Issues Paper No. 22IMPACT OF HIV AND AIDS ON
FAMILIES AND CHILDREN This paper is a part of a series issued by UNDP and UNICEF in collaboration with UNAIDS. These publications are an element in the 1997 World AIDS Campaign which has as its theme "Children Living in a World with AIDS". The purpose of the papers is to raise issues relating to children and families affected by the HIV epidemic with the intention of raising awareness of the complex and difficult problems now faced by many countries.
TABLE OF CONTENTS Introduction
Let me first introduce myself. My name is Catherine Nyirenda and I come from Zambia. I am 24 years old and I have two sons, Darlington and Simon, who are 3 and 1 years old. I am not married, and live alone with my sons in Lusaka, the capital of Zambia. Lusaka is a city of about 1 million. Within the city, I live in Mutendere, a crowded residential area. Before I get on to the main subject of my talk, which is about the impact of HIV on the family and children, I want to explain a bit about Zambia. My country is very poor. The annual income per person in Zambia is the equivalent of 300 dollars a year and it is very unequally distributed, so that 70% of people live below the poverty line, which means that they spend most of their total income on basic food alone. I am a typical urban person, so let me briefly explain what I spend in a month. In a month, I earn about 50,000 Kwacha, which is worth 50 U.S. dollars. We'll talk later about how I earn it. This is how I spend my monthly earnings: My rent is 25 dollars a month. If I don't pay, I can get credit for two months, but if I fail to pay after that time I will be thrown out. I spend the next 11 dollars on maize meal, our staple food. I have about 14 dollars left for everything else. Charcoal to cook on, cooking oil and vegetables cost 12 dollars in a month. This leaves 2 dollars for the month to buy sugar, soap, baby requirements, my own clothes, transport, health needs and medical services. My impression is that the North is sick of poverty and death in Africa - this is all that gets attention, in your news. Many may think that suffering is normal for us - but it isn't. We hurt and grieve and hunger as much as you would, and we hate disease, poverty, poor medical services, and schools. In Zambia, the family is of great importance. We pride ourselves on looking after our relatives, including the sick and the orphans. This can be hard at times, especially with the poverty suffered by most families. Health services are very basic, even where the commitment of the Ministry and its staff is good. Some drugs are supposed to be free - like TB medicine - but they are often unavailable so people have to buy them privately. There is hardly any safety net for people unable to cope with poverty. Some projects and NGOs offer services in particular areas, but this extends to very few people. Last year, it was shown that only 3% of the population had contact with social welfare activities, half of this being non-Governmental. The annual Government social welfare budget is less than one dollar for every person in Zambia. These harsh realities are being made worse by HIV. HIV currently affects up to one-quarter of the sexually active population. Everyone knows people who have died, who are sick, or who are HIV positive. Everyone knows orphans, many of whom are unloved, uncared for, and uneducated. HIV in a situation of harsh poverty is particularly cruel. It takes away our children's parents when they are most needed, both economically and emotionally. Quietly and gradually, HIV has eaten into many families in Zambia, causing high levels of hardship and distress.
IMPACT OF HIV ON THE FAMILY AND CHILDREN I want to speak now on the main subject of this speech - the impact of HIV on the family and children. I am going to speak here from personal experience, so first I will tell you about the impact of HIV on me and my family. In 1991, when I was 20 years old, I was living in the house of a preacher. That year, I was sick, I had contracted an STD. After treatment, the STD persisted and I was told I should go for an HIV test. When the test came back, the results were positive. I went to the priest's house and told him what had happened. Over a short period of time, he became more and more unfriendly. He said that he feared catching the disease from me, and said that it was embarrassing for him to share a house with me. Later, they chased me out of the house. I went to my sister's house, but her husband felt the same way as the priest and insisted that I couldn't stay. I knew then that I would have to support myself, and find a place to live by myself. I looked for a job, and managed to find one at an organisation called Kara Counselling and Training Trust. Kara is an organisation primarily concerned with HIV and AIDS. Although at first the job was just a way of earning money, Kara's work gradually drew me further into the organisation. In 1992, I became the only woman member of the Positive and Living Squad (PALS), formed at Kara by Winstone Zulu, the first Zambian to declare his positive status publicly. I began to move more and more into outreach work, doing AIDS education for different groups and workplaces, always starting by explaining that I was myself HIV+. In 1993 and 1995, I became pregnant. I became pregnant because I wanted to. It is very difficult to come to terms with not having children, particularly in Zambia, a place where childless women are outcasts. Darlington, my first son, was born in February 1993. Simon, my second son, was born in July 1995. My colleagues at Kara and in support group were not happy about me, a colleague, not following my own advice. Most people condemned me outright for having two children. I was seen as irresponsible, and a bad example to hold up as an educator. My own needs as a woman and a mother were not considered, and I had little support from people whose support I most needed. I soon had to leave my job. My oldest son, Darlington was sick sometimes, but overall has been healthy. After two years, I could have tested him for HIV, but I have not done it. Because he hasn't been very sick I dare to hope for the best. If the results were positive, I could not cope with that. If it were negative, I would have to face seriously the problem of who will look after him to adulthood. My second son, Simon is a sickly child, and I have had problems with him at times. The sicknesses are never serious, but they just keep coming. In the last year, my financial problems have worsened, as I can only pick up occasional work as an outreach educator or assistant on HIV research work. With two babies, one sick, it is hard to be available for work on some days. I have also become more isolated. My sister lives in Lusaka, and I see her quite often, but she often speaks harshly of me, saying I have been irresponsible. But she is my sister, and my closest relative who may accept to look after my children when I die, so I keep friendly with her. She has also agreed to care for my children so that I can be here to speak with you at this conference.
