Orphans due to AIDS
Module by Shauna Sutton
December 1, 2008
Fair Use and Privacy Policies
• I have read the policy on Fair Use developed by American
University and have read the Privacy Policies for the
reports included in this module. The information provided
in this lesson plan is cited correctly, and will not be used
for business purposes or for any form of profit. The
intended use of this module is solely educational and
informational. Sources are located on each slide (including
URL addresses) and a reference page is included after each
section with full citations.
– Note: Much of the information is directly from policies,
frameworks, or other reports in order to be as accurate as possible.
Therefore, some things are portrayed in this module exactly as
written in the reports and is the work of the authors; anything that
is italicized is an exact quote from a cited work.
Learning Module Objectives
• This module is intended for advanced high school
students, college students, and others interested in
developing an understanding of orphans due to
AIDS
• To provide a sociological perspective on orphans
due to AIDS.
• To provide estimates of the global AIDS pandemic
using statistics and graphs
• To provide estimates of the number of orphans due
to AIDS
Learning Module Objectives
• To provide a focus on one country, Zambia, to
enhance recognition of the social implications and
consequences for the children orphaned due to
AIDS in this particular society
• To serve as a model for others to build modules
illuminating other countries where there are large
numbers of orphans due to AIDS
Lesson plan
• 1. Summary of the AIDS pandemic – 2007
–
–
–
–
–
Global
Sub-Saharan Africa
Zambia
Implications for those affected by HIV/AIDS
References and suggested readings/resources
• 2. Operationalization of ‘orphan’
–
–
–
–
–
Maternal, paternal, double, total, new
Vulnerable children
Positive and negative terms
How do the orphans want to be defined?
References
• 3. Summary of orphans due to AIDS
– Current
– 2010 projections
– References and suggested readings
Lesson Plan
• 4. Sociological perspective
– Sociological concepts
– References
• 5. Zambia – Sociological concepts and implications for orphans due to
AIDS
–
–
–
–
–
–
Why Zambia?
Social structure
Institutions
Inequalities
Connections between structure, institutions, and inequalities
References and suggested readings/resources
• 6. Responses to HIV/AIDS pandemic and orphans
–
–
–
–
–
Frameworks
Global
Africa
Zambia
References suggested readings/resources
Section 1
Summary of the AIDS Pandemic
AIDS
• A disease of the immune system characterized by
increased susceptibility to opportunistic infections,
as pneumocystis carinii pneumonia and
candidiasis, to certain cancers, as Kaposi's
sarcoma, and to neurological disorders: caused by
a retrovirus and transmitted chiefly through blood
or blood products that enter the body's
bloodstream, esp. by sexual contact or
contaminated hypodermic needles.*
*Dictionary.com
Summary of the AIDS pandemic
• Global organizations often provide ranges
along with estimates for the number of people
that have AIDS. The pandemic has spread
quickly in many areas and it is difficult to find
every individual that is infected. For this
module, I have included the ranges provided by
these organizations.
Summary of the AIDS pandemic – Global
• Number of people living with HIV in 2007
–
–
–
–
Total = 33.2 million [range, 30.6-36.1 million]
Adults = 30.8 million [range, 28.2-33.6 million]
Women = 15.4 million [range, 13.9-16.6 million]
Children under 15 years = 2.5 million [2.2-2.6 million]
• Deaths due to AIDS in 2007
– Total = 2.1 million [range, 1.9-2.4 million]
– Adults = 1.7 million [range, 1.4-2.1 million]
– Children under 15 years = 330,000 [range, 310,000380,000]
*UNAIDS, Global summary of the AIDS epidemic, December 2007
- http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf
*UNAIDS http://data.unaids.org/pub/EPISlides/2007/071119_epislides_en.pdf
*UNAIDS http://data.unaids.org/pub/EPISlides/2007/071119_epislides_en.pdf
Summary of the AIDS pandemic –
Sub-Saharan Africa
• Number of people living with HIV in 2007
– Adults & children = 22.5 million [range, 20.9–24.3
million]
• Deaths due to AIDS in 2007
– Adults & children = 1.6 million [range, 1.5-2.0 million]
• 68% of all people that are HIV-positive live in Sub-Saharan
Africa
• 76% of all AIDS deaths occur in Sub-Saharan Africa
*UNAIDS – Global summary of the AIDS epidemic, December 2007
*UNAIDS http://data.unaids.org/pub/EPISlides/2007/071119_epislides_en.pdf
*UNAIDS http://data.unaids.org/pub/EPISlides/2007/071119_epislides_en.pdf
*UNAIDS http://data.unaids.org/pub/EPISlides/2007/071119_epislides_en.pdf
Summary of the AIDS pandemic – Zambia
• Infected with HIV: 1.1 million in 2005
– Estimated 17% prevalence rate in adults aged 15-49***
• Prevalence rates**
– Urban: 23%
– Rural : 11%
– Women: 18%
– Men: 13%
• Deaths per year due to AIDS 2007: 56,000 [low and high
estimates: 47,000 and 66,000]*
– 2001 estimates were much higher: 78,000 [high and low estimates:
68,0000 and 89,000]*
*Epidemiological Fact Sheet on HIV and AIDS, Zambia, 2008 Update
**Ministry of Health, Republic of Zambia
***UNICEF – Zambia Statistics
Summary of AIDS pandemic, Zambia –
estimated number of deaths
*Epidemiological Fact Sheet on HIV & AIDS, Zambia, 2008 Update (http://www.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_ZM.pdf)
Implications for those affected by
HIV/AIDS
* Foster and Williamson. 2000. (http://www.hsrc.ac.za/Document-2177.phtml)
References – Section 1
•
•
•
•
•
World Health Organization. “Epidemiological Fact Sheet on HIV and AIDS:
Core data on epidemiology and response, Zambia, 2008 Update.” Retrieved
October 30, 2008
(http://www.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_Z
M.pdf).
Ministry of Health – Republic of Zambia. Retrieved October 7, 2008
(http://www.moh.gov.zm/files/Shared_alth_Strategic_Plan_Revised_July_20_2
