Study Paper No. 7

FROM SINGLE PARENTS TO CHILD-HEADED HOUSEHOLDS:
THE CASE OF CHILDREN ORPHANED BY AIDS IN KISUMU AND SIAYA DISTRICTS

A research project report
By Ayieko, M A, PHD

I. INTRODUCTION

1.1 OVERVIEW

The socio-economic consequences of the HIV/AIDS epidemic are felt in a growing number of countries. Increasing mortality rates among adults are threatening economic and social well-being. Women and children are bearing the heavy burden of nursing the sick and managing households with over-stretched resources. Observations show that when a husband dies of AIDS in a family, the mother is also often living with HIV/AIDS and dies shortly thereafter, leaving children as orphans.

Most parents, even if they are aware of their terminal illness, do not attempt to make any alternative living arrangements for their children before their death. Children are left in the household with limited, or no, resources. As the epidemic spreads, these child-headed households are becoming more and more frequent in rural areas.

Children in such conditions are deprived of their childhood and the opportunity to go to school. Economic hardships lead them to look for means of subsistence that increase their vulnerability to HIV infection, substance abuse, child labor, sex work and delinquency. This study looks at the status, needs and skills of orphans, especially those orphaned by AIDS. The study documented available family and community resources with the intention of facilitating future development of community-based interventions for children affected by HIV/AIDS in Kenya.

1.2 UNDERLYING ASSUMPTIONS FOR THE STUDY

Most Kenyans live within communities of extended families and kin in rural areas. The villagers are endowed with basic resources, production information, customs and traditions essential for sustaining life and raising families in a rural community. As discussed above, this study examined possibilities of using such resources to support community-based interventions. The study therefore was based on three major assumptions:

i) Raising Children in Familiar Surroundings

Children develop better socially, mentally and emotionally in familiar surroundings with extended families and thus should be cared for in such environments as long as possible.

The role and value of raising children in their own families cannot be over estimated. In the interest of the orphans they need to be retained in their own communities under the care of an adult. As argued by Reid (1993), families do not cease to exist when parents die. Secondly, children grow better in their own communities where they can have opportunities to relate to adults and other children of similar backgrounds. Therefore, to give orphans better opportunities, they should be retained and supported within their own villages as long as possible. This would foster their psychosocial development, allow them to know their extended families and their culture, and provide them with a sense of security and belonging. Such a head-start will go a long way in helping to improve their socio-economic status in the long run.

ii. Parental Concerns at Terminal Stages

Counselling terminally ill parents would make them more likely to pass on crucial production knowledge to their children at earlier ages.

After the diagnostic and denial stages, death becomes real to most people living with HIV/AIDS, and they often start expressing concern over the future of their children (Reid, 1993; Topouzis, 1994). With appropriate counselling at this stage, the patients are likely to pass on vital production skills and information to their surviving family members. The terminally ill parents within the community could thus be encouraged to join support groups and start instructing their children. Such support groups could be given special counselling sessions to help prepare youth in the villages and encourage peer support for orphans.

iii. Utilising the Minimum Available Resources

In most typical rural communities, there are certain resources available for all residents. These resources can be identified to support children in their rural home under the care of extended families.

AIDS orphans are often left with some minimum resources such as land, housing and some supportive relatives who could be approached to take care of them. With additional support from outside, such resources could effectively be utilised to sustain orphans within their natural surroundings and communities. Such an arrangement would also minimise the future cost of land to settle the children during their adult lives because the orphans would then automatically inherit their own ancestral land. It would also reduce the number of cases in which corrupt relatives swindle unsuspecting orphans of their rightful land inheritance.


1.3 PURPOSE OF THE STUDY

The prevailing poor economic conditions have caused many families to live in severe poverty. Furthermore, child oriented NGO projects being expensive and less self-sustainable, are not common in most rural areas. Therefore, responsibilities such as providing for orphans are most of the time left to households, close relatives, or communities to manage. The goal of this study was to examine orphans' coping strategies and to explore possibilities for community-based interventions for rural youth. In order to support specific interventions, it is necessary to know the nature of available community resources and how they are (or can be better) mobilised to meet the needs of the children. The survey also assessed the need for additional resources for developing and supporting interventions, and reviewed possibilities for villagers to run projects with minimum assistance from outside the community.


