This is an archived USAID document retained on this web site as a matter of public record.
Administrator J. Brian Atwood
Press Roundtable on Children on the Brink: Strategies to Support a Generation
Isolated by HIV/AIDS Report
Washington, D.C., November 19, 1997
U.S. Agency for International Development
The focus of this year's World AIDS day is "Children living in a world with AIDS."
On Worlds AIDS day USAID will release a report that should serve as a powerful
wake up call alerting us all to a crisis of terrible magnitude.
According to the U.S. Census Bureau, 15.6 million children will have lost their
mothers or both of their parents in the 23 countries studied in this report by the year
2000. Largely as a result of the HIV/AIDS epidemic, the number of children who will
lose their mothers or both parents in these 23 countries will increase to 22.9 million
by 2010.
As stark as these figures may be, they do not fully convey the impact of HIV/AIDS
on children and families in these countries. In order to develop a fuller picture of this
impact, USAID expanded Census Bureau estimates to also include the number of
children who will likely lose their fathers in these countries. Tracking the projected
growth in the number of paternal deaths provides a fuller understanding of the impact
of HIV/AIDS on children, for several reasons:
Single mothers are the most impoverished members of these societies, and their ability
to support children without the assistance of the father is very limited.
In many societies, children whose fathers die of AIDS often lose their mothers soon
after due to illness or social forces.
In most of these countries, the social safety net provides only minimal assistance to
widows and their children.
When paternal deaths are included, the total number of children who will lose one or
both of their parents from all causes in these 23 countries is projected to increase from
34.7 million in 2000 to 41.6 million in 2010. The human and social costs of these
numbers are staggering.
In countries across Africa, Asia and Latin America, HIV/AIDS is unraveling years of
progress in economic and social development. Life expectancy -- which has been
steadily on the rise for the last three decades -- will drop to 40 years or less in nine
sub-Saharan countries by the year 2010. In countries like Botswana, Zambia, and
Zimbabwe, which would have had life expectancies of 60-70 years without
HIV/AIDS, we will see life expectancies plummet to around 30 years with
HIV/AIDS. In all the countries included in this study, AIDS-related mortality will
eliminate the gains made in child survival over the past 20 years. In Zambia and
Zimbabwe, infant mortality rates will likely nearly double, and child mortality rates
will triple.
HIV/AIDS will cause fundamental social and economic changes in the 23 study
countries that will affect the demand for labor, the availability of social services,
access to health care, educational opportunities and the rates of poverty at the
household level. The epidemic will continue to have a profound impact at the local
level on families, communities and small-scale industries.
The costs of HIV/AIDS related illness and death can be enough to send a household
into permanent poverty. Per capita and household income will decline as more
families are thrown into poverty by costs of illness and health care. The loss of
women's labor in the home and in agriculture will create deficits in food supplies and potentially in exports.
HIV/AIDS causes illness and death among adults in the most productive age groups.
Costs of absenteeism and reduced productivity may be higher than the costs of
eventual deaths. HIV/AIDS will significantly slow the growth of the labor force and
will create labor shortages in certain markets. A study in Uganda estimated that there
would be 2 million fewer people in the working age groups by 2010, 12 percent less
than without HIV/AIDS.
Higher HIV infection rates in urban areas will aggravate the situation of the urban
poor more than the rural poor, who have broader household and community support
systems and can fall back to, to some extent, on household food production as their
incomes decline.
Increases in HIV/AIDS-related illness and death will likely cause a decline in school
attendance as declining household incomes put pressure on children to help meet
household needs for labor and income. A 1992 World Bank study in Tanzania
suggested that HIV/AIDS may reduce the number of primary school children by 22
percent and the number of secondary school children by 14 percent from the level that
could be expected without HIV/AIDS. AIDS-related illnesses will continue to swamp
hospital beds and budgets in many of the countries in this study.
In many of the sub-Saharan African countries included in this study, the HIV/AIDs
epidemic began early and is now severe, with the percentage of the population
infected with HIV reaching more than 30 percent in some urban areas.
However, the countries that are most seriously affected by HIV/AIDS are in Asia and
they are home to over 20 percent of the world's population. By 2020 the largest
number of children to lose parents to HIV/AIDS will likely be in South and Southeast Asia. The sheer size of the population at risk for HIV/AIDS in Asia means that the
problem of parental deaths there will eventually eclipse that of sub-Saharan Africa.
The number of children likely to lose their parents due to HIV/AIDS will also
continue to grow in Latin America and the Caribbean, where the epidemic also started
later.
Unfortunately, data is unavailable to make accurate projections of the number of
children to lose parents to HIV/AIDS in most Asian countries where the epidemic
impact is likely to be severe, in countries such as India, Burma, Cambodia and
Vietnam. This lack of data underscores the importance of understanding how children
and households are being affected and can best be assisted in sub-Saharan Africa so
that these lessons can be applied when the problem of parental deaths becomes more
severe in Asia and elsewhere.
The growing number of children who will lose parents will have a profound impact on
these societies. The economies of the developing nations in this study will all struggle
to deal with the immense economic dislocation and costs of illness, death and lost
opportunity.
Further, with children who have lost parents eventually comprising up to a third of the
population under age 15 in some countries, this outgrowth of the HIV/AIDS epidemic
will create a lost generation -- a sea of youth who are disadvantaged, vulnerable,
undereducated and lacking both hope and opportunity.
