Understanding the Impact of AIDS on Children

Situation in the Mbarara District

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In the battle against Apartheid we scored a tremendous victory in the face of considerable evil. The solidarity of people from around the world, including the UK strengthened us at some of our darkest moments. Now as we enter another battle - the battle against HIV/AIDS we need the same solidarity, the same passion, the same commitment and energy.  
-- South African Archbishop Emeritus Desmond Tutus


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understanding the impact of aids on children

Generally, there are three categories of children affected by the HIV/AIDS epidemic: AIDS orphans and abandoned children (otherwise known as social orphans); children with HIV; and children living in families with HIV-positive parents. There are also many other children affected by the epidemic more indirectly, including for example, those children with malaria or other diseases who find it more difficult to access health care systems overloaded by the AIDS emergency; or children living in areas whose economy has contracted because of AIDS and who find it more difficult than before to extricate themselves from poverty.¹

The impacts of HIV/AIDS on children are consistently and clearly devastating; impacting care, socialization, and emotional and cognitive development.²  At a macro level, AIDS has negative impacts on the quality and delivery of education, on child and infant mortality, nutrition, and health systems. 

The decrease in incomes suffered by families with AIDS death or illness imposes constraints on food expenditures, contributing to declining child nutrition and, amongst the poor, to increased child malnutrition.³ Families having to take in orphans of AIDS often face increasing financial constraints and more difficulty in maintaining nutritional intake. Children affected by AIDS also confront material deprivation including lack of shelter, clothing and bedding.

Educational quality has been affected on two fronts. Firstly, the staffing and quality of education has declined due to a loss of teachers and morale. The loss of experience and expertise of teachers and administrators has impacted the overall delivery of training and management of the educational system, inadvertently contributing to a brain drain within the educational sector. Along with health workers, teachers are amongst one of the higher risk professions for AIDS infection due to social status, relative affluence, and mobile lifestyle away from family.⁴ Educators themselves have thus become less productive in school due to AIDS related illness.  They suffer low morale, frequent absences, reduced contact times with students and difficulties in concentrating.^5&6 World Bank projections for East African countries suggest an AIDS induced loss of one to two percent of the total number of teachers every year, having impacts on a potential shortage.⁷ In Uganda, HIV/AIDS caused the death of 450 teachers in 2000.⁸

Secondly, children themselves affected by AIDS have suffered lower performance at school, have higher rates of drop out,⁹ and suffer from lack of parental guidance and affection. Children from affected families may face a more difficult situation in school by missing class more often due to involvement in domestic duties and difficulties in buying school necessities¹⁰ due to a lack of money and parental care.¹¹ The drop out rate of children due to AIDS is extremely high with the Ministry of Education and Sports reporting that this percentage increased from 45% in 1995 to 53% in 1999.¹²  Those managing to remain in school face problems of lack of parental guidance, inadequate socialization, lack of financial and material support. These problems contribute to low self-esteem and performance of children, as well as a grim outlook for children on their uncertain future. Studies indicate that these children face emotional deprivation and psychosocial stress, contributing to ill mental health. Some children have become aggressive, or have turned to the street or drugs. Young girls often become sex workers to supplement family income. Psychosocial stress for these children may be manifested by depression and behavioral problems at school.¹³ There is a true emotional, psychological, and mental impact on children affected by AIDS which has not been effectively addressed in both policy and programming.  The long-term effects of emotional deprivation and ill mental health of orphans growing up in difficult social arrangements is really only now starting to be perceived.¹⁴

The psychosocial needs of orphans and AIDS affected children are often neglected in these communities. AIDS causes not only death, hunger and other material deprivations among orphans but also a sense of abandonment, depression and rejection.  Children do not verbalize their feeling, become withdrawn, play truant, become antisocial and may become prone to depression in adult life.  In several cases, entire cohorts of young people will grow up in situations in which mental disease is rife.¹⁵ Orphans are grieving loss and if they not helped to overcome, can become psychologically disabling.¹⁶

