H.I.V and Aids has affected children more than any section of the population in Africa.

 It is undisputable that children have suffered more than any other section of the population due to the fact that they are children and therefore they are vulnerable and they do not have the capacity to take care of themselves. It is hard to overemphasize the trauma and hardship that children affected by HIV and AIDS are forced to bear. The epidemic not only causes children to lose their parents or guardians, but sometimes their childhood as well. As parents and family members become ill, children take on more responsibility to earn an income, produce food, and care for family members. It is harder for these children to access adequate nutrition, basic health care, housing and clothing as well as education.

By affected children are meant orphans, fostered children and child-headed households. The term ‘affected children’ is also used to denote children living in households that have taken in orphans, who are sometimes referred to as co-residents. These children are affected in the sense that household resources are stretched by the increased dependency ratio created by additional children.¹ John Williamson says that the common impacts of HIV/AIDS include deepening poverty, such as pressure to drop out of school, food insecurity, reduced access to health services, deteriorating housing, worsening material conditions, and loss of access to land and other productive assets. Psychosocial distress is another impact on children and families, and it includes anxiety, loss of parental love and nurture, depression, grief, and separation of siblings

among relatives to spread the economic burden of their care.²

A decline in school enrolment is one of the most visible effects of the epidemic. This in itself will have an effect on HIV prevention, as a good, basic education ranks among the most effective and cost-effective means of preventing HIV.³ There are numerous barriers to school attendance in Africa. Children may be removed from school to care for parents or family members, or they may themselves be living with HIV. Many are unable to afford school fees and other such expenses which is particularly a problem among children who have lost their parents to AIDS, who often struggle to generate income. Studies have suggested that young people with little or no education may be around twice as likely to contract HIV as those who have completed primary education.  In this context, the devastating effect that AIDS is having on school enrolment is a big concern. In Swaziland and the Central African Republic, it was reported that school enrolment fell by 25-30% due to AIDS at the beginning of the millennium.

As projections of the number of AIDS orphans rise, some have called for an increase in institutional care for children. However this solution is not only expensive but also detrimental to the children. 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.⁴ There are other alternatives available. One example is the approach developed by church groups in Zimbabwe, in which community members are recruited to visit orphans in their homes, where they live either with foster parents, grandparents or other relatives, or in child-headed households.

The relationship between AIDS and the education sector is circular that is as the epidemic worsens, the education sector is damaged, which in turn is likely to increase the incidence of HIV transmission. There are numerous ways in which AIDS can affect education, but equally there are many ways in which education can help the fight against AIDS.⁵ The extent to which schools and other education institutions are able to continue functioning will influence how well societies eventually recover from the epidemic. "Without education, AIDS will continue its rampant spread. With AIDS out of control, education will be out of reach."⁶ This therefore means that the spread of HIV/AIDS is causing much suffering to the children as they cannot access one of the important needs in their lives that is education.

To add to the above, in households affected by HIV/AIDS, the school attendance of children drops off because their labour is required for subsistence activities and, in the face of reduced income and increased expenditure, the money earmarked for school expenses is used for basic necessities, medication and health services. Even where children are not withdrawn from school, education often begins to compete with the many other duties that affected children have to assume. In addition, stigmatisation may prompt affected children to stay away from school, rather than endure exclusion or ridicule by teachers and peers. A study in Zambia, for example, showed that 75% of non orphaned children in urban areas were enrolled in school compared to 68% of orphaned children. At a national level, a World Bank study in Tanzania suggested that HIV/AIDS may reduce the number of primary school children by as much as 22% and secondary school children by 14% as a result of increased child mortality, and decreased attendance and dropping out.⁷

According to the 1999 South African October Household Survey, as many as 35% of rural African children between the ages of six and 17 years do not attend school. In the sub-Saharan region, an estimated 44 million children, more girls than boys, are not attending school.⁸ School dropout is likely to increase as families become unable to afford the costs of schooling and as children’s contribution to care and work is required at home. Experience suggests that the most vulnerable orphans are those in their school years, aged ten years and older. Thus, despite all their shortcomings, schools have significant potential to play a critical role in obviating the worst effects of the HIV/AIDS epidemic on children. Apart from the accrued personal and social benefits of education for work and national development, schooling provides stability, institutional affiliation and the normalisation of experience for children. It also places children in an environment where adults and older children are potentially available to provide social support.