1.4 . RESEARCH QUESTIONS

To find out how children cope under such difficult conditions, research questions were formulated to facilitate fact finding. These were:

· How do orphans manage their farms, younger siblings, and sick members of their households?
· How can extended families and the community as a whole be mobilised to help manage orphans within the villages?
· Where do orphans, children more generally, turn for emotional support?
· How do orphans make sense of what has happened to them?
· What kind of production options and survival mechanisms are available to orphans?
· What are the immediate needs of orphans for food production and security, housing, health and education?


1.5 RESEARCH OBJECTIVES

The broad objectives of this study are to assess the social and economic status of households headed by children, and to identify available and required resources that may be utilised to initiate and support HIV/AIDS community-based interventions. The objectives are:

i) To identify and map the prevalence of child-headed households in selected areas in Kenya--Nyanza province.

ii) To identify and describe the needs and constraints of home-based children orphaned by AIDS and their potential caregivers in rural areas.

iii) To survey the availability of national and community support for home-based orphans in rural areas.

iv) To describe and propose possible small-scale community-based interventions for orphans.

v) To motivate communities so as to initiate small-scale interventions within villages to help support orphans.



II. METHODOLOGY

2.1 INTRODUCTION

A number of methods were used to collect data. These were questionnaire schedules, focus group discussions, participant observation, personal interviews with different personalities and affected household members, community meetings, case studies, and two local workshops, one with district level officials, and the other at grassroots level with villagers and community workers.

The job of collecting information began by a brief survey in Nairobi and the sampling area to get to know what has been done or what is being done with regards to HIV/AIDS in Kenya. Potential supporters were contacted and informed of the research project. An attempt was also made to contact key people such as religious and civil leaders, and other opinion leaders in the area of operation. The data collection was conducted as follows:


2.2 RESEARCH TOOLS

2.2.1 Questionnaire Schedules:

To be able to quantify some of the information, questionnaire schedules were developed and administered to affected households. This task started with a three day training workshop for the data enumerators and their field support staff from the Ministry of Agriculture, Marketing and Livestock Production. Quantitative information on household characteristics, resources and other quantifiable demographic data on households headed by children and elderly grandparents was collected.

Enumerators training workshops

At the beginning of the project, one training workshop was conducted to prepare nine enumerators and their would-be supervisors from the Ministry of Agriculture. The enumerators were trained to administer the questionnaires and also to do HIV/AIDS prevention work in the villages. Half-day seminars for the enumerators were held every month throughout the period with data collection. These seminars were conducted to review progress of data collection, learn of new relevant issues arising in the region, respond to the enumerators' concerns and to receive feedback on the villagers' responses to the questionnaire. During these seminars, the enumerators were also given further instructions on working with villagers, advocating behaviour change, and HIV/AIDS prevention in general. The seminars were especially helpful as the only direct contact with those households that were not going to be interviewed by the project.

2.2.2 Interviews

The second part of the data collection process involved personal interviews with local and national authorities. These included interviews with NGO staffers, selected senior government officials from the Ministries of Agriculture, Education, Health, and Social Services; religious organisations; community workers in the provinces, districts and divisions. These organisations were interviewed on their activities to alleviate the impact of HIV/AIDS, what they thought was lacking in their programmes which could be supplemented by community-based intervention. They were also interviewed on what their organisations could contribute to the initiation of and support for interventions.

In the list of interviewees were church elders, opinion leaders and significant local leaders and politicians in the area. Personal interviews with caregivers, the orphans themselves, and terminally ill parents in their homes and hospitals were also conducted to learn how people living with HIV were coping with their parenting roles during the last days of their lives. Others included AIDS workers in the area, medical personnel, AIDS activists, counsellors and even condom sales distributors. An effort was made to talk to every person or organisation involved in any aspect of HIV/AIDS prevention in the community. It was necessary to have all such individuals involved because their support for interventions would be crucial.

