CHILDREN IN FAMILIES AFFECTED BY THE HIV EPIDEMIC: A STRATEGIC APPROACH
Annotated References
Drew, R. "Identifying Orphaned Children in Community Programmes," In Children affected by HIV/AIDS; Report from an International Conference 4-6 November 1994, Nyanga, Zimbabwe. Harare: Southern African Network of AIDS Service Organisations. This article examines different levels of support to orphaned children, discusses why community-based responses should be the primary levels of response and lists steps needed to establish a community orphan support programme, 4 pp.
Drew R, Foster G., Chitima J. "Cultural Practices of Orphaned Families in the North Nyanga District of Zimbabwe," Journal of Social Development in Africa, 11: 79-86, 1996. This survey examines the cultural practices of 211 orphaned families. The families are poor with only 3% having a working latrine-type toilet; only 7% receive government assistance. Most orphans in this survey live with paternal relatives; 76% had inherited their parent's property although only 7% had any form of will. The practice of wife inheritance was reported in only 4% of families; however in 44% of families children had been born more than two years after the father's death. An understanding of these factors is essential for the planning of effective intervention strategies.
Family AIDS Caring Trust . "Practical Steps to Starting and Implementing Community-Based Orphan Support Programmes," Southern African AIDS Training Programme (CPHA) in partnership with CIDA, 1995. The report of a clinic bringing together staff and volunteers of three orphan support programmes. The report covers areas such as questions people ask when trying to start a programme, enumeration, defining an orphan, record systems and report forms, selection of orphans to receive assistance, selection of volunteers, guidelines for needs assessment, the role of social welfare and external agencies, monitoring, involving the local community in the programme, keeping volunteers motivated and bible teaching on orphans, 24 pp.
Foster, G., Chinemana F, Shakespeare R. "Orphans in Zimbabwe - a Descriptive and Enumerative Study," VIII International Conference on AIDS. Amsterdam, July 1992 [Abstract PoD 5158]. OBJECTIVE: 1) To enumerate orphans in the Manicaland province of Zimbabwe 2) To study through naturalistic methods qualitative aspects of orphans. METHODS: In 1991, 1781 children from 586 randomly selected households were surveyed. Focus group discussions were held with mother-surviving, father-surviving and double orphan households from one rural and one urban sampling site. RESULTS: 9.9% of households and 6.9% of children under 15 years had lost one or both parents; 53% of parental deaths occurred in the preceding 20 months; the number of orphans 0-4 years old was 35% lower than expected. Other detailed information will be presented. CONCLUSION: Children orphaned by AIDS in Zimbabwe are a significant problem; appropriate interventions for caring agencies are suggested.
Foster, G., Shakespeare, R., Chinemana, F., Jackson, H., Gregson, S., Marange, C., Mashumba, S. "Orphan Prevalence and Extended Family Care in a Peri-Urban Community in Zimbabwe". AIDS Care, 1995, 7:3-17. An orphan enumeration survey of 570 households was conducted in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans; 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a periurban rural area (17.2%) and lowest in a middle income high density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less educated than non- orphan household heads. The majority of orphaned children are being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families in the community by utilising existing community-based organisations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.
Foster, G. "Mobilising Communities to Assist Orphaned Children in Need". In Children affected by HIV/AIDS; Report from an International Conference 4-6 November 1994, Nyanga, Zimbabwe. Harare: Southern African Network of AIDS Service Organisations, 1995. This article gives a detailed description of how to set up a community-based programme, based on FACT's experience. Steps include situation analysis, choosing an implementing organisation, mapping, detailed programme planning and establishment, ongoing programme training and support and monitoring, 5 pp.
Foster G. 1995 "Coping with the Impact on Children - Positive Lessons from the African Experience"; AIDS Analysis Africa, August 1995. This article briefly reviews orphanhood and programme responses in Zimbabwe. Traditional and contemporary patterns of orphanhood are contrasted using data from a Zimbabwe orphan programme. Changes taking place in caregiving practices of orphans in Zimbabwe are discussed. Finally, a community- based orphan visiting programme is described, 2pp.
Foster G. "Am I My Brother's Keeper? Orphans, Aids and the Extended Family's Choice of Caregiver," Societes d'Afrique et SIDA, October 1995. Changes are taking place in the choice of caregivers for orphans following the rapid increase in the number of orphans and the corresponding increase of burden of caring for orphans by reducing numbers of adult survivors. This article discusses these changes in Zimbabwe, comparing choice of caregivers observed in peri-urban and rural areas, 3 pp.