While in these circumstances, children are obviously not receiving the care they need from their parents, the extent to which the communication gap between parents affects children’s lives is difficult to assess. Undoubtedly, some children may feel as much distressed as adults may. An analysis of children’s drawings reinforces the impression that the presence of HIV/AIDS within a family, even though people will avoid talking about it, has an impact on the way in which children reconstruct the image of their families and social environment.⁹

The movements of children, which follow the death of one of their parents or the disruption of marriage, are intimately related to complex social and cultural practices. When the father dies, for instance, tradition implies that the widow will automatically marry his younger brother and the children will consequently move to another location. When the mother dies, her own sister would traditionally replace her in the household (phenomenon called sororat), but informants affirmed that this phenomenon is progressively loosing importance in the areas covered by our survey. However, even if sororat is not applied, the widower will typically seek another wife without much delay, and as a result, the children of the deceased wife will usually leave their father’s house.¹⁰ For nearly three decades, HIV and AIDS have been devastating individuals and families with the tragedy of untimely death and medical, financial and social burdens. Although children’s concerns have always been present within the great spectrum of need associated with HIV, they have to some extent been overshadowed by the very scale of the epidemic in the adult population.

In 2000, around 12 million children were left without parents due to the pandemic.¹¹ It is estimated that by 2012 the numbers will nearly double. Those children who are fortunate enough to have a parent alive often drop out of school to care for them. With no education they will find other means for survival, whether it be working unskilled jobs, begging, or performing criminal activities. Others who have been completely orphaned are adopted by their relatives, usually their grandparents, and raised as best as possible given the conditions they have.

If children’s parents die due to AIDS, the children either go live with another family member who will try to at least raise them or the eldest of the siblings becomes the head of the family. However, this means that they won’t have enough money to pay school fees and they will have to stop going to school and start working. In the case of the boys, they will most probably end up working on the fields of someone who owns a large farming land, on the other hand girls, will either take care of the house or will be forced by a family member to begin prostituting.¹² If the girls are forced into prostitution they have an even higher risk of contracting HIV.

In Angola, as well as recovering from the effects of a prolonged civil war, have to come to terms with a rising rate of HIV/AIDS. Nearly 4% of the adult population is affected and more than 100,000 children were orphaned as a result of HIV/AIDS in 2003. Botswana has, according to most estimates, one of the highest infection rates for HIV/AIDS. 37% of the adult population is affected. 120,000 children were orphaned as a result of HIV/AIDS, 75% of all orphans.¹³ This is having a dramatic impact on the relatively high standards achieved since independence. The number of children orphaned as a result of HIV/AIDS is estimated to be between 60 000, and 80,000. Food and water shortages in Ethiopia have been followed by an increase in the incidence of HIV/AIDS. It is estimated that 4.4% of the population is affected, that 720,000 children were orphaned as a result of HIV/AIDS, 18% of all orphans, and that 200,000 children are living with HIV/AIDS. Nearly 7% of the adult population of Kenya is affected by HIV/AIDS. There are more than 600,000 children who are orphans as a result of HIV/AIDS - 38% of all orphans. HIV/AIDS is a major cause of infant and child illness and mortality.¹⁴

The pandemic has also effects on households. The effect of the AIDS epidemic on households can be very severe, especially when families lose their income earners. In other cases, people have to provide home based care for sick relatives, reducing their capacity to earn money for their family. Many of those dying from AIDS have surviving partners who are themselves infected and in need of care. They leave behind orphans, who are often cared for by members of the extended family.