2.2.3 Community meetings

Researchers also participated in several community meetings such as religious congregations, chiefs' barazas and leaders' conferences to address the villagers on HIV/AIDS and orphans issues, and to collect information for the project wherever this was possible. It was at such meetings where we heard the community members talk about what they were going through and how they were responding to the problems as individuals, households and as a community. During such meetings, we learnt how the villagers discussed the issue amongst themselves, as opposed to what they tell data collectors, and how they respond to conversations with outsiders.

2.2.4 Focus Group Discussions

A total of 18 focus group discussions were conducted. In these forums, we discussed existing ideas about raising orphans in rural areas given the current poverty situation, fear and uncertainty amongst the villagers. Cultural practices for child adoption and caregiving were discussed to further our understanding of how these may prevent, inhibit or discourage a relative from taking care of a child. The main objective of the group discussions was to provide a forum for the affected groups to discuss in more detail what effects them and to explore ideas for support groups, interventions and management committees for orphans and widows. Convenient locations in the nine divisions were selected for the focus group discussions. In each of the divisions, there was one group for orphans and another group for caregivers. The caregivers groups mainly discussed the various traditions, customs and norms in the Luo community that govern child adoption and caregiving in the event of the death of both parents. Possibilities for income generation activities were also explored to assist economically poor but willing and capable caregivers.

2.2.5 Leaders' Workshops and Seminars

Two local workshops, one in Siaya and the other in Kisumu districts were conducted for feedback, and to sensitise the community on the status of the HIV/AIDS epidemic in the area and their role in managing orphans. The workshops also provided forums for dissemination of some basic findings from the study and to discuss modalities for the community intervention, and to propose and to develop ideas for support and ownership of the interventions by villagers.

The Kisumu workshop brought together researchers, individuals, extension workers, district leaders, civic and other community leaders. During this workshop, the following topics were discussed and resolutions passed by the group:

a. availability of community resources for development and support of the intended interventions in the communities
b. legal and ethical support systems necessary for interventions
c. spiritual and social well-being of orphans
d. sustainability of the interventions and support groups
e. orphans' property ownership and inheritance rights
f. essential concerns such as education, health and food security
g. mobilisation of the community for the project interventions including involvement, empowerment and guardianship of orphans
h. community strengths and resources
i. community weaknesses and difficulties
j. resolutions and suggestions for future action

The second workshop was organised for grass-roots community workers and selected villagers. In attendance were village elders, primary school teachers, church leaders, caregivers, widows and widowers, village AIDS workers, community volunteer health workers and village social workers. To facilitate active discussion and to provide new ideas, the discussion topics were presented in question form as follows:

a. how can we involve the whole community in running the intervention?
b. how can villagers be empowered to take the major role in running the intervention?
c. who should identify or appoint a guardian for orphans should parents die without having done so?
d. how can we impart to orphans a sense of belonging to encourage them to live in their own community rather than running away to the streets?
e. what are the various Luo community strengths that can help manage the interventions?
f. what are the major community weaknesses that may hinder the smooth running of the intervention? how can we deal with these?
g. what resources are available in the rural areas that can be used to manage such an intervention?
h. what are the possible community difficulties that may be encountered by the intervention?
i. which customary laws and norms can be used with government laws in protecting the needs of orphans?

The two complete workshop reports are available as separate documents.

2.2.6 Case Studies

Several special case studies were undertaken. These included special interviews with households headed by female orphans, male orphans, joint leadership, and those headed by very elderly grandparents. Some of the case studies are reported here as box inserts.

2.2.7 Video Filming and Photographs

To accompany the data collection, photographs were taken and some actions captured on videotapes to facilitate production of a documentary film. The documentary film is available as a supplementary report.

