Ainembabazi Needy Children's Project

Understanding the Impact of AIDS on Children

Situation in the Mbarara District

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Can we watch one-quarter of some countries' people die? Can 27 million orphans be left to fend for themselves? We may not be able to solve the entire problem today, but let us not be discouraged from taking the steps necessary to begin the journey. -- 118 bishops of the Episcopal Church, USA, Letter on global AIDS funding to US President Bush and the US Congress, June, 2001

the situation in mbarara district

The AIDS epidemic hit Uganda over the past twenty years with the first case reported in 1982. It has affected two districts in particular: Gulu and Mbarara. Gulu, in Northern Uganda, has been at the centre of an ongoing civil war resulting in consequences that make the spread and effects of the disease difficult to contain with a continuing prevalence rate of 11.9%. The magnitude of the epidemic in Mbarara however remains equally daunting with a prevalence rate of 10.8%.¹ While being an area of relative stability in Southern Uganda, Mbarara is the 'hub' of traffic traveling within East Africa.

The transient culture of Mbarara has contributed to AIDS being much more volatile and destructive. Evidence indicates that the first risk factor in increasing AIDS include high spatial mobility caused by migration, displacement or containing the characteristics of professions involving protracted absence from the family (as in the case of truckers, fishermen and soldiers). Truckers have been particularly at risk² with 75% of their deaths said to be a result of AIDS.³ The nature of Mbarara's placement as a 'hub' for transportation contributes to the impact of AIDS in the area. Mbarara is one of the Districts along through which the main Trans Africa highway passes (connecting Kenya, Uganda, Rwanda and Democratic Republic of Congo), associated with the heavy traffic and the seasonal movement of people. Commercial sex is characteristic of the towns along this highway.

One of the long-lasting and heart-breaking impacts of the virus has been the orphaning of thousands of children, leaving them helpless in the face of economic austerity. They face a number of challenges in attaining education, gaining access to economic resources and income, and being confronted with stigmatization and exploitation within their communities. The overall result is that these orphans, while not necessarily infected with AIDS themselves, suffer a terrible and uncertain fate. Many are helped by relatives who cannot afford to help them with the basic amenities of life like clothing, medical care, attention and education. Despite declining prevalence rates of HIV/AIDS, the number of AIDS deaths and orphans will continue to rise in the future⁴ and efforts to address this 'epidemic' are essential.

While the exact number of AIDS orphans in Uganda is uncertain, what remains clear is its massive proportions; approximately 20% of the child population. In 2000, the Uganda AIDS Commission maintained that there were 1.7 million cumulative children orphaned by AIDS,⁵ comparative to the Ministry of Health, at the end of 2001, indicating a total of 1.7 million.⁶ Hunter and Williamson point out that the figure could be as high as 2.35 million.⁷ UNAIDS, UNICEF, and USAID in 2003 report a total of 2 million living orphans in Uganda, with 940,000 due to AIDS.⁸ While the exact figures and measurement vary, the impact remains the same. Approximately 25% of households in Uganda are housing at least one orphan⁹ placing stress on families and communities. AIDS remains responsible for a significant number of deaths in Uganda¹⁰ and the orphan population will only continue to increase into the next decade as HIV positive parents become ill and die from AIDS. AIDS orphans are a long wave problem that will last well after the reduction of the HIV prevalence rate and ultimately, the 'orphan epidemic' is still in its infancy and is expected to grow to devastating proportions over the next 10 years and will be with us for at least two more generations.¹¹

The need for education of orphans and vulnerable children cannot be understated. Evidence indicates that completion of primary education makes a strong and direct impact on HIV infection rates, especially among young women. UNAIDS indicates that investment into primary education, especially for girls, is one of the most effective and urgently needed measures to fight the epidemic,¹² and also to improve the general well-being of children. Measures taken so far within Uganda have tended to have a nearly exclusive focus on prevention and the health sector. Evidence indicates that this approach appears now limited and a broader policy and programmatic approach is necessary.¹³ The educational sector, as a sphere of prevention as well as an area to contribute to societal acceptance of those affected by AIDS has been largely ignored, despite the fact that schools are a major source of infection.¹⁴ Schools are a high-risk environment, and HIV/AIDS represents an insurmountable threat to education itself.¹⁵

¹ STD/AIDS Control Programme, p. 10.² Giovanni Andrea Cornia. AIDS, Public Policy and Child Well-Being. Florence: United Nations Children's Fund Innocenti Research Centre, june 2002. p.4.³ Robert Basaza and Darlison Kaija. The Impact of HIV/AIDS on Children: Lights and Shadows in the Successful Case of Uganda in AIDS, Public Policy and Childrens Well-Being, Florence: United Nations Childrens Fund Innocenti Research Centre, June 2002. p. 19.⁴ G.A. Cornia. AIDS, Public Policy and Child Well-Being, p. 1.⁵ R. Basaza and D. Kaija. The Impact of HIV/AIDS on Children, p. 46.⁶ Succession Planning in Uganda: an Early Outreach for AIDS-affected children and their families. Kampala: Horizons Program, Makerere University, Sociology Department, Plan/Uganda, 2004. p. 4.
⁷ Hunter and Williamson. Children on the Brink: Updated Estimates and Recommendations for Intervention. Arlington: USAID, 2000.⁸ Children on the Brink 2004: A Joint Report of New Orphan Estimates and a Framework for Action. New York: UNAIDS, UNICEF, USAID, July 2004. p. 26.
⁹ Succession Planning in Uganda, p. 4. ¹⁰ R. Basaza and D. Kaija. The Impact of HIV/AIDS on Children, p. 37.¹¹ G.A. Cornia. AIDS, Public Policy and Child Well-Being, p. 11. ¹² Gerald Mwale. Civil Society Organizations Slam Africas Poor Health Record, available here. ¹³ G.A. Cornia. AIDS, Public Policy and Child Well-Being, p. 1.¹⁴ G.A. Cornia. AIDS, Public Policy and Child Well-Being, p. 17.¹⁵ G.A. Cornia. AIDS, Public Policy and Child Well-Being, p. 26.