The creation of such a large and disaffected demographic "youth explosion" could
propel some of these societies to significant unrest and destabilization over the long
term. The threat to the prospects for economic growth and development in the most
seriously affected countries is considerable. New approaches -- including policy innovations for women and children -- must be developed within the next few years to
nurture and develop local efforts to assist families and communities affected by the
crisis.
But even more important than the numbers contained in this study is the human story
they tell.
The problems children face as a result of HIV/AIDS begin long before their parents
die, as they live with sick relatives in households stressed by the drain on their
resources. Children's are left emotionally and physically vulnerable by the illness or
death of one or both parents. In countries with even only moderately severe HIV-infection rates, up to 25 percent of children born to healthy women may have at least
one HIV-infected parent by their fifth birthday.
Subsequently, children who have lost parents are more likely to be removed from
school because their households need new sources of income and labor. Children are
increasingly forced to assume adult roles in the home and the workplace.
Strains on households and families may result in increases in child abuse and neglect.
Girls may face pressure to marry at younger ages.
HIV/AIDS also causes the dissolution of families. Children may be fostered or
adopted prior to the death of a parent. Orphans are cared for by grandparents, uncles,
aunts, or siblings. Female orphans may be preferred for adoption over male orphans
because they can provide domestic labor, sexual diversion, and, in many places, a
bride price. In short, forty million children losing one or both of their parents are 40
million children more likely to be forced into child labor; 40 million children who
may never have an opportunity to attend school; and 40 million children more at risk
of contracting HIV themselves.
Indeed, last year alone -- according to UNICEF figures 1,000 children around the
world die of AIDS every day.
It is impossible to overemphasize or exaggerate the scope and complexity of
challenges faced by children affected by HIV/AIDS and by the families, communities,
and governments responsible for them. The international community -- through
organizations such as UNICEF, USAID and a host of concerned partners -- are
working to prevent new HIV infections and deal with the immense problem of
children who have lost parents to AIDS. The international community, developing
nations and families are trying to hold back this powerful tide despite limited
resources and long odds.
The first and most important responses to the problems caused by AIDS comes from
the affected children, families and communities themselves. Arranging access to credit
or ways to generate additional income can help families overcome the economic
setback of illness and death. Reducing "property grabbing" by protecting women's and
children's property and inheritance rights is vital. This can be done, for example, by
informing affected communities about ways women's and children's inheritance rights
can be enhanced and by supporting legal services for widows and orphans.
Measures should also be taken to reduce the health risks to children in households
affected by HIV/AIDS. These may include developing home-based health services,
supporting child nutrition programs, making special efforts to include these children in
immunization programs and other health outreach efforts and targeting especially
vulnerable children.
Many of the communities hardest hit by HIV/AIDS have fashioned similar responses
to HIV/AIDs and the needs of families and children.
The community responses have included systems to enumerate and assess the needs of
families and children, targeted assistance to those most in need, ad hoc monitoring
systems of vulnerable children, shared labor, broader access to credit, protection of
the legal rights of women and children, efforts to help orphans support themselves,
repair of deteriorating houses, apprenticeships to teach adolescents marketable skills
and efforts to change local laws and practices that burden needy families and children.
We need to find new ways to strengthen these community responses.
Developing country government leadership is also needed to encourage all elements of
society to collaborate in developing realistic strategies to meet the needs of children
and families affected by HIV/AIDS. These strategies can directly target the problems
caused by HIV/AIDS, or they can seek to have a much wider social impact, such as
providing free primary education or improving water and sanitation systems in
vulnerable communities. The strategies should include attempts to harness private, as
well as public and charitable, resources.
The significance of efforts by governments, NGOs, donors, religious bodies, and
other entities will depend largely on the extent to which they make it easier for
children, families, and communities to cope with the effects of HIV/AIDS. In addition
to the strategies for direct intervention described above, all parties must work together
toward the overarching goal of creating an enabling environment for those affected.
Stigma and discrimination impede efforts to prevent the spread of HIV/AIDS and
improve care and support of those with HIV/AIDS. The process of reducing stigma
and discrimination is largely one of reducing fear, ensuring basic legal protection and
transforming the public perception of HIV/AIDS.
Lastly, we must continue to support AIDS prevention programs. Prevention is a
question of awareness, education and resources. Without more effective prevention
programs, the international community will never get the upper hand in the battle to protect children and families from the impact of HIV/AIDS. USAID works with
more than 500 private voluntary and nongovernmental organizations in 40 countries to
implement HIV prevention programs. The agency has reached more than 15 million
people with comprehensive HIV prevention education.
USAID has committed more than $700 million to HIV/AIDS programs during the past
eight years. This commitment has enabled the Agency to establish effective
partnerships with international organizations, donors, national governments and
nongovernmental organizations, develop innovative approaches to HIV/AIDS
prevention and build community capacity to slow the spread of the epidemic. Given
the threat the epidemic poses to sustainable development, USAID has made reducing
transmission of HIV and other sexually transmitted diseases one of its strategic
objectives.
I am happy to take any questions you may have.
This is an archived USAID document retained on this web site as a matter of public record.
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Last Updated on: July 18, 2001
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