Moreover, these children orphaned by the HIV/AIDS epidemic are very vulnerable as they, most of the times have no one to protect them not to mention about listening to them. Sexual abuse is therefore rampant even from the family members who take advantage of the orphaned children that they have nowhere to report. This has been worsened by the fact that there are some people who have spread the gospel that having sexual intercourse with a virgin cures the disease and as a result many children are at risk of contracting the virus. Sexual exploitation and child trafficking has also worsened due to the pandemic. There is very little hard data available on the extent and nature of human trafficking in either the region or beyond and much of what is available is based on relatively small-scale research.¹⁵ According to the International Organization for Migration (IOM), however, the trafficking of women and children is the third most lucrative type of organized crime in the Southern African region, following the sale of arms and drugs. A recent report released by the IOM suggests that considerable numbers of women and children are trafficked annually in the Southern African region. Trafficking in children occurs for the purposes of child prostitution, illegal and false marriage, illegal adoption and child labour. An unknown number of children are trafficked for body parts. In the Southern African Development Community (SADC) region, children are trafficked primarily as bonded labour and for the purpose of sexual exploitation. The IOM report highlights, as examples of trafficking in the region, a European-led child sex tourism industry in Malawi and the trafficking of Mozambican children into prostitution in Johannesburg.¹⁶ It is likely that as the ratio of dependent children increases as a result of the

HIV/AIDS epidemic, so will the chances of children being lured into trafficking and sexual exploitation. Once imprisoned, or left without the means of escape, children are at their most vulnerable.

The problem of street children has also worsened especially at the turn of the new millennium as a result of different reasons of which the HIV/AIDS epidemic is no exception. This has been due to the fact that most of the children find it difficult to live in extended families and consequently run away to just be independent from their relatives. The problem in Africa has also been worsened by the fact that child rights have been neglected by most African governments as their protection rights are not realized. No laws have been set up to allow for the protection of children from discrimination, neglect, physical, emotional and sexual abuse. This has been as a result of lack of willingness on the side of the governments as most African governments channel their funds and efforts towards regime security.

The pandemic has had negative effects on the economic wellbeing of households. In several countries, income in orphan households has been found to be 20–30% lower than in non-orphaned households. Studies in urban households in Côte d’Ivoire, for example, show that where a family member has AIDS, average income falls by as much as 60%, expenditure on health care quadruples, savings are depleted and families often go into debt to care for sick individuals. Other studies have suggested that food consumption may drop by as much as 41% in orphan households. Asset selling to pay for health care, loss of income by breadwinners and funeral costs may deplete all household reserves, as well as savings.¹⁷

Migration has been identified as an important family and community coping mechanism in the face of the HIV/AIDS epidemic and this is especially so in Southern Africa. Migration occurs for several reasons and people move both within and between rural and urban areas. Some identified forms of migration include ‘going-home-to-die’, rural widows moving to town to seek work or the help of relatives, and potential caregivers and dependants moving between kin households to achieve the most optimum care arrangements for all concerned.¹⁸ Children are frequently relocated. Adolescents are particularly affected by migration, as girls are sent to help out in other households, or as children are encouraged to try and fend for themselves by working, including street work. Because AIDS claims the lives of people at an age when most already have young children, more children have been orphaned by AIDS in Africa than anywhere else. Many children are now raised by their extended families and some are even left on their own in child-headed households.

Furthermore there is the issue of changes in caregiver and family composition. As a result of death and migration, family members, including dependent children, often move in and out of households. Caregivers change and siblings may be split up. Separation from siblings has not only been found to be a predictor of emotional distress in children and adolescents, but children become more vulnerable when they are cared for by very aged relatives due to the conditions of mutual dependency that often exist between adult and child.¹⁹ Death and migration may also result in the creation of child-headed households. These are most likely to form when there is a teenage girl who can provide care for younger children, when there are relatives nearby to provide supervision, and siblings either wish to stay together or are requested to do so by a dying parent.