2.2.8 Personal Observation

The purpose of personal observation was to gain acceptance in the affected households, churches and the villages in order to record less obvious but essential information about HIV/AIDS management in the area. By walking around in the villages and visiting with the affected families, some vital information about the households, practices and beliefs were recorded and are presented in the report. To verify certain issues that were observed, these were brought up for discussion during the workshops and seminars. Most traditions and customs in the Luo community are fairly uniform with minor variations from one location to another. However, due to marriages across the locations, variations are generally accepted and are practised freely by households.


2.3. SAMPLE SELECTION METHODS

2.3.1 The Study Area

The study was conducted in Kisumu and Siaya districts in Nyanza province. Nyanza is an administrative province in western Kenya with a total population of 3 million (Kenya Bureau of Statistics, 1994). A mid-year medical report of 301 patients at the ante natal clinic from the Ministry of Health, Nyanza Provincial General Hospital indicates that a total of 34.3% of mothers who visited the clinic were HIV positive. HIV prevalence is uniformly distributed amongst all types of homes. Table 2.1 shows the details of reported cases of the epidemic amongst women in the ante natal clinic.

Table 2.1 Distribution of Patients by Marital Status

Source: NACP Sentinel Surveillance Summary Sheet, New Nyanza Provincial General Hospital - 1997, Analysis of ANC Patients

Nyanza has the highest number of HIV infections in the country. The province is divided into seven administrative districts of which Kisumu and Siaya are the most affected districts with the highest levels of HIV prevalence and HIV-related mortality in the province.

2.3.2 Sampling Methodology

Purposive and convenience sampling methods were used to collect data. A total of nine enumerators were selected from the research areas to enable them to relate easily to the respondents. Each enumerator was assigned to cover two administrative divisions with about 25,000 households each. Due to limited resources (time and money), only nine divisions were relatively well covered by the enumerators. Three other divisions were partially covered. With the help of chiefs and trained research assistants, an attempt was made to identify all households with orphans.

2.3.3 Sampled Population

A total of 1101 households participated in the study with a total of 2878 orphaned children. From Kisumu district, 493 (44.7%) households from eight divisions and 605 (55.3%) households from six divisions in Siaya district were selected as shown in Table 2.2 below. Muhoroni, Lower Nyakach, Kadibo, Maseno, Madiany, Bondo, Boro, Ukwala, and Wagai divisions were strategically selected as "the home divisions" for the enumerators, such that all households identified with orphans were included in the study. The data collectors were instructed to enumerate all other households in the bordering locations upon completing their home divisions.

Table 2.2 Distribution of Sample Population by District and Division (N = 1101)

The intention was to cover the neighbouring divisions working from outside inward. Given the distance to be covered, weather conditions and limited time, only a few sublocations were reached. This brought about the inclusion of a few respondents from the neighbouring divisions such as Yala and Upper Nyakach. In any case the sampled households display a typical pattern of the spread of orphans in the region.

III. STUDY FINDINGS

DEFINITIONS

In this study, the term household and family are used interchangeably to mean a group of orphaned children (brothers and sisters, sisters or brothers only) living under one caregiver, or alone under one head. Therefore, more than one group from different parents could be found living under one caregiver. Such groupings were enumerated as different families. Not more than 5 of such households were enumerated.


3.1 DESCRIPTION OF HOUSEHOLDS

1. Number of Orphans per Family

Orphaned children try to stick together as much as possible. However, in certain cases when the surviving parent is ailing and increasingly becoming incapable of attending to family needs, some children start worrying about being separated. This is particularly so because many have witnessed their friends being separated when parents die. Such fears were expressed by many children participating in focus group discussions and in personal interviews. Cases of two or three different families of orphans living together in a single grandparent's household were not unusual.

Table 3.1 Distribution of Siblings in Households

Average number of siblings per households = 2.6

Most households had few siblings as indicated by Table 3.1. It is possible that the first two categories of households with not more than two children may have had some of their members dispatched to other destinations. As explained later under movement of orphans, a larger percentage of one- and two-child families include orphans of unwed mothers as well. These families encounter frequent illnesses and experience high mortality rates because the children were mainly under five years of age.