Foster G., Makufa C., Drew R., Kambeu S. & Saurombe K. "Supporting Children in Need Through a Community-Based Orphan Visiting Programme," AIDS Care 8:4, 389-404, August 1996. There is an urgent need for programmes to be established to support the growing number of orphans in countries severely affected by AIDS. Most orphans are being cared for by extended families under difficult circumstances. Few descriptions of community-based orphan support programmes exist. We describe one such programme established in Zimbabwe in 1993. Twenty-five volunteers identified 300 orphan households. During one year, volunteers made 1725 home visits and 123 households received an average of $11 in material support or school fees. In 292 orphan households there were 702 orphans, 14.7% of children under 15 years in the area. The rate of parental deaths was increasing with 3.5% of households in the area having a parental death in 1994. Forty-five per cent of caregivers were grandparents and 33% of caregivers were over 60 years. Three per cent of orphans were cared for by adolescent siblings. The poorest orphan households were those in receipt of school fees, with out-of-school children or with an older sibling as caregiver. Community members initiated activities to help orphans. The programme described is targeted, effective and replicable. Community-based organisations such as local churches and women's groups can be mobilised to administer programmes which provide support to the poorest orphan households.
G Foster(1,2), C. Makufa(1), R Drew(1), S Mashumba(3), & S Kambeu(4) "Perceptions of Children and Community Members Concerning the Circumstances of Orphans in Rural Zimbabwe" 1. Paediatric Department, Mutare Provincial Hospital; 2 Family AIDS Caring Trust, Mutare; 3 Plan International, Mutare, Zimbabwe; 4 Chirovakamwe Christian Life Centre, Kuhudzai, Mutare. Focus group discussions and interviews were held with 40 orphans, 25 caretakers and 33 other community workers recruited from a rural area near Mutare, Zimbabwe. Orphan concerns included feeling different from other children, stress, stigmatisation, exploitation, schooling, lack of visits and neglect of support responsibilities by relatives. Many community members, while recognising their limitations due to poverty, volunteered or were already actively helping already involved in activities to help orphans and caretakers. Extended family networks are the primary resource for orphans, though some relatives exploit orphans or fail to fulfill their responsibilities. Interventions are suggested which support community coping mechanisms by strengthening the capacities of families to care for orphans. Outside organisations can develop partnerships with community groups, helping them to respond to the impact of AIDS, by building upon existing concern for orphan families. They can help affected communities who are at an early stage of the epidemic to develop setting up committees and developing orphan support activities. Such activity encourage caring responses by community leaders and relatives and which discourage property grabbing and orphan neglect. Material support channelled through community groups to destitute families at critical times can strengthen family coping mechanisms. Income generating activities should build upon communities' existing capabilities and benefit the most vulnerable orphan households. Some communities are responding to the AIDS disaster by adaptions to cope with devastating changes taking place in their communities.
Dr Geoff Foster & Choice Makufa, "Children Rearing Children - a Study of Child-Headed Households," Department of Paediatrics, Mutare Hospital and Family Aids Caring Trust. INTRODUCTION: Recently, child- and adolescent-headed households (CHH & AHH) have appeared in countries severely affected by AIDS. Children and adolescents in these households are living in extremely difficult circumstances. To date, no study has specifically studied the coping mechanisms of CHH & AHH to determine the most appropriate forms of support. BACKGROUND: The Families, Orphans and Children Under Stress (FOCUS) Project is administered by FACT and supervised by church-led committees. Volunteers from each village identify all orphan households. Needy orphan households are prioritised for fortnightly visiting and limited material support. By early 1996, 81 volunteers were supervised by FOCUS committees in four rural areas of Manicaland with a population of 35,000; 616 orphan households received an average of 1,101 visits per month. METHODS: This is the first phase in an ongoing case control study of CHH & AHH. Orphan programme records were reviewed and details of CHH headed by persons under 18 years and AHH by persons 18-24 years were analysed. Structured interviews were conducted with children and adolescents heading selected households. RESULTS: Details will be presented of the proportion of CHH & AHH, dates of establishment, reasons for establishment, economic support and frequency of visiting by extended family, community and programme, schooling, discrimination, migration, income generation, poverty assessment, exploitation, sexual vulnerability and the extent and possibility of family reconstruction. CONCLUSION: CHH & AHH are developments in extended family coping mechanisms. Their appearance is the result of over-burdening of the capacity of relatives to fulfil their traditional role of caring for orphans. Some CHH & AHH receive visits and support from relatives and to a lesser extent, community members. Sexual exploitation of female household heads is the result of their extreme poverty. Early identification of CHH & AHH by concerned, influential community members can provide protection and support to vulnerable children and adolescents. (research in progress, abstract submitted to Durban conference)
Gregson, S., Garnett, G.P., Shakespeare, R., Foster, G., Anderson, R. "Determinants of the Demographic Impact of HIV-1 in Sub-Saharan Africa: the Effect of a Shorter Mean Adult Incubation Period on Trends in Orphanhood," Health Transition Review, 1994, 4:65-92 . Recent evidence suggests that the HIV-1 incubation period may be shorter in some sub-Saharan populations than in Western populations. In this article we use mathematical-model-based simulations to show that, other things being equal, a shorter incubation period can result in smaller but more pronounced HIV-1 epidemics and faster, more acute changes in demographic features such as adult mortality, orphanhood and population structure. Empirical studies of orphanhood reveal similar patterns to those found in simulations, but suggest that migration patterns and structural factors can give rise to greater concentrations of orphans in areas of relatively low HIV-1 prevalence.