New responsibilities and work for children which lead to child labour. Several studies have shown that responsibilities and work, both within and outside of the household, increase dramatically when parents or caregivers become ill or die. In such circumstances, instances of work and responsibility being given to children as young as five have been observed.²⁰ Responsibilities and work in the household include domestic chores, subsistence agriculture and provision of care giving to very young, old and sick members of the household. Work outside of the home may involve a variety of formal and informal labour, HIV/AIDS, vulnerable children and security in Southern Africa including farm work and begging for food and supplies in both the community and beyond.²¹ While not all child labour is necessarily injurious, a moderate amount of responsibility can have a positive influence, illegal child labour can be damaging to children’s physical and mental health, may prevent children from attending school and may be cruel and dehumanizing. Child labour is likely to increase as economic conditions of children in families affected by HIV/AIDS deteriorate. Instruments dealing with child labour infringements such as the Convention on the Rights of the Child and, in South Africa, the constitution and multiple laws do not in their current form lead to financial assistance for the child or the family to ameliorate the economic conditions leading to child work.²² As effects on households deepen and parents die, children may suffer the loss of their home and livelihood through the sale of livestock and land for survival, as well as through asset stripping by relatives. Loss of skills also occurs because fewer healthy adults are present in the household and/or are involved in livelihood activities.

 Children affected by HIV/AIDS may receive poorer care and supervision at home, may suffer from malnutrition and may not have access to available health services, although no studies have yet demonstrated increased morbidity and mortality among broadly affected children compared to unaffected control groups. In this regard, it has been suggested that the safety nets of families and communities are still sufficiently intact to protect the majority of children from the most extreme effects of the epidemic; or alternatively, that orphans may not be worse off than peers living in extreme poverty.²³ Indeed, with high levels of ambient poverty in most high-prevalence communities, it is difficult to ascertain which effects on children’s health are attributable specifically to HIV/AIDS.

Affected and orphaned children are often traumatized and suffer a variety of psychological reactions to parental illness and death. In addition, they endure exhaustion and stress from work and worry, as well as insecurity and stigmatisation as it is either assumed that they too are infected with HIV or that their family has been disgraced by the virus.²⁴ Loss of home, dropping out of school, separation from siblings and friends, increased workload and social isolation may all impact negatively on current and future mental health. Existing studies of children’s reactions suggest that they tend to show internalizing rather than externalizing symptoms in response to such impacts—depression, anxiety and withdrawal—as opposed to aggression and other forms of antisocial behaviour.²⁵

 Apart from other impacts, children affected by HIV/AIDS are themselves often highly vulnerable to HIV infection. Their risk for infection arises from the early onset of sexual activity, commercial sex and sexual abuse, all of which may be precipitated by economic need, peer pressure, lack of supervision, exploitation and rape. Some studies of street children, for example, show that vulnerable children do little to protect themselves from HIV infection because the pressures for basic survival such as finding food far outweigh the future orientation required to avoid infection.²⁶

 Another issue is long-term psychological effects of emotional deprivation. Children who grow up without the love and care of adults devoted to their wellbeing are at higher risk of developing psychological problems.²⁷ A lack of positive emotional care is associated with a subsequent lack of empathy with others and such children may develop antisocial behaviours. Not all children are, however, affected or affected to the same degree. Protective factors in the form of compensating care from other people, including teachers, as well as personality predisposition may lessen the impact on children of reduced care in the home environment.

School drop out, child labour, sexual exploitation and child trafficking present real dangers to children as well as to society: they reduce individual and national developmental potential; marginalize and dehumanize children and separate them from available sources of help and support; engender widespread disregard for children; and have close associations with crime.²⁸ Without schooling, both individual potential and social capital is lost, leaving affected individuals vulnerable to unemployment, menial working conditions and poverty. Similarly, child labour is often physically damaging, psychologically stunting and demeaning to the dignity of children whose labour is exploited. Together with sexual exploitation and the trafficking of children, school drop out and child labour indicate the disintegration of the social institutions that

serve to protect and develop children and, by their existence, they further undermine fragile families and communities.²⁹ In addition, child labour and sexual exploitation fuel crime as children become traded for profit.

The HIV/AIDS epidemic is going to be more terrible to live through especially to children than any of us can imagine. We are only beginning to experience the effects of AIDS deaths. Children suffer the most as they are much more vulnerable than any other section of the population. The most important interventions for children are nationally oriented responses that identify, target and effectively implement mechanisms to provide economic and other assistance to poor families and to maintain and improve their access to services. In this way, the values and organizing coherence of families, neighbourhoods and schools will assist children to cope with the increasing adversity accompanying the epidemic.