However, the rate of dispersion as a coping mechanism for caregivers is higher in larger groups probably due to economic reasons. It was observed also that many adolescents and older teenagers in the larger families tend to leave their homes in search of better living conditions elsewhere. Others were also taken away from home to live with sympathising relatives and friends in other locations.

3.1.2 Age Range of Orphans

About one quarter of the households (24%) had fairly young children with the oldest being not more than 10 years old. A total of 44% of the homes had adolescents aged 11 to 15 years (Table 3.2). This is a crucial stage in a child's social development process requiring a lot of parental guidance. Another 22% of households had at least an older teenager (ages 16 to 18 years) as an older sibling living in the same family. This is the age group that is currently managing some of the orphaned families. Youth were treated as young adults and expected to behave as mature adults with families. As much as they try to work in the home and provide some leadership for their families, they are still children. They need guidance, time and a chance to be children, to be teenagers and to experience this important stage of human development.

Table 3.2 Distribution of the Orphans by the Oldest Member of Family

Only 20% of homes had children aged 0 to 5 years. This is a critical age group for child survival. It is a vulnerable age group in developing countries and needs parental care and adequate health and other services. Although this age group gets free medical care in most public hospitals and clinics in Kenya, their caregivers may not be keen to facilitate this. Some of them do not know of the existence of this health privilege at clinics.

A number of sibling groups do not have female children. There were no girls in 34% of households compared to only 18% for boys. This was an unusual variation in sex distribution in orphaned families. It may be an indication and a confirmation from personal observations that girls are more likely than boys to be separated from other siblings to live away from home with relatives, friends or other persons.


3.2 MORTALITY RATES

Orphans experience a high death rate in rural areas (Table 3.3). A number of children are born HIV infected, hence, a jeopardised beginning to life. About 20-25% of children born to mothers who are HIV positive also become infected before or during the birth. A further 15% become infected with HIV during breastfeeding. Most of these children are exposed to a poor environment, malnutrition, lack of medical attention and parental despair which further compromises their quality of life.

Table 3.3 Orphan Mortality Rate

During one focus group discussion session, cases of death as a result of carelessness and child abuse by caregivers were reported and discussed. Also other children are hurt in fatal accidents at home in the course of providing labour and due to ignorance in accident prevention. It is not possible to report all deaths in the families because some respondents were not informed of the whereabouts of other children not living at home. These figures may thus be underestimates.

3.3 EDUCATIONAL NEEDS

Many orphans are not in school. Figure 3.1 indicates low levels of educational attainment amongst children orphaned by AIDS. According to age distribution, about 4% were below the minimum age for school attendance (5 years of age).

Figure 3.1

It was also recorded that a total of 20% of the households do not have children in school due to several reasons, the most common being lack of funds. Poverty is the main reason why most children are not in schools. Some orphans are kept away from schools by malicious caregivers in order to suppress their future economic potential. During focus group discussions with youth, a number of children expressed their concerns about education. When orphans were asked to discuss how they related to classmates and teachers at school, they narrated incidents of embarrassment and fear at being stigmatised as AIDS orphans. One pupil discussed how he no longer attends classes because he may be bewitched and die like his deceased educated parents. When asked to explain further, he discussed his beliefs on how his parents were bewitched because they were well educated and envied by their extended family line. Of course, others stay away from school due to lack of parental guidance and encouragement.

Discussions with teachers revealed that many of the orphans are not in school due to the heavy domestic responsibilities most of them have to do before going to school. As stated earlier, many of them provide all the necessary labour in their homes. During certain agricultural seasons they are also expected to provide labour in the morning before going to school and in the evening after school. Going to school is not compulsory or a priority in such families, and many orphans choose to quit school. For those who remain in school, many have poor academic performance due to low class attendance, lack of school materials, poor diet and appalling living conditions.

