality, bowing to socially-defined norms governing female behaviour. The Report moreover states that health-care systems expect women, who already do the majority of caretaking duties for the HIV-afflicted, to naturally fill such positions. It also warns that if preventive health measures tend to view the mother solely as a bearer of children and not as individuals deserving treatment, these measures "risk violating women's human rights and failing to attract as many participants as possible".

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As entire generations of children are unable to grow into productive adults, countries in sub-Saharan Africa face economic collapse. The orphans have to be looked after by grandparents or extended families, whose households are expected to earn 31 per cent less than others. The problem seems to be not a lack of effective programmes but programmes of scale.

RELATED ARTICLE

* No other region has been hard hit by HIV/AIDS as sub-Saharan Africa, which is home to nearly three quarters of the global population of people living with HIV/AIDS.

* By 2010, about half of all the orphans in sub-Saharan Africa will have become orphans because of HIV/AIDS.

* More than half of those orphaned by HIV/AIDS in sub-Saharan Africa are between the ages of 10 and 15.

* At the end of 2002, there were more than 29 million people in sub-Saharan Africa living with HIV/AIDS. Nearly 10 million of them were young people between the ages of 15 and 24; almost 3 million were children under the age of 15.