Makufa, C. "Assessing Orphaned Children in Need," In Children affected by HIV/AIDS: Report from an International Conference 4-6 November 1994 Nyanga Zimbabwe. Harare: Southern African Network of AIDS Service Organisations, 1995. This article examines needs assessments of orphan households, by considering the advantages of assessments carried out by community members. The methods by which community groups assess orphaned children and different kinds of needs are discussed. The way in which needs are prioritised are addressed, using financial data from an orphan visiting programme, 4 pp.
General Material on AIDS-affected Children and Families
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Street Children
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AIDS and Education
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Bibliographies
"Bibliography of Information Materials on Orphaned Children," Family AIDS Caring Trust, Mutare, Zimbabwe, 3 pp.
"Selected Bibliography," Family AIDS Caring Trust, Mutare, Zimbabwe, 5 pp.
Situation Analyses
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Estimates and Projections of Orphans
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Programme Descriptions and Organizational Responses
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Programme Reports and Evaluations
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Socio-economic Impacts of AIDS
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Danzinger, "The Social Impact of HIV/AIDS in Developing Countries," Social Science and Medicine, Vol. 39, No. 7, 1994, pp. 905-917.
Devereux, S. and Graham Eele, "Monitoring the Social and Economic Impact of AIDS in East and Central Africa," prepared for UNDP HIV and Development Programme, 61 pp.
Drinkwater, M. "The Effects of HIV/AIDS on Agricultural Production Systems in Zambia: A Summary Analysis of Case Studies Conducted in the Mponge Area, Ndola Rural District, and Teta Area, Serenje District, August 1993," September 1993, a report prepared for FAO, 51 pp.
Forsythe, S., Sokal, D., Lux, L., King, T. and Johnson, A. AAn Assessment of the Economic Impact of AIDS in Kenya", Family Health International, AIDSTECH/AIDSCAP, August 1993, 68 pp.
Forsythe, S. and Rau, B. "AIDS in Kenya: Socioeconomic Impact and Policy Implications," Family Health International/AIDSCAP, 1996, 189 pp.
Foster, S. and Lucas, S., Socioeconomic Aspects of HIV and AIDS in Developing Countries, Public Health and Policy, London School of Hygiene and Tropical Medicine, Publication No. 3, 1991, 116 pp.
Gillespie, S., "Potential Impacts on Farming Systems: A Case Study from Rwanda," Land Use Policy, October 1989, pp. 301-312.
"The HIV Epidemic as a Development Issue," UNDP, 4 pp.
Hunter, S., Bulirwa, E., and Kisseka, E., "Report of a Land Utilization Survey: Masaka and Rakai Districts," draft, October 1991, 76 pp.
Kaduru, G., Mweige, E., and Nambi, A., "A Preliminary Report on a Needs Assessment of Rakai and Masaka Districts with Particular Reference to the Socio-economic Impact of the AIDS Epidemic," March 1990, 25 pp.
Norse, D., "Impact of AIDS on Food Production in East Africa," AIDS Analysis Africa, November/December 1991, pp. 10 & 11.
Over, M. and Ainsworth, M., "The Economic Impact of Fatal Adult Illness from AIDS and Other Causes in Sub-Saharan Africa: A Research Proposal," World Bank, research in progress.
Reid, E., "The HIV Epidemic and Development: The Unfolding of the Epidemic," United Nations Development Programme, 1992, 16 pp.
Sills, Yole, The AIDS Pandemic: Social Perspectives, Greenwood Press, Westprot Connectucut, London, 1994 [partial copy. 171 pp].
Van de Walle, E., "The Social Impact of AIDS in Sub-Saharan Africa," The Millbank Quarterly, Vol. 68., supplement 1, 1990, pp. 1 - 31.