During a focus group meeting, caregivers discussed various strategies they use to retain orphans in school. One middle-aged caregiver who has 9 orphans in his household explained how he sends them to school when they have attained the age of 10 years and only keeps them until standard 7. The older ones who came under his care while in secondary school are also retained there until form 3 only. He does this because the final years (standard 8 and form 4) are expensive and have too many school requirements that he cannot afford. He also explained that sending a child to school four years late is also cheaper. The children can help provide labour at home and go to school as well, conditions which would be too difficult for the younger ones. In that manner, the orphans pay for their own education. A few caregivers also talked about seeing their orphans through primary education only because high school education is now a luxury and too expensive even for their own children.


3.4 LIVING ARRANGEMENTS

3.4.1 Living Without Parents

Traumas of parental death were still very fresh in young minds as they narrated how they are learning to live alone. More than 15% of the children interviewed had been made orphans in the last 6 months prior to our interviews. About 12% had been orphaned for one year and only 5% had been orphaned for two years.

Death of a father deprives children of male authority, a status symbol in many communities. But the subsequent death of a mother further deprives the children of crucial emotional and mental security as well.

Many women infected by HIV migrate back to their maternal homes during the later stages of their illness. Frequent illnesses which precipitate deteriorating economic conditions, a sense of despair and worthlessness have weakened many marital bonds that obligate wives to remain in the nuptial home when husbands die. As such, a significant number of women return to their maternal homes when their husbands die. Other women return to their homes because they are too frustrated by their in-laws to continue living with them. A few terminally ill women respondents in this study opted to return home with a hope that children would find a male authority (maternal grandfathers and uncles) and social and emotional security amongst maternal kin. Of course, this has not solved the problem in many homes because death still does catch up with many. When the mothers eventually die, such orphans are twice disadvantaged by a second trauma of parental death and adjusting to unfamiliar relatives in a foreign place.

3.4.2 Wife Inheritance

There is a growing concern among women for being blamed for the death of their husbands. Many young Luo women whose husbands die are frequently encouraged to remarry within the extended family regardless of what caused the death of their spouses. When such husbands subsequently die, lack of adequate knowledge about HIV transmission encourages negative rumours associating the death with the widow's witchcraft. They are thus branded "husband killers", mistreated and encouraged to leave their marital homes.

3.4.3 Guardians and Caregivers

A significant number of children do not have caregivers in their households (Table 3.4). Of the 5.2% (57) of households without living-in guardians, 17 had no caregivers at all. Such children live and manage their own household activities without supervision of an adult. The rest had at least one answerable adult in a nearby home. However, some of these adult relatives only claimed responsibility for orphans where they anticipated rewards.

Due to a lack of counselling services for the caregivers and orphans, a number of guardians were experiencing caregiving fatigue. These were the consequences of being stressed by children from other families, strained relations between them and the orphans, and high demands on their time, particularly for nursing ailing children. Given the growth of individualism and the nuclear family amongst villagers many caregivers do not welcome the obligations that come with an extended family support system.

Table 3.4 Appointment of Caregivers

Twenty orphaned families reported that distant relatives occasionally bring them gifts such as maize meal, beans, and potatoes and to check on how they are doing.

Unfortunately most parents do not make alternative living arrangements for their children before they die. This oversight by parents is becoming increasingly burdensome to the communities. Only 3.7% (41) of families said their sick parents made prior arrangements with friends and relatives to help take care of their children. Most caregivers (59%), however, were identified by virtue of being next of kin or by being the closest relative in the home. This kind of appointment has brought a lot of resentment and difficulties for many caregivers because they may not necessarily be willing to take care of the orphans.

From the grassroots workshop, it was observed that tradition does not allow one to turn down such an assignment which is normally done by the village elders. Nevertheless, due to economic reasons, refusals are becoming common without any reproach. Self- appointed caregivers were observed to be working best. This is probably because of personal willingness and commitment by the caregivers to take responsibility without economic support from the extended family. Cases of self-appointed caregivers becoming unsupportive leading to the abandoning of the orphans were also reported. Such incidents although not common, could be attributed to individual differences and preconceived motives for self-aggrandisement. One caregiver narrated how she gave up the responsibility after being suspected of self-interest in the wealth of the deceased. When the extended family realised that the orphans were now suffering more, she was requested to disregard the talk and re-assume responsibility for the children.