006_1_.pdf).
UNAIDS. 2007. “Global summary of the AIDS epidemic.” Retrieved October
7, 2008 (http://data.unaids.org/pub/EPISlides/2007/2007_epiupdate_en.pdf).
UNAIDS. 2007. “Global summary of the AIDS epidemic.” Retrieved October
7, 2008 (http://data.unaids.org/pub/EPISlides/2007/071119_epislides_en.pdf).
UNICEF. “Zambia Statistics.” Retrieved October 7, 2008
(http://www.unicef.org/infobycountry/zambia_statistics.html).
Suggested Readings & Resources
•
Avert, AVERTing HIV and AIDs. “Home.” Retrieved November 23, 2008
(http://www.avert.org).
Section 2
Operationalization of ‘orphan’
[Operationalize means to define a concept or variable so that it can be
measured or expressed quantitatively]*
*Dictionary.com
Operationalization of ‘orphan’
• Maternal orphans are children under age 18 whose mothers, and
perhaps fathers, have died (includes double orphans)
• Paternal orphans are children under age 18 whose fathers, and
perhaps mothers have died (includes double orphans)
• Double orphans are children under 18 whose mothers and fathers have
died
• Total orphans are children under age 18 whose mothers or fathers (or
both) have died. The total number of orphans is equal to the sum of
maternal orphans and paternal orphans, minus double orphans
(because they are counted in both the maternal and paternal
categories).
• New orphans are children under age 18 who have lost one or both
parents in the last year
* Note: Definitions are exactly as provided in UNAIDS, UNICEF, USAID. “Children on the
Brink 2004: A Joint Report of New Orphan Estimates and a Framework for Action” [p. 6]
Operationalization of
‘vulnerable children’
• Vulnerable children refers to those children whose survival,
well-being, or development is threatened by HIV/AIDS*
• A research project conducted in Zambia provides this
definition for a vulnerable child:
– Vulnerable child is defined as a child who is at increased risk due
to an ill parent, high level of poverty, or is living in a household
with orphaned children.**
Note: Definitions are exactly as provided in these references. *UNAIDS, UNICEF, USAID. “Children on the Brink
2004: A Joint Report of New Orphan Estimates and a Framework for Action” [p. 6]; **USAID/Zambia – Results of
the Orphans and Vulnerable Children Head of Household Baseline Survey in Four Districts in Zambia [p. 12]
Operationalization
• Children on the Brink 2004 suggests positive and negative
terms for referring to orphans*
– Negative
• AIDS orphans
• OVC: orphans and vulnerable children
• CABA: children affected by HIV/AIDS
– Positive
• Orphans due to AIDS
• Children orphaned by AIDS
• Children in Zambia are particularly stigmatized or looked
down upon when referred to as ‘AIDS orphans’**
– A community focus group provided the term mulanda meaning a
vulnerable or suffering child who has no parents
– Orphans and vulnerable children in Zambia may also be referred to
as children in difficult circumstances***
*UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint Report of New Orphan Estimates and a Framework for Action” [p. 6]
**Situation Analysis of Orphans and Vulnerable Children in Zambia, Summary Report [p. 7]
***Smart, Rose. USAID. “Polices for Orphans and Vulnerable Children: A Framework for Moving Ahead” [p. 4]
Operationalization
• Has anyone asked the children what term they
prefer?
– UNICEF indicated that when compiling the data for
Children on the Brink 2004, they asked some children
what they would like to be called. They replied,
• Just call us children
*Children on the Brink 2004 [p. 6]
References – Section 2
•
Manda, Karen Doll, Michael J. Kelly, and Mark Loudon. 1999. “Situation
Analysis of Orphans and Vulnerable Children in Zambia, Summary Report.”
Volume 1, Retrieved September 20, 2008
(http://www.harare.unesco.org/hivaids/webfiles/Electronic%20Versions/SituationAnalysi
sofOrphans.doc).
•
•
•
Smart, Rose. 2003. USAID. “Polices for Orphans and Vulnerable Children: A
Framework for Moving Ahead.” Retrieved September 20, 2008
(http://www.policyproject.com/pubs/generalreport/OVC_Polices.pdf).
UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint Report of
New Orphan Estimates and a Framework for Action.” Retrieved September
20, 2008 (http://pdf.usaid.gov/pdf_docs/PNACY333.pdf).
USAID – Zambia. “Results of the Orphans and Vulnerable Children Head of
Household Baseline Survey in Four Districts in Zambia.” Retrieved October 7,
2008
(http://www.fhi.org/NR/rdonlyres/eu6n5zdvgoyjqjnhzzpn5hlqnwloaso7z2uosdeengj2lz2
4lfasjknxwxbektsabfdpr5ynpfvuco/HHHOVCREPORTfinalenhv.pdf).
Section 3
Summary of orphans due to AIDS
Summary of orphans due to AIDS
• Global organizations often make estimates
using a range because it is incredibly difficult
to capture exact numbers of orphans and
vulnerable children. For this module, I have
included the ranges as well as estimates from
two different organizations.
Summary of orphans due to AIDS –
current statistics
• Global: 15 million*
• Sub-Saharan Africa: 12.3 million*
• Zambia:
– World Health Organization (WHO) estimates 2007:
600,000 [low and high estimates: 530,000 and
660,000]**
– The United Nations Children’s Fund (UNICEF)
estimates: 710,000***
– Orphans due to AIDS as a percentage of all other
orphans: 57%****
**UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint Report of New Orphan Estimates
and a Framework for Action”; **Epidemiological Fact Sheet on HIV and AIDS, Zambia, 2008 Update;
***UNICEF – Zambia Statistics; ****Avert
Summary of orphans due to AIDS
– 2010 projections
• Projected number of orphans due to AIDS,
globally, 2010
– 15.7 million
• This number is 30 percent of the total 53 million orphans
projected for 2010
• Projected number of orphans due to AIDS, SubSaharan Africa, 2010
– 10 million
• This means that 10 million children will have lost or will lose
both parents by 2010 [NOTE: This is an enormous number, but
it is still less than 2007, as the numbers are slowly declining.]
