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Best Practices for the Care of HIV/AIDS Orphans

When we say practices and care, what really comes to your mind is holistic care. We other words, we are referring to the ATTENTION and PRACTICES of "caregiver" (mother, father, and sibling, child care providers) to provide the food, health care, stimulation, emotional, academic, shelter and spiritual SUPPORT necessary for children’s healthy survival, growth and development within a given environment.

Speaking of practice, we are talking of the actual performance or application. The systematic exercise for proficiency of the caregiver toward the child. This is something the caregivers does or work at repeatedly.

How many Orphans are we talking about here and where are they?
The issue surrounding this topic is a very interesting one, especially now that the world leaders are giving their attention to the pandemic. It will be nice to take few minutes to call our attention to the recent global statistics of AIDS as at December 2004. We need to point out that the range around the estimates in the following table define the boundaries within which the actual numbers lay, based on the best available information.

Number of People living with HIV in 2004

• Total 39.4 million ( 35.9 - 44.3 million)
  - Adults 37.2 million ( 33.8 - 41.7 million)
  - Women 17.6 million ( 16.3 - 19.5 million)
  - Children under 15 years 2.2 million ( 2.0 - 2.6 million)

AIDS Deaths in 2004

Total 3.1 million ( 2.8 - 3.5 million)
Adults 2.6 million (2.3 - 2.9 million)
Children under 15 years 510,000 (460,000 - 600,000)

Young Women - An Endangered species

Women make up nearly half of the 37.2 million adults living with HIV. In Sub-Saharan Africa the proportion rises to almost 60%. In the same region, three-quarters of all 15 - 24 year olds living with HIV are female. In some sections of Sub-Saharan Africa, Young women have no access to education or job. They are often economically dependent on men and have not the power to resist sex or ask their husband or partner to use protection.

Innocent Victims of Silent Killer - AIDS - CHILDREN

HIV/AIDS Orphans statistics

Global: Over 15 million children under the age of 15 have lost one or both parents to AIDS
Region Sub-Saharan Africa: 12.3 million

May I point out here that the AIDS orphan crisis is not restricted to sub-Saharan Africa. There are an estimated 1.8 million orphans living in South and South-East Asia, 85,000 in East Asia and the Pacific, 330,000 in Latin America, 250,000 in the Caribbean, and 65,000 in North Africa and the Middle East.      

Countries at High Risk

Already there are, for example, an estimated 1.5 million orphans living in Nigeria, 890,000 in Kenya and 780,000 in Zimbabwe. These numbers will increase as the pandemic develops. It has been estimated that the number of children orphaned by AIDS will rise dramatically in the next 10-20 years, especially in southern Africa.

The scale of the problem

As the number of adults dying of AIDS rises over the next decade, an increasing number of orphans will grow up without parental care and love and will be deprived of their basic rights to shelter, food, health and education. In African countries that have already had long, severe epidemics, AIDS is generating orphans so quickly that family structures can no longer cope. Traditional safety nets are unraveling as more young adults die of AIDS related illnesses. Families and communities can barely fend for themselves, let alone take care of the orphans. Typically, half of the people with HIV become infected before they are aged 25, developing AIDS and dying by the time they are aged 35, leaving behind a generation of children to be raised by their grandparents or left on their own in child-headed households.

The deep-rooted kinship systems that exist in Africa, extended - family networks of aunts and uncles, cousins and grandparents, are an age-old social safety net for such children, and it has long proved itself resilient even to major social changes. But capacity and resources are now stretched to breaking point, and those providing the necessary care are in many cases already impoverished, often elderly and have often themselves depended financially and physically on the support of the very son or daughter who has died.

Almost throughout sub-Saharan Africa, there have been traditional systems in place to take care of children who lose their parents for various reasons. But the onslaught of HIV slowly but surely erodes this good traditional practice by simply overloading its caring capacity by the sheer number of orphaned children needing support and care. HIV also undermines the caring capacity of families and communities by deepening poverty due to loss of labour and the high cost of medical treatment and funerals.

Having given the about statistics and the plight in which the AIDS orphans find themselves, the following then is the seven (7) best practices for the care of HIV/AIDS orphans.
Adequate living environment - Shelter
Child Counseling/Support Groups
Academic Stimulation - Schooling
Vocational and Artisan Training
Sustainable Development Program
Advocacy & Preventive Empowerment
Improved nutrition

Adequate living Environment - Shelter:
There are various kinds of shelter when it comes to care. However, the best preferred type of Shelter for HIV/AIDS Orphans are:
- Extended Family Network
- Foster Families
- Child - Headed Household
- Adoption

We have found out that the above system have proven to be the best especially due to the old cultural traditions of the Africans, Asians and those from South America.