Law and Policy
"Guidelines on Care of Orphans," Ministry of Labour and Youth Development, The United Republic of Tanzania, March 1994, 10 pp.
Herb, A., "The New York State Standby Guardianship Law: A New Option for Terminally Ill Parents," Levine, C. ed., Orphans of the HIV Epidemic, United Hospital Fund of New York, 1993, pp. 87-93.
"Lusaka Declaration," International Children's Centre, in Action for Children Affected by AIDS: Programme Profiles and Lessons Learned, WHO and UNICEF, New York, December 1994, pp. 112-114.
Mushota, L. "Women and Property Rights," [English and French] Programming for a Positive World: The Community Development Response to HIV and AIDS, Interagency Coalition on AIDS and Development, Workshop Report, November 1993, pp. 20-23.
Perryman, S., "Family Concerns about Confidentiality and Disclosure," Levine, C. ed., Orphans of the HIV Epidemic, United Hospital Fund of New York, 1993, pp. 67-74.
Pinot, M., "Custody and Placement: The Legal Issues," Levine, C. ed., Orphans of the HIV Epidemic, United Hospital Fund of New York, 1993, pp. 75-84.
"Policy Guidelines for the Care of Orphans in Malawi and Coordination of Assistance for Orphans," Task Force on Orphans, Ministry of Women and Children Affairs and Community Services, Government of Malawi, July 1992, 9 pp.
"Property-grabbing: Why Zambia Needs Stronger Laws to Protect Widow's Rights," AIDS Analysis Africa, Vol. 4, No. 4, July/August 1994, pp. 1&7.
Stein, G., "New York State's Standby Guardian Law: Recommendations for Amendments, Implementation, and Education," The Orphan Project, June 1994, 13 pp.
Small Enterprise Development in AIDS-affected Communities
Batchelor, C. "Credit and Microenterprise," [English and French] Programming for a Positive World: The Community Development Response to HIV and AIDS, Interagency Coalition on AIDS and Development, Workshop Report, November 1993, pp. 24-27.
"The UNDP Spends $2m. on Grass-roots Income-generation in Uganda," AIDS Analysis Africa, Vol. 4, No. 4, July-August 1994, p. 16.
Psychosocial Issues
Dane, B., "Mourning in Secret: How Youngsters Experience a Family Death from AIDS," Levine, C. ed., "Orphans of the HIV Epidemic," United Hospital Fund of New York, 1993, pp. 60-68.
Dudley, R., "All Alike but Each One Different: Orphans of the HIV Epidemic," Levine, C. ed., Orphans of the HIV Epidemic, United Hospital Fund of New York, 1993, pp. 56-59.
Draimin, B., "Adolescents in Families with AIDS: Growing Up with Loss," Levine, C. ed., Orphans of the HIV Epidemic, United Hospital Fund of New York, 1993, pp. 13-23.
"How Children React When a Family Member Has AIDS," [English and Spanish] a brochure produced by Beth Israel Medical Center in New York City.
Jareg, E., "Psychosocial Issues Related to Children and the AIDS Epidemic," Addressing Some of the Psychosocial Consequences of AIDS and Examining the Home Based Care Model, Redd Barna, September 1992.
McKelvy, L., "The Well Children in AIDS Families Project: A Hospital-based Program," Levine, C. ed., Orphans of the HIV Epidemic, United Hospital Fund of New York, 1993, pp. 104-109.
Mayer, R., "When the Butterfly Dies: The Loss of a Parent to AIDS," Levine, C. ed., Orphans of the HIV Epidemic, United Hospital Fund of New York, 1993, pp. 27-35.
Siegel, K. and Gorey, E., "Childhood Bereavement Due to Parental Death from Acquired Immunodeficiency Syndrome," Journal of Developmental and Behavioral Pediatrics, supplement: "Priorities in Psychosocial Research in Pediatric HIV Infection, eds. Bauman, L. and Wiener, L., Vol. 15, No. 3. June 1994, pp. 66-69.
Guidelines
Because You Love Them: A Parent's Planning Guide, Child Welfare League of America, 1994, 74 pp.
Newsletters
The Drum, The African Aids Project of the Anglican Church, Pasadena, California, United States.
The Vulnerable Child, Uganda Community Based Association for Child Welfare, Kampala, Uganda.
Video
The Orphan Generation, produced by Small World Productions, 10 and 40 minute segments.
Please send additions and corrections to the above list to John Williamson, 4110 Forest Hill Avenue, Richmond, VA 23225, U.S.A., tel & fax: (804) 232-3408.