*Africa’s Orphaned and Vulnerable Generations: Children Affected by AIDS 2006
http://www.unicef.org/publications/files/Africas_Orphaned_and_Vulnerable_Generations_Children_
Affected_by_AIDS.pdf
Summary of orphans due to AIDS
– 2010 projections
• The report compiled by the United Nations
Children’s Fund (UNICEF) – “Africa’s Orphaned
and Vulnerable Generations: Children Affected by
AIDS” – included methodology for how the 2010
projections were produced. For that information,
refer to the annex of that report on pages 40-42.
(http://www.unicef.org/publications/files/Africas_Or
phaned_and_Vulnerable_Generations_Children_Aff
ected_by_AIDS.pdf)
References – Section 3
•
•
•
Avert, AVERTing HIV and AIDS. “AIDS Orphans.” Retrieved October 15,
2008 (http://www.avert.org/aidsorphans.htm).
UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint Report of
New Orphan Estimates and a Framework for Action.” Retrieved September
20, 2008 (http://pdf.usaid.gov/pdf_docs/PNACY333.pdf).
UNICEF. “Africa’s Orphaned and Vulnerable Generations: Children Affected
by AIDS 2006.” Retrieved October 14, 2008
(http://www.unicef.org/publications/files/Africas_Orphaned_and_Vulnerable_Generatio
ns_Children_Affected_by_AIDS.pdf).
•
•
UNICEF. “Zambia Statistics.” Retrieved September 20, 2008
(http://www.unicef.org/infobycountry/zambia_statistics.html).
WHO. “Epidemiological Fact Sheet on HIV and AIDS: Core data on
epidemiology and response, Zambia 2008 Update.” Retrieved October 26,
2008
(http://www.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_Z
M.pdf).
Suggested Readings & Resources
•
Nybo, Thomas. 2005. “Orphaned by AIDS, young girl struggles to care for her
family.” UNICEF: Unite for Children, Unite Against AIDS. Retrieved
November 23, 2008
(http://www.uniteforchildren.org/knowmore/knowmore_28887.htm).
Section 4
Sociological perspective
Sociological Perspective
• What is sociology?
– Sociologists systematically study groups of people, the impact of their
social environments, their interactions with one another and with
institutions in society. Additionally, sociologists focus on the structural and
cultural factors that affect the behavior of individuals.
• Purpose of sociological perspective on orphans due to
AIDS
– The purpose of incorporating a sociological perspective is to encourage
viewers to consider a number of social factors affecting the opportunities
for orphans. I want to illuminate the implications for orphans by including
elements from their social environments. That is, what factors affect their
life chances? For example, does the gender of the head of household
affect children’s opportunities? Does family structure affect children’s
access to education? What about inequalities based on gender or the
stigma of HIV/AIDS?
– It is important to note that I am not conducting primary research for this
module. Rather, I am compiling information on the factors associated with
orphans due to AIDS. Moreover, I am challenging you to consider the
social factors that influence orphans’ “choices.” Often, structural and
cultural norms, values, and beliefs limit children from making real
choices.
Sociological Concepts
• To understand the circumstances of orphans due to AIDS, it is
important to consider the social organization and environment of
society in which the orphans live. This includes the overall social
structure, institutions, and inequalities and equally important the
connections or intersections between each. As part of the social
structure, it is important to consider the norms, values, and beliefs
of the people in this society, which are apparent as we explore each
of these three major concepts throughout the next section.
• Social structure
– Institutions
• Family
• Educational system
– Inequalities
• Gender
• HIV/AIDS stigma
Section 5
Zambia – Sociological concepts and
implications for orphans due to AIDS
http://www.lonelyplanet.com/maps/africa/zambia/
Why Zambia?
• Zambia is one of the African countries hit hardest with the
HIV/AIDS pandemic, and it is also one of the poorest
nations in the world. Many of the implications for orphans
in this country are the same in other countries affected by
the virus. However, poverty and disease make conditions
even tougher for orphans and vulnerable children. Zambia
has received an enormous amount of media attention and
many efforts have been implemented to combat
HIV/AIDS. This relatively small country is firmly
committed to the fight against HIV/AIDS. Their latest
country response report to UNAIDS shows decreases in
HIV prevalence.
Social Structure
• Zambia statistics
– Population: 11.9 million
– Life expectancy, 2006: 41
– Gross national income (GNI) per capita: US$630 (annual)
• In 2002, GNI was US$353 per year and 78% of the population was
below the poverty line***
– Percent of population below US$1 per day: 64
• More than half of Zambia’s population lives in extreme poverty
– Percent of population urbanized, 2006: 35
– Percent of central government expenditure allocated to health,
1995-2005: 13
**UNICEF – Zambia Statistics, ***USAID - Zambia
Social Structure
• Implications for orphans
– Orphans are often affected by the twin pressures of poverty
and disease**
• This can lead to extreme levels of food insecurity
– These two pressures often force children to find ways to
survive
• Participation in risky behaviors, exploitation*
• Work on the streets to buy food
• Exchange/sell their bodies (both boys and girls) for food or
money***
**UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint Report of New Orphan
Estimates and a Framework for Action”; **Fleshman, “AIDS orphans: facing Africa’s ‘silent
crisis’”; ***Situational Analysis of Orphans and Vulnerable Children in Zambia, Summary
Report 1999
Institutions – Family
Family Structure in Zambia
Family Types
Focus Group discussions identified and described three types of families. They are:
Bakankala, bavubide; (the rich, well
off)
These families are said to:

have plenty of food to eat

live in good houses with iron
sheet roof

keep many goats and in some
cases cattle;

send their children to school

can afford health costs

hire the poor to work on their
fields

have a lot of money
Bapina, balanda, basaukide; (poor,
suffering)
These families are said to:

have some food to last them
much of the year

live in properly built and
thatched houses

keep some chickens and goats

make money by selling beer

send their children to school and
clinic

own some farm implements,
particularly the hoe

wear nice clothes

keep some orphans
Inchusi, bapengele; (who suffer a lot),
bapina sana/bacete ( the very
poor
These families are said to:

eat one meal a day at best, but
sometimes go for days without
food

live in small poor houses

own no livestock or farm
implements

go from house to house begging
and borrowing

cannot afford education and
health costs

are often widows and elderly

keep orphans
Note: This chart was compiled by the authors of the situation analysis report and is used to highlight how the
members of Zambian society view family structure. I did not re-type this graph, but used it directly from this
study.
*Situation Analysis of Orphans and Vulnerable Children in Zambia, Summary Report, 1999
(http://www.harare.unesco.org/hivaids/webfiles/Electronic%20Versions/SituationAnalysisofOrphans.doc)
Institutions – Family
• Where do orphans live?
– Almost half of orphans reside in a household headed by a surviving parent
– Grandparents look after 38% of double orphans and aunts/uncles look
after 29%
– In rural areas double orphans are more likely to be looked after by
grandmothers
– In urban areas double orphans are looked after more often by aunts and
uncles than other relatives*
(Results from a comprehensive study of orphans in Zambia published in
November, 1999)*
– Some children are even forced to be the heads of household caring for
themselves and siblings**
Note: Data highlighted here are the exact results from the situation analysis summary report and were provided
using their words in order to relay the results precisely. *Situational Analysis of Orphans and Vulnerable
Children in Zambia, Summary Report 1999; **Fleshman, “AIDS orphans: facing Africa’s ‘silent crisis’”
Institutions – Family
• As part of the Strengthening Community Participation for the
Empowerment of Orphans and Vulnerable Children (SCOPE-OVC), a
USAID/FHI funded project, a baseline survey was conducted
questioning the heads of households caring for orphans and vulnerable
children. Their sample consisted of 1,014 randomly selected
households, but each household had to have at least one orphan or
vulnerable child under the age of twenty-five.
• This particular study revealed similar results of family structure:
– 65% living with a surviving parent
– 14% living with grandparents
– 11.9% living with aunts/uncles
– 4.5% living with siblings as heads of household
• Generally, orphans live in female-headed households
– Of the 1,014 households surveyed, 70% were female-headed
households
*USAID/Zambia – Results of the Orphans and Vulnerable Children
Head of Household Baseline Survey inn Four Districts in Zambia
Institutions – Family
• Implications for orphans
– Living with surviving parent:
• Loss of income from deceased parent
• More expenses because of sick parent
• Loss of productive labor in order to cultivate food*
– Living with grandparent(s):
• Elders in this society are supposed to be taken care of by their
children. However, many grandparents are taking care of their
orphaned grandchildren. The grandparents may be too old to
cultivate and produce food for the family, meaning the children
must labor.** Similarly, if grandparents cannot work to
produce an income, children may have to find ways to make
ends meet for the family.
*Bollinger, Lori & John Stover. “The Economic Impact of AIDS in Zambia”
**Fleshman, Michael. “AIDS orphans: Africa facing a ‘silent crisis’”
Institutions – Family
– Living in family with female heads of household
• Females make nearly half the income that their male
counterparts make in Zambia
• Less income provides even fewer opportunities for children to
access food, education, and health care*
• Female heads of household are likely to have larger numbers of
children and other orphans living with them which stretches
resources even further. Findings from a study by the World
Food Programme indicate an average of five children per
household. [p. 8]**
*USAID/Zambia – Results of the Orphans and Vulnerable Children Head of Household
Baseline Survey inn Four Districts in Zambia
**World Food Programme - Orphans and Vulnerable Children in Zambia:
An Assessment of Vulnerability in Selected Districts Supported
Under the Community Schools Feeding Programme
Institutions – Family
• It is important to see the impact of these living conditions
through the children’s and caregivers viewpoints. Here are
valuable links to stories from those affected by the
changing family structures due to AIDS.
– See the section ‘Strengthening the family’ in Michael Fleshman
“AIDS orphans: facing Africa’s ‘silent crisis’”
(http://www.un.org/ecosocdev/geninfo/afrec/vol15no3/153child.htm)
– Jim Lehrer, “Orphaned by AIDS,” May 9, 2002
(http://www.pbs.org/newshour/bb/health/jan-june02/aids_zambia_5-9.html)
Institutions – Educational system
• Education estimates in Zambia:
–
–
–
–
–
–
–
–
–
–
Male youth (15-24 years) literacy rate: 73
Female youth (15-24 years) literacy rate: 66
Primary school enrollment ratio 2000-2006, net, male: 89
Primary school enrollment ratio 2000-2006, net, female: 89
Primary school attendance ratio 2000-2006 ratio, net, male: 55
Primary school attendance ratio 2000-2006 ratio, net, female: 58
Secondary school enrollment ratio 2000-2006, net, male: 29