Institutionalized system is the less preferred type of shelter. Institutionalization stores up problems for society, which is ill equipped to cope with an influx of young adults, who have not been socialized in the community in which they have to live. UNICEF believes that whenever possible, children who are orphaned should remain in their communities to be raised by their extended family. Recognizing that family care is far better for children and far less costly than institutionalized care is also very vital.

Children who grow up in families also develop better social skills and are psychologically better adjusted than those who grow up in institutions because they receive more affection and attention and develop a better sense of personal identity. Children growing up in communities disrupted by the epidemic, orphans are more likely to cope if they can live in surroundings that are familiar, stable and as nurturing as possible. Many believe that orphans should be cared for in family units through extended family networks, foster families and adoption. At the very least, siblings should not be separated.

Botswana government encourages communities to provide extended family care for AIDS orphans and encourages institutional care only as a last resort. In Swaziland, as many as one in 10 households are run by orphans. In Zimbabwe, the Farm Orphan Support Trust (FOST) was set up as a community response to the situation of orphans in commercial farming areas. FOST aims above all to keep sibling orphans together, within a family of the same culture, and in a familiar environment.

FOST promotes five levels of orphan care:
(1) It's preferred care is within the extended family.
(2). Orphans are placed within substitute families.
(3). The third choice is for small groups of orphans to live together on a farm, looked after by a caregiver employed by the farm for this purpose.
(4). The next most preferred type of care is an adolescent child-headed household with siblings remaining together, preferably in the family home.
(5). FOST will arrange for temporary care in an orphanage, until a better solution can be found.

Academic Stimulation:

Keeping orphans at school is crucial for their future. It can provide education that can work as a safety net in the child's life. Schooling can also help to break the cycle of poverty.

Sustainable Development Program:
In Uganda, UNICEF supports the Uganda Women’s Effort to Save Orphans (UWESO), which helps communities start income-generating projects such as beekeeping or sustainable farming. It also provides micro-credit to help women start small businesses.

Vocational / Skill Acquisition Centre:
Orphans who are unable to complete even primary or High School, usually due to the need for them to be at home to care for their siblings are provided Artisan Training such as job experience in bicycle repair, radio repair, carpentry and tailoring among others. The skills attained help them to earn a living.

In Nigeria, government approved vocational training institutions such as fashion design, secretarial and computer skills, and home economics has been established with the AIDS orphans in mind.

Preventive Empowerment:
Empowering affected children first of all means regarding them as active members rather than just victims. Many children already function as heads of households and as caregivers. They are a vital part of the solution and should be supported in planning and carrying out efforts to lessen the impact of HIV/AIDS in their families and communities.

Improved Nutrition:
We strongly recommend working in partnership with States nutritionists, women affairs directors, social workers, community developers, educators and child care providers in prescribing a balanced but very cost effective diet for care givers regardless of their social status.

Child Counseling/Support Groups:

Relief oriented support such as distributing food, blankets, and resettlement
Educational sponsorship.
Being in contact with traumatized children who have had the unfortunate experience of seeing their parent’s fall sick and die, a child-counseling centre are & should be developed to specifically offer emotional treatment for such children.
Regular visitation to their homes by care providers has helped reduce the rate of stigmatization & marginalization. Through centres like this, identification of abused children is noted and prevention of child abuse in schools and families carried out.

Enemy of the practices:

Poverty is a huge problem in the developing nations. In Malawi, it is estimated that 65% of the people live below the poverty line. "Communities who want to help but are living on the edge of starvation, have run out of ways to feed orphans. Farmers say, 'we cannot get food to feed them'." In Zambia, one of the countries hit hardest by the HIV/AIDS pandemic, research shows that the traditional mechanism for the care of vulnerable children that is the extended family, has started to break down under the twin pressures of poverty and disease. Mismanagement of resources and abuse of authority is another enemy of these practices.

Although we have visibly the enemy of the recommended practices, we have not doubt that the practices are be the best. We are gradually eliminating the enemy of the practice by empowering the grassroots community and even the orphan communities. We would encourage all the various Community Development Organizations working with AIDS orphans and their caregivers to make a conscientious effort to apply or integrate the practices in their programs.

Food for Thought
• "It’s not enough to give the child all he need monetarily but also to create an enabling environment which would protect the life, dreams, future of the world’s child . . ."(Young Man, 21, Nigeria)