HIV affects many children who are not infected by the virus. It affects children whose brothers and sisters or parents are infected. Children as young as 5 years old nurse their parents as they die. This often means that they are unable to attend school. The children rarely have assistance and support in coping with their stress and grief. When a child's parents die, they may only have more distant relatives to turn to for support. Some AIDS orphans are well aware that they are unwanted and resented by their guardians. Sickness prevents parents from earning money. Consequently, we have seen a steady increase in child malnutrition since 1992. Chronic malnutrition, now affects 44% of urban children, and 60% of rural children. The nutritional status of Zambia's children is amongst the worst in the world, and it is made worse by AIDS. With no money, children also cannot go to school. For primary school, pupils need uniforms, shoes and socks, books, and other items, costing about $25 per child a year. This is too expensive for people with low incomes, or large families. Teachers are reporting increased problems in school from children who are tired, hungry, distressed or upset by their home situation, mostly due to AIDS and poverty. Teachers try to help, but have few resources and little time.
HIV attacks relationships between men and women. The arrival of HIV in a family usually causes tension between husband and wife for the obvious reason that it reveals unfaithfulness. Women know that many married men are unfaithful, but they can't talk or act. They fear that their husbands may beat them, or throw them out, leaving them unable to support themselves or losing their children. There are many women who contract HIV after they know or suspect their husband is infected, as they do not dare to ask their husbands to use condoms or discuss his status. Men also suspect women of extramarital affairs, and are likely to respond by throwing the wife out of the home.
I wanted to mention young women in particular, since the infection rate amongst teenage girls is so great. According to one survey nearly one urban girl in five is HIV positive by the age of twenty! In Zambia, many young women are involved in relationships with older men, who we call 'sugar daddies'. The stereotype of this relationship is the fat man in the Mercedes Benz, taking school girls to expensive hotels. If this were the extent of the problem, the numbers would be limited. But the truth is that many, perhaps most, older men have teenage girlfriends. They think that young girls are free from HIV. The girls - and often their parents - see the sugar daddy as a way of relieving their poverty.
Of course we have programmes in Zambia to combat HIV/AIDS and its consequences. There are Government programmes, aid programmes, NGO programmes, community programmes and church programmes. Some very dedicated officials in the Ministry of Health struggle to coordinate all these. Part of the problem is lack of resources - yes. But if I may be pardoned for making an observation that may hurt some of you here: a large part of the problem is that HIV/AIDS is not the only item on the agenda of many of these programmes. We have recently had a large anti-AIDS programme that seems to have been more concerned with funding universities in the donor country than with taking action on the front line. We at Kara did get a small grant from this huge programme - and we were then visited by 26 donor consultants flown in at a much higher cost. This makes me wonder about the real purpose of this donor funding. The various churches have policies which contradict each other and cause confusion. Use condoms, don't use condoms, condoms are not effective anyway. Talk about sex, don't talk about sex. Who are we to believe? And similar differences appear between NGOs. Even our politicians seem to have difficulty with forming a single policy aimed at the problem of HIV/AIDS and its effects. One Minister put condom advertisements on the TV - one featuring our football captain Kalushya Bwalya and the other a famous Zairean singer, Tshala Muana. Along comes another Minister and has them taken off as "immoral" - the first because Kalushya is married, and second because Tshala is unmarried. Our MPs are dying of AIDS like anyone else (we have lost over 20 out of a Parliament of 150 in four years) but they don't seem to be able to form a common position. So the subject of AIDS is hardly debated at all. For what it is worth I think this: that if HIV/AIDS and its consequences were the only item on the agenda of all of us who are in the fight then we would get a lot further with the resources we already have.
I have told you some things that I could about the impact of AIDS on children and families in Zambia. Now I will return home to be with my two young sons in a country where only a tiny few can dream of DDI and AZT. Thank you for a stay in a luxury hotel which costs the equivalent of three years rent for me. Thank you for a club class air ticket, the cost of which would feed my children from now until they reach adulthood, God willing. And thank you very much for listening. This paper was first presented at the XI International Conference on AIDS, Vancouver, July 7-12, 1996 |