Secondary school enrollment ratio 2000-2006, net, female: 23
Secondary school attendance ratio 2000-2006, net, male: 17
Secondary school attendance ratio 2000-2006, net, female: 19*
Note: These numbers are exactly as presented on the statistics page. *UNICEF –
Zambia Statistics
Institutions – Educational system
• Primary school enrollment and attendance are much higher
than secondary education. Children have access to early
education, but many drop out before secondary education.
Some reasons that children may drop out (especially
orphans) include:
– To help care for a sick (HIV-infected) parent
– To work in the fields
– To contribute to household duties and because parents or
caregivers cannot afford to send child to school*
*Bollinger, Lori & John Stover. “The Economic Impact of AIDS in Zambia”
Institutions – Educational system
• Zambia’s DHS EdData Survey, April 2003
presents findings about the impact of AIDS on
education:
– 50% of parents/guardians sampled disclosed that
children in the community do not attend school because
their parents are sick with or died of AIDS, 39%
respondents indicated this was not the case in their
communities
– 12% of parents/guardians sampled disclosed children in
their own families do not attend school because their
parents are sick with or died of AIDS
*Central Statistical Office. “Zambia DHS EdData
Survey 2002: Education Data for Decision-making”
(http://www.zamstats.gov.zm/media/zdes.pdf)
Institutions – Educational system
• Heads of households caring for orphans indicate that the
number one reason for children in their homes not
attending school is because of the financial burden
– In the baseline survey on heads of households, more than
three-fourths [83% out of 1,014] interviewed gave this
reason for the children in their care not attending school**
– In February 2002, Free Basic Education was implemented in
Zambia. Additionally, school fees were said to be removed
in 2003.* However, secondary education is still costly.
*Raja Kattan. “Implementation of Free Basic Education Policies”
**USAID/Zambia – Results of the Orphans and Vulnerable Children Head
of Household Baseline Survey inn Four Districts in Zambia
Institutions – Educational system
• Implications for orphans
– If children are lucky enough to be enrolled and can attend school, it
is exceedingly difficult to retain teachers. As the pandemic
spreads, more people must stay home to care for loved ones or are
personally infected.
– Though the education is ‘free’ in some public schools, some
children and families cannot afford school supplies and uniforms.
– If enrolled in school, attendance rates may be low because children
have to miss school to work for food and necessities [for
themselves and their families].
– Reports from teachers indicate that orphans and vulnerable children
living in extremely difficult situations may be exhausted from labor
and chores at home, thus making it difficult for them to concentrate
during school.*
*Robson & Sylvester, “Orphaned and vulnerable children in Zambia: the
impact of the HIV/AIDS epidemic on basic education for children at risk”
Inequalities – Gender
• In Zambia, a greater number of the poor are women
compared to men
• Women are considered inferior to men and are taught to
have sex with their husbands whenever the husbands ask
– Men often have extra-marital partners, although women do not
– If men do not want to wear condoms, the women are taught not to
argue with them**
• Women have higher HIV prevalence rates than men (See
Section 1 of this module)
**UNAIDS. “Zambia Country Report: Multi-sectoral AIDS Response Monitoring and
Evaluation, Biennial Report 2006-2007”
(http://data.unaids.org/pub/Report/2008/zambia_2008_country_progress_report_en.pdf)
Inequalities – Gender
• Implications for orphans:
– If young girls are valued less than young boys, they
may be the ones to stay home and care for sick parents
ore relatives rather than going to school
– If poverty and gender intersect, forcing young girls into
sex work, they be at an increased risk for contracting
HIV
• Additionally, there was a virgin-cure myth in Zambia in which
older men targeted young females that were virgins believing it
would cure them of HIV/AIDS*
*Avert (http://www.avert.org/aids-zambia.htm)
Inequalities – HIV/AIDS Stigma
• HIV-positive people may be treated unequally compared to
those without the virus. A stigma of blame or even
sympathy can be associated with those that will develop
AIDS. Stigmas emerge for various reasons:
– Fear
– Insufficient awareness about the disease and transmission
– In order for various groups in society to gain power over
others.*
*ICRW – “Disentangling HIV and AIDS stigma in Ethiopia, Tanzania, and Zambia”
Inequalities – HIV/AIDS Stigma
• HIV/AIDS stigma in Zambia
– When HIV first struck Zambia in 1984, the government,
authorities, and media were expected to keep the virus a
secret. The leader of Zambia at that time, President
Kaunda, had a son that died of AIDS in 1986. Initially,
some thought he should not publicly announce that his
son was infected. After his public announcement, he
became a key advocate in the fight against HIV/AIDS.
He feels that the only way to combat this epidemic is to
speak openly about it. The stigma must removed and
the public must be well informed about the HIV and the
consequences of this virus.*
*USAID, Bureau for Global Health, Success Stories
Inequalities – HIV/AIDS Stigma
• Implications for children
– Children may be more likely to be exposed to HIV because
of their participation in risky behaviors.
– Children may be blamed for HIV because of their behaviors
and for going against the values they were taught and
socialized to believe in by their parents.*
– Children are stigmatized because they [or a relative] has HIV
