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AIDS orphans: Africa's lost generation.

"There have been as many plagues as wars in history," observes the narrator of Albert Camus' novel, The Plague, "yet always plagues and wars takc people equally by surprise."

Unfortunately, the AIDS pandemic has affirmed yet again the tragedy of Camus' insight into human denial. A decade after the outbreak of AIDS, the disease is still taking us by surprise. To many near-sighted policymakers in the developed world, it remains simply another health problem, and a relatively containable one at that. But in Central and East Africa, the disease is crippling entire townships, threatening not only people's health, but their most fundamental social structures. In the midst of Africa's bleak war with the disease, AIDS' newest and perhaps most neglected victims are the orphaned children it leaves in its wake.

Already, more than two million HIV-negative children from the region have lost at least their mother to AIDS. Of course, somc infants are dying of AIDS, but many are born before their mother contracts HIV, and only about 30 percent of the children born to HIV-positive mothers actually inherit the virus. Surviving orphans try to seek out relatives or friends on whom they can depend, but these days more and more are ending up on their own, scrambling to meet their basic physical and psychological needs. Set adrift in countries that regularly have trouble just feeding their populations, some AIDS orphans cannot eat even when food is available. Lenina, a 9-year-old orphan from Tanzania who watched as her parents gradually withered and died of AIDS, was lucky enough to be taken in by her grandmother, but she now spends most of her days just sitting under a tree.

As the rising number of orphans attests, AIDS has truly become a family disease in Central and East Africa, a perception rarely attributed to AIDS in other parts of the world, where it is either relatively uncommon or is highly concentrated among intravenous drug users and homosexuals. In Africa, however, the virus is almost always passed heterosexualy and often between husbands and wives. Almost every AIDS victim in Africa, then, is likely to leave behind severl dependents. And, according to the most recent data from the World Health Organization (WHO), more than seven million African adults are alreade HIV-positive and face almost certain death. After only two years' time between 1989 and 1991, in four districts of Uganda studied by Susan Hunter, a UNICEF consultant, the proportion of children who had lost their mother to AIDS (WHO's working definition of AIDS orphans) had almost doubled, from 7 to 13 percent. Hunter estimates that by the year 2000 about 28 million children from 10 of the hardest but African nations - or a third of those 14 years old and younger - will be missing at least one parent. Sub-Saharan Africa will then be home to about 90 percent of the world's AIDS orphans.

In a region already plagued by famine and war, this flood of orphans will be overwhelng. The AIDS explosion in Africa, which is striking mainly adults in their most economically productive years, could bankrupt entire countries within the next decade, given that African industry and agriculture still depend heavily on an able-bodied work force. In addition, the health care systems in many African nations are ill-equipped to handle the AIDS crisis. African governments are already far behind in providing basic services - they currently spend only between $1 and $10 annually on each person's health care - and as AIDS rages through their countries, they will face the staggering challenge of paying for new facilities, supplies, and training programs. In this scenario, AIDS orphans' chances for even basic health care are dim.

Current AIDS policies, moreover, allow us to continue ignoring the immediate needs of those already struck by the disease and the families they leave behind. The typical approach of powerful aid organizations such as the U.S. Agency for International Development and the World Bank has been simply to try to prevent the future spread of the disease, usually by distributing condoms. Prevention is the ken, to the eventual conquest of AIDS, but meanwhile millions of vulnerable children, not to mention the millions of infected adults, demand immediate care. Many Africans, especially AIDS orphans, need food and clothing more than condoms. And all orphans, whether they lost their parents to AIDS, war or starvation, need help in surviving their loss and finding acceptance within their communities. Without such help, they often end up wandering the countryside or the city streets, resentful and purposeless.

Unfortunately, the widespread denial surrounding AIDS has colored even local efforts to relieve the orphan crisis. All too frequently, relatives reject appeals from AIDS orphans either because they fear contagion or because they simply don't want the stigma of AIDS - which, to many people, still implies sexual promiscuity - attached to their family. Even sympathetic relatives with the desire and the resources to help orphans have difficulty acknowledging their family's tragedy. The prospect of discussing a loved one's death from a sexually transmitted disease is so daunting that guardians often simply withdraw from orphans. During a recent Red Cross study, for which field workers interviewed the extended families of orphaned children in Kigali, Rwanda, only six of 126 parental deaths were idenfified by relatives as AIDS-related. Yet people with AIDS occupy 80 percent of the beds at the Kigali Hospital Centre, and Rwanda's National Program to Combat AIDS reports an HIV infection rate of 27 percent for Kigali women of child-bearing age.

Gradually, though, community activists are beginning to recognize how important it is to acknowledge openly the grave impacts of AIDS. Father Methodius Ndyamukama, a priest in rural Tanzania, teaches that guardians can help orphans most by simply encouraging them "to talk about their fears and problems." A nod of understanding, Father Methodius insists, is sometimes all orphans need to inspire them to find a way of supporting themselves, perhaps by selling fish from Lake Victoria or vegetables from their parents' land. A few organizations have even made it their business to publicize the social catastrophes caused by AIDS and to provide direct care to the most needy families. In some parts of Uganda, a group of orphaned siblings might be living with a relative, but their true caretakers might be the members of a local kabondo, or group of Christian volunteers, who visit with the children regularly, help fetch water or fuelwood, prepare their food, wash their clothes, and maybe even teach them vocational skills.

Such community-level coping structures, which signal a shift in basic social patterns, are the keys to managing the AIDS orphans crisis in Africa. Larger-scale solutions involving orphanages would not only be inappropriate to many African cultures, which place a high value on family and clan connections, but would also be impractical: governments would have to build scores of high-rise orphanages to house all the children expected to lose their parents to AIDS in the coming years.

But while orphans will have to be cared for within their own communities, assistance will have to come from both national and international institutions. Communities simply don't have the resources to meet all of the orphans' needs, which range from food, shelter and health care, to education about safe sex, and protection from exploitation. Just meeting AIDS orphans' most basic needs will be a huge task, and like most development issues, this one boils down to the necessity for a massive transfer of resources from the North to the South. Beyond that framework, though, the harder people work to fight the stigma surrounding AIDS, the easier it will be for communities to provide orphans with the services they require. Shifts in attitude on both local and international levels could help provide the needed social and financial support. And those orphans lucky enough to be well cared-for already could themselves become part of the solution: by sharing their stories, they could help their neighbors, and the rest of us, to acknowledge the far-reaching repercussions of AIDS - an essential first step toward action. "We have to accept that there is AIDS," begins a Ugandan song written by the leader of a kabondo, and the song's message is a global one.
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Title Annotation:AIDS claims the lives of several parents in Africa
Author:Sachs, Aaron
Publication:World Watch
Date:Sep 1, 1993
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