3.5 HOUSING AND SHELTER

Many orphans move from their parents' house to live with grandparents or move in with uncles and aunts when both parents die (Table 3.5).

Table 3.5 Persons Who Provided Current Residential Shelter

About 400 (36%) households reported living in their grandparents house, and 149 (13.5%) lived with uncles. One quarter of the families (26.6%) lived in their original parents' house. By Luo tradition, when both spouses die, their house cannot be maintained by repairing the roof by somebody else unless the wife was inherited by customary laws. This causes many children to move into different houses for shelter. Most of the original houses found intact were semi-permanent or permanent buildings which do not fall down immediately with lack of maintenance. Of course, at the time of our visits, some houses were still standing and in good condition. In some cases the houses could be repaired at minimal costs to provide shelter for the children. We also learned that there are certain rules that could be observed to provide housing for the orphans in their grandparents home if funds were available.

3.6 MOVEMENT OF THE ORPHANS

3.6.1 Relocation

A number of children move to new localities to live with relatives and family friends on the death of both parents. Others simply run away in an effort to find a more suitable living arrangement for themselves. During focus group discussions, the children discussed the feelings brought about by moving to live with others families. Some expressed negative feelings while the majority did not seem to have any ill feelings against it, or were probably shy of expressing their concerns. In any case, guilt feelings in children contribute to behavioural problems because of being looked at as a liability when living in someone else's home. The caregivers observed that some orphans tend to be moody, withdrawn, and prone to over reacting to minor stimuli. When such behaviours are misunderstood, they are likely to be misinterpreted and responded to inappropriately.

It was noted that girls are often taken away by relatives and are more easily absorbed in other families than boys. This is particularly so because most girls when old enough work in their new adopted homes as house helps. Also upon growing up, girls get married and move away from the home. Hence, they are not permanent members of the home and do not pose long term competition for family resources with caregivers' own children.

In the event that both parents are ill simultaneously, some children were sent away to live with relatives soon after one parent dies. It was regarded as a coping strategy to ease the burden of child care for the remaining but unhealthy parent. In 67% of the cases, fathers died first. The strategy of sending away children to live with relatives was reported in cases where mothers died first. Most mothers stayed with all children under their care until they died. Only two cases were reported where mothers sent children to live with relatives in anticipation of death.

Some girls are lured into leaving their parents' home with a promise of job training by their would be hosts. However, most of them turn out to be used as domestic workers during the day and child sex workers at night. The double role that girl child orphans play in their alleged new homes makes it difficult for the law enforcement authority to fight against child exploitation in towns and other neighbouring shopping centres. The occasional rounding up of sex workers in Kisumu town has shown that a large percentage of the young females on the streets are orphaned children.

Unlike girls, boys get left behind in their rural homes because of four main reasons:

• Boys take longer to mature and thus they do not leave the foster home as quickly as girls.
• When boys grow up, they need land on which to build homes for themselves. It is therefore to their advantage to be left on their ancestral land.
• Upon growing up, boys would one day want to marry. The cost of providing dowry might turn out to be too expensive for the caregivers.
• In some families, it is traditionally believed that an orphan is likely to thrive and crowd-out other sons in their foster home. This is particularly a major problem facing many boys.
• Fostered sons are ill-treated in such households to prevent them from thriving in the home lest they inhibit other sons from becoming prosperous.

Table 3.6 Movement of Orphans Upon Death of Parents (N = 1101)

Of the households surveyed, about 48% had lost some of its members by relocating to live away from their communities (Table 3.6). Some of the orphans were actually residing with relatives in the same or different districts within the Luo community. This was noted when the researchers found that a number of children had relocated into the study area and were not necessarily left there by their departed parents. Of course, caregivers also distribute the orphans to different relatives as a strategy to spread the economic burden of supporting them.