The disintegration of traditional social arrangements, support structures, and social relations at the basis of these children’s life further increases the stresses placed upon them. Schools and communities have become an insecure environment as children face mounting stigmatization.¹⁷ Lack of awareness within the community has also lead communities to believe that if parents are infected with AIDS, the children must be as well and have often obstructed the admittance of children of AIDS parents to school.¹⁸ There has been a systemic marginalization of people affected by HIV/AIDS and discrimination inflicts every aspect of life, in schools, in health care, in community centers and even at play. Discrimination of children affected by AIDS has deprived them of their basic human rights, including that of inheritance of the possessions of the dying parents. Loss of inheritance through ‘property grabbing’ further limits children’s ability to successfully face insurmountable challenges in the wake of the AIDS epidemic. The children have become vulnerable to abuse, hostility, ostracism, ridicule, banishment and violence from family, clan and community members. Stigma within the community and schools places a considerable obstacle in face of children affected by AIDS; it works against prevention and shuts the door to their future. The fear of stigma and isolation leads people not to disclose their health status for example furthering the continued spread of the disease. This is an area in which public policy and community responses have done little and achieved even less.¹⁹ AIDS related stigma in the classroom (and discrimination on the part of teachers, students and parents) can also cause children to drop out – contravenes the underlying principles of the Education For All initiative.²⁰

Traditionally, the extended family in Africa has provided a safety net for individuals in times of need but this is declining fast because of poverty and immediate family demands. The major constraint facing families today is a lack of income.²¹ A high proportion of the orphans are living with grandparents (20.2), 11.9 with other relatives, and 25.3 are child headed households.²²  Study shows that those fostered by grandparents had the least chances of educational success.²³

A particularly vulnerable group of children are those that have been forced to become heads of households upon the death of parents. Children, usually young girls, are forced to give up their education in order to provide for the needs of their siblings. Gender disparities and cultural practices tend to render the girl child particularly exposed to exploitation and heavy domestic responsibilities.²⁴ This has contributed to a rise in paid and unpaid child labor, homelessness, as well as movement into the commercial sex industry. HIV orphans constitute an entire generation of educationally disenfranchised young people who most often the educational system has not been able to integrate. In many cases they dropped out of school and were not retained long enough to graduate.²⁵

The overall economic impact of this epidemic and its affect on Orphans and Vulnerable children, research indicates that in low-income countries with medium to high prevalence rates, the epidemic causes a decline of .5-1.0 percent in the annual GDP growth rate.²⁶  Families that have lost the head of household due to AIDS experience a 30-40 percent decline in household income over the subsequent year and while this eventually picks up, the impoverishment effect lasts several years. Resultantly, the epidemic is likely to throw an increasing number of children into poverty, a situation which will not allow them to satisfy several of their basic needs.²⁷

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¹ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 7.
² G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 2.
³ R. Basaza and D. Kaija. "The Impact of HIV/AIDS on Children," p. 36.
⁴ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 5.
⁵ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 10.
⁶ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 11
⁷ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 15.
⁸ R. Basaza and D. Kaija. "The Impact of HIV/AIDS on Children," p. 43.
⁹ T. Boler and K. Carroll.  Addressing the educational needs of orphans and vulnerable children. London, ActionAID Internatinal and Save the Children Fund, 2003. p.1.
¹⁰ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 11.
¹¹ Ntozi, J.P. "Effects of AIDS on children and the problem of orphans in Uganda" in Health in Transition Review, volume 7 (supp); p 23-40.
¹² R. Basaza and D. Kaija. "The Impact of HIV/AIDS on Children," p. 40.
¹³ Succession Planning in Uganda, p. 5.

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¹⁴ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 3.
¹⁵ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 30.
¹⁶ T. Boler and K. Carroll, Addressing the educational needs of orphans and vulnerable children. p.2.
¹⁷ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 12.
¹⁸ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 16.
¹⁹ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 18.
²⁰ T. Boler and K. Carroll, Addressing the educational needs of orphans and vulnerable children. p.2.
²¹ R. Basaza and D. Kaija. "The Impact of HIV/AIDS on Children", p. 31.
²² R. Basaza and D. Kaija, "The Impact of HIV/AIDS on Children," p. 47.
²³ R. Basaza and D. Kaija. "The Impact of HIV/AIDS on Children," p. 48.
²⁴ R. Basaza and D. Kaija. "The Impact of HIV/AIDS on Children," p. 34.
²⁵ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 15.
²⁶ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 13.
²⁷ G.A. Cornia.  AIDS, Public Policy and Child Well-Being,  p. 13.

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