and also because they are an orphan.**
*ICRW – “Disentangling HIV and AIDS stigma in Ethiopia, Tanzania, and Zambia”
**Situation Analysis of Orphans and Vulnerable Children in Zambia, Summary Report 1999
Connections – culture, institutions,
and inequalities
• In sociology, we refer to the connections between multiple
social factors influencing behavior as intersectionality.
• For example:
– The intersection of a large family structure and poverty may force
children into risky behaviors (sex labor, multiple sexual partners,
working on the streets for money), which may increase their
chances of stigmatization.
– The intersection of poverty and gender may force young girls into
relationships with older men and little voice in condom use and
protection.
– Cultural beliefs and social structure limit women to receiving half
as much income as men, but those caring for orphans are more
likely to be female headed households, pushing women further into
poverty.
References – Section 5
•
•
•
•
•
Avert, AVERTing HIV and AIDS. “AIDS Orphans – Zambia.” Retrieved
October 7, 2008 (http://www.avert.org/aids-zambia.htm).
Bollinger, Lori and John Stover. 1999. USAID – The Policy Project. “The
Economic Impact of AIDS in Zambia.” Retrieved November 2, 2008
(http://www.policyproject.com/pubs/SEImpact/zambia.pdf).
Central Statistical Office. “Zambia DHS EdData Survey 2002: Education Data
for Decision-making.” Retrieved November 7, 2008
(http://www.zamstats.gov.zm/media/zdes.pdf).
Fleshman, Michael. 2001. “AIDS orphans: facing Africa’s ‘silent crisis.’”
Africa Recovery 15 (3). Retrieved October 7, 2008
(http://un.org/ecosocdev/geninfo/afrec/vol15no3/153child.htm).
International Center for Research On Women (ICRW). 2003. “Disentangling
HIV and AIDS stigma in Ethiopia, Tanzania, and Zambia.” Retrieved
November 2, 2008 (http://www.icrw.org/docs/stigmareport093003.pdf).
References – Section 5 (cont.)
•
Kattan, Raja Bentaouet. 2006. The World Bank. “Implementation of Free
Basic Education Policies.” Education Working Paper Series No. 7. Retrieved
October 7, 2008
(http://siteresources.worldbank.org/EDUCATION/Resources/EDWP_User_Fees.pdf).
•
Manda, Karen Doll, Michael J. Kelly, and Mark Loudon. 1999. “Situation
Analysis of Orphans and Vulnerable Children in Zambia, Summary Report.”
Volume 1, Retrieved September 20, 2008
(http://www.harare.unesco.org/hivaids/webfiles/Electronic%20Versions/SituationAnalysisofOrphans.
doc).
•
•
•
Robson, Sue and Kanyanta Bonaventure Sylvester. 2007. “Orphaned and
vulnerable children in Zambia: the impact of the HIV/AIDS epidemic on basic
education for children at risk.” Educational Research 49(3): 259-272.
UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint Report of
New Orphan Estimates and a Framework for Action.” Retrieved September
20, 2008 (http://pdf.usaid.gov/pdf_docs/PNACY333.pdf).
UNAIDS. “Zambia Country Report: Multi-sectoral AIDS Response
Monitoring and Evaluation, Biennial Report 2006-2007.” Retrieved October 7,
2008
(http://data.unaids.org/pub/Report/2008/zambia_2008_country_progress_report_en.pdf).
References – Section 5 (cont.)
•
UNICEF. “Zambia Statistics.” Retrieved September 20, 2008
(http://www.unicef.org/infobycountry/zambia_statistics.html).
•
•
USAID. Bureau for Global Health, Success Stories HIV/AIDS. “Kaunda
Campaigns Against HIV/AIDS in TV, Radio Spots.” Retrieved November 2,
2008 (http://www.usaid.gov/our_work/global_health/aids/News/successpdfs/zambiastory4.pdf).
USAID – Zambia. “Results of the Orphans and Vulnerable Children Head of
Household Baseline Survey in Four Districts in Zambia.” Retrieved October 7,
2008
(http://www.fhi.org/NR/rdonlyres/eu6n5zdvgoyjqjnhzzpn5hlqnwloaso7z2uosdeengj2lz24lfasjknxwxb
ektsabfdpr5ynpfvuco/HHHOVCREPORTfinalenhv.pdf).
•
USAID/Zambia. “Zambia in Brief.” Retrieved October 15, 2008
(http://www.usaid.gov/zm/zm.htm).
•
World Food Programme. 2006. “Orphans and Vulnerable Children in Zambia: An
Assessment of Vulnerability in Selected Districts Supported Under the
Community Schools Feeding Programme.” Retrieved November 2, 2008
(http://documents.wfp.org/stellent/groups/public/documents/vam/wfp117663.pdf).
Suggested Readings & Resources
• “CNN Presents: Living with AIDS.” CNN – Health (12/2/2005).
Retrieved November 21, 2008
(http://edition.cnn.com/2005/HEALTH/conditions/11/29/aids.samura)
• I have not watched any of the documentaries on orphans due to AIDS;
however, there are quite a few that might be worth viewing:
–
–
–
–
–
–
Sorious Samura: Living with AIDS, Zambia (On the Frontlines of AIDS)
A Generation of Hope
Tiny Tears
Mercy
The Orphans of Nkandla
The Blood of Yingzhou District
Section 6
Responses to HIV/AIDS pandemic
and orphans
Responses and Frameworks
• There are quite a large number of frameworks,
policies, and responses to help fight HIV/AIDS
and to support the orphans and vulnerable children
affected. For this module, I have included the
major frameworks and global responses. Also, I
have included the specific responses by the
Zambian government and people. For other
organizations and support efforts, see the
suggested readings & resources at the end of this
section.
Frameworks
• United States Agency for International Development (USAID)
provided a framework for addressing HIV/AIDS and the consequences
for countries. This report, conducted in 2003, addressed the major
existing policies and provided a framework entitled OVC [orphans and
vulnerable children] policy package (p. 14). This package consists of
twelve components that countries should address when implementing
policies for children and their families.
–
–
–
–
–
–
–
–
–
–
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Laws protecting the rights of all children
National HIV/AIDS strategies that include an explicit focus on OVC
National OVC policy and guidelines
Targeted issues-based advocacy
A multisectoral OVC structure
Situation analysis and needs assessment
Regular national OVC consultations
Mechanisms for defining and identifying the most vulnerable children
State support for OVC (education, food security, etc.)
An OVC focus within development and PRSP’s and as a criterion for
HIV/AIDS-related funding
– 11. An emphasis on education
– 12. Monitoring of policy implementation*
* Smart, Rose. USAID. “Policies for Orphans and Vulnerable Children: A Framework for Moving Ahead”
Frameworks
• Another framework for addressing the needs of orphans and vulnerable
children due to AIDS was developed and endorsed by UNAIDS in
2004. The Framework for the Protection, care and Support of
Orphans and Vulnerable Children Living in a World with HIV and
AIDS includes five components suggesting the most effective methods
of response.
– 1. Strengthen the capacity of families to protect and care for orphans and
vulnerable children by prolonging the lives of parents and providing economic,
psychosocial, and other support.
– 2. Mobilize and support community-based response to provide both immediate
and long-term support to vulnerable households.
– 3. Ensure access for orphans and vulnerable children to essential services,
including education, health care, birth registration, and others.
– 4. Ensure that governments protect the most vulnerable children through
improved policy and legislation and by channeling resources to communities.
– 5. Raise awareness at all levels through advocacy and social mobilization to
create a supportive environment for children affected by HIV/AIDS.*
*UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint
Report of New Orphan Estimates and a Framework for Action” [p. 21-24]
Frameworks
• The Enhanced Protection for Children Affected by AIDS: A
companion paper to The Framework for the Protection,
Care and Support of Orphans and Vulnerable Children
Living in a World with HIV and AIDS offers three areas of
action:
– 1. Social protection
– 2. Legal protection and justice
– 3. Alternative care*
*UNICEF. “Enhanced Protection for Children Affected by AIDS: A companion
paper to The Framework for the Protection, Care and Support of Orphans and
Vulnerable Children Living in a World with HIV and AIDS” [p. 19-32]
Responses to pandemic and orphans
due to AIDS – Global
• President Bush’s Emergency Plan for AIDS Relief
(PEPFAR) - 2003
– Commitment of $15 billion over five years
• $10 billion for 15 focused countries: Botswana, Cote d’Ivoire,
Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia,
Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam,
Zambia
• $4 billion for other PEPFAR countries and for HIV/AIDS
research
• $1 billion for Global Fund to Fight AIDS, Tuberculosis, and
Malaria*
*The United States President’s Emergency Plan for AIDS Relief.
“Strategy.” (http://www.pepfar.gov/about/c19380.htm)
Responses to pandemic and
orphans due to AIDS – Global
• Unite for Children, Unite against AIDS is global campaign
launched by UNICEF to support children affected by
HIV/AIDS and centers around the “four P’s”
–
–
–
–
1.
2.
3.
4.
Prevent mother-to-child HIV transmission
Provide pediatric treatment
Prevent infection among adolescents and young people
Protect and support children affected by HIV/AIDS*
• The campaign website includes information on funding
resources, who is involved, statistics, partnerships, etc.
*Unite for Children, Unite against AIDS. “Campaign Objectives.”
(http://www.uniteforchildren.org/knowmore/knowmore_28757.htm)
Responses to pandemic and
orphans due to AIDS – Global
• The United Nations General Assembly’s Twenty-sixth session, agenda
item eight developed a “Declaration of Commitment on HIV/AIDS.”
The Zambian Government, along with 189 other countries, endorsed
and adopted this declaration in 2001.**
– Because this module has outlined some of the social implications for
children, item number twenty on this declaration is particularly relevant.
It illustrates an awareness of the importance of culture, social structure,
and family in each individual society and the creators of this declaration
recognize that an understanding of this is crucial in order to provide
support to those countries:
• 20. Emphasizing the important role of cultural, family, ethical and religious
factors in the prevention of the epidemic and in treatment, care and support,
taking into account the particularities of each country as well as the
importance of respecting all human rights and fundamental freedoms [p. 4].*
*United Nations. General Assembly, Session 26, Agenda item 8. “Declaration of Commitment
on HIV/AIDS” (http://www.un.org/ga/aids/docs/aress262.pdf)
**UNAIDS. “Zambia Country Report: Multi-sectoral AIDS Response Monitoring and
Evaluation, Biennial Report 2006-2007”
(http://data.unaids.org/pub/Report/2008/zambia_2008_country_progress_report_en.pdf)
Responses to pandemic and
orphans due to AIDS – Africa
• The World Bank launched a campaign to help Africa
specifically with HIV/AIDS. The Multi-Country AIDS
Program (MAP) for Africa was implemented in 2000 under
the Bank’s larger support effort ACTafrica.
– MAP has committed $1.6 billion to over 30 countries and five subregional projects.
– The goal of this campaign is to dramatically increase access to
HIV/AIDS prevention, care, and treatment programs, with
emphasis on vulnerable groups (such as youth, women of
childbearing age, and other groups at high risk).*
*The World Bank. “Multi-Country HIV/AIDS Program (MAP)”
(http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAF
RHEANUTPOP/EXTAFRREGTOPHIVAIDS/0,,contentMDK:20415735~menuPK:100
1234~pagePK:34004173~piPK:34003707~theSitePK:717148,00.html)
Responses to pandemic and
orphans due to AIDS – Zambia
• Zambia National Response to HIV/AIDS
(ZANARA) was approved in December 2002, but,
the project status is now ‘closed’ as of August
2008. The total cost of this project was $42
million and had four major components:
– 1. Support for community response to HIV/AIDS (CRAIDS),
through financing activities by community based organizations
– 2. Support to the National AIDS Council and Secretariat
– 3. Support to the line ministries, in order to mainstream HIV/AIDS
related activities into the work programs of all line ministries, and
finance the Ministry of Health for support implementation activities
– 4. Program administration*
*The World Bank. “Zambia National Response to
HIV/AIDS (ZANARA) – Overview.”
(http://web.worldbank.org/external/projects/main?p
agePK=64312881&piPK=64302848&theSitePK=4
0941&Projectid=P003248)
Responses to pandemic and
orphans due to AIDS – Zambia
• The Zambian Government and other global organizations
fighting the HIV/AIDS pandemic have adopted the ThreeOne’s strategy to more effectively implement policies.
This means:
– 1. One agreed HIV and AIDS Strategic Framework that provides
the basis for coordinating the work of all partners
• Zambia: Fifth National Development Plan (FNDP 2006–2010) and National
HIV and AIDS Strategic Framework (NASF 2006–2010)
– 2. One National AIDS Coordinating Authority, with a broad-based
multi-sectoral mandate
• Zambia: National HIV/AIDS/STI/TB Council (NAC)
– 3. One agreed country-level Monitoring and Evaluation System.
• Zambia: the NAC has also developed a Monitoring and Evaluation (M&E)
Framework and Plan.*
*UNAIDS. “Zambia Country Report: Multi-sectoral AIDS Response Monitoring and
Evaluation, Biennial Report 2006-2007”
(http://data.unaids.org/pub/Report/2008/zambia_2008_country_progress_report_en.pdf)
Responses to pandemic and
orphans due to AIDS
• There are a number of other organizations that are doing work for
orphans due to AIDS or just raising awareness about the problem. A
list of some of these should be included.
– Strengthening Community Partnerships for the Empowerment of Orphans
and Vulnerable Children [SCOPE-OVC]
(http://www.harare.unesco.org/hivaids/webfiles/Electronic%20Versions/S
COPE%20OVC%20brochure3.doc)
– World AIDS Orphans Day (http://www.worldaidsorphans.org)
– Zambian Orphans of AIDS (http://www.zambiaorphans.org)
References – Section 6
•
PEPFAR. “The U.S. President’s Emergency Plan for AIDS Relief.” Retrieved
November 7, 2008 (http://www.pepfar.gov/about/c19380.htm).
•
The World Bank. “Multi-Country HIV/AIDS Program (MAP)” Retrieved
November 7, 2008
(http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTAF
RHEANUTPOP/EXTAFRREGTOPHIVAIDS/0,,contentMDK:20415735~menuPK:1001
234~pagePK:34004173~piPK:34003707~theSitePK:717148,00.html).
• The World Bank. “Zambia National Response to HIV/AIDS
(ZANARA) – Overview.” Retrieved November 7, 2008
(http://web.worldbank.org/external/projects/main?pagePK=64312881&piPK=64302848
&theSitePK=40941&Projectid=P003248).
• United Nations. General Assembly, Session 26, Agenda item 8.
“Declaration of Commitment on HIV/AIDS” Retrieved November 7,
2008 (http://www.un.org/ga/aids/docs/aress262.pdf).
References – Section 6 (cont.)
•
•
•
UNAIDS. “Zambia Country Report: Multi-sectoral AIDS Response
Monitoring and Evaluation, Biennial Report 2006-2007.” Retrieved October 7,
2008 (http://data.unaids.org/pub/Report/2008/zambia_2008_country_progress_report_en.pdf).
UNAIDS, UNICEF, USAID. “Children on the Brink 2004: A Joint Report of
New Orphan Estimates and a Framework for Action.” Retrieved September
20, 2008 (http://pdf.usaid.gov/pdf_docs/PNACY333.pdf).
UNICEF. 2007. “Enhanced Protection for Children Affected by AIDS: A
companion paper to The Framework for the Protection, Care and Support of
Orphans and Vulnerable Children Living in a World with HIV and AIDS.”
Retrieved November 7, 2008
(http://www.unicef.org/publications/files/Enhanced_Protection_for_Children_Affected_by_AIDS.pdf
).
•
•
UNICEF. Unite for Children, Unite against AIDS. “Campaign Objectives.”
(http://www.uniteforchildren.org/knowmore/knowmore_28757.htm).
Smart, Rose. 2003. USAID. “Polices for Orphans and Vulnerable Children: A
Framework for Moving Ahead.” Retrieved September 20, 2008
(http://www.policyproject.com/pubs/generalreport/OVC_Polices.pdf).
Suggested Readings & Resources
• The President’s Emergency Plan for AIDS Relief: U.S. Five-Year
Global HIV/AIDS Strategy. 2004. Retrieved November 3, 2008
(http://www.state.gov/documents/organization/29831.pdf).
• The President’s Emergency Plan for AIDS Relief. “The Power of
Partnerships: Latest PEPFAR Results.” Retrieved November 10, 2008
(http://www.pepfar.gov/documents/organization/106385.pdf).
• The World Bank. Zambia National Response to HIV/AIDS. Retrieved
November 10, 2008
(http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRI
CAEXT/ZAMBIAEXTN/0,,contentMDK:21935171~pagePK:141137~
piPK:141127~theSitePK:375589,00.html)
What did you learn?
• The statistics of the HIV/AIDS pandemic – global, Sub-Saharan
Africa, Zambia
• The number of orphans due to HIV/AIDS – global, Sub-Saharan
Africa, Zambia
• The implications for children/orphans who are affected by
disease. Moreover, an explanation of various social factors –
social structure, institutions, family, education, culture,
inequalities – and how each can affect opportunities for children
and their families.
• Although Zambia is one of the poorest countries in Africa and
hardest hit by the pandemic, frameworks have been established
with an appreciation of social and cultural factors, and HIV
prevalence has decreased.
Contact Information
• If you have any questions about this module or resources used
throughout, please do not hesitate to contact me.
– Shauna Sutton
Graduate student, 2007-2009
Illinois State University
Department of Sociology and Anthropology
slsutton621@gmail.com