3.7 CONTACTS WITH EXTENDED FAMILIES

Although many children live alone with caregivers, or move to other locations, more than 45% of households remain in touch with their extended families who come to visit with them regularly. Table 3.7 shows that only 52% of the households do not get to be visited on a regular basis. Focus group discussion respondents complained that due to the high cost of travelling, few relatives get to visit orphans who live in different locations.

Table 3.7 Frequency of Relatives' Visits to Orphans

Travelling is indeed expensive for most villagers. The high cost of fuel and poor road conditions in Kenya have led many transporters to charge exorbitant fares which has discouraged long distance travel. Furthermore, during the rainy seasons, the villagers walk long distances to catch a bus. A caregiver commented that "worrying about your next meal is enough, why would you think of travelling?" Many people who can still afford travelling, now meet relatives during funerals only. Figure 3.2 below indicates that a large percentage of households (51%) do not receive visitors.

Figure 3.2

However, uncles and aunts do make many efforts to remain in touch with their orphaned nephews and nieces. Grandparents, however, are the most frequent visitors when not staying with the orphans.


3.8 FAMILY SUPPORT SYSTEM

Frequent deaths are weakening the extended family support system and threatening to separate household members. It is likely to continue reducing surviving members' capacity to manage and support each other until an effective educational programme is established. Orphans are the major victims of the incohesiveness settling on the community.

The growing individualistic trend could also be attributed to the frequent droughts, famine and civil unrest that have weakened and undermined many other societies. The current urban lifestyle and tendency to emulate the Western nuclear family are also playing a role in eroding the concept of extended family support system in Nyanza. Funeral rituals and expenses which were once an affair of the whole community are becoming a household burden. Children are no longer the collective responsibility of communities, a legacy that has been historically associated with child rearing in Africa. Extended families no longer feel obliged to welcome orphans when they are not even sure of the future for their own children. This is due to the over stretched household resources and the discouraging number of deaths in communities from HIV/AIDS. Kenyan communities have been known for their spirit of support. Family and friends would unite in pooling resources together to help each other during major financial needs. Such devotion and attachment are slowly fading away as each family fends for its own survival.

3.9 FOOD SECURITY

Food security is a major concern for households affected by HIV/AIDS for four main reasons.

3.9.1. Marginal Land

Like other parts of Nyanza, many parts of Kisumu and Siaya districts are situated on marginal land. Most of the households in the region, cannot therefore produce adequate food supply to last a whole year using traditional technology. This is a threat to food supply and predisposes the households to low food supply for six to eight months after harvest.

3.9.2. Inadequate Land

The second factor contributing to lack of food in households is lack of land for food production. Some families do not own adequate land for agricultural production. During the terminal stages of the illness, many households sell off land to raise money for hospital bills and medication. Some hospitals and clinics also encourage terminally ill patients to surrender land title deeds as security for medical bills. This happens with full knowledge of the medical personnel that the patients will not recover fully to claim back the documents. This makes certain households lose a lot of land to such medical institutions. Furthermore, property such as land is sold off in a desperate bid to raise money for medication and other essentials to support families when parents are ailing. By the time both parents are dead, families are left with limited land and property. The situation is even made worse in cases where the ancestral land has not been subdivided yet amongst the sons. The grandparents (in particular the grandmothers), in an effort to save her dying sons or daughters-in-law, sell possession to raise money for medication. Such activities deprive households of the essential means for sustainable livelihood in rural areas.

3.9.3 Lack of Human Labour

Gathering at funerals or visiting with the sick members of the household is not only unique to the Luo communities but common in many cultures in rural areas. Many household members thus spend a lot of time nursing the sick and attending funerals. As respect to a dead relative, one cannot attend to farm work or other income generating activities within the close relative circle until all the burial rituals have been completed. Further, as many people fall sick, they spend valuable production time seeking medical attention or nursing their ailing bodies. This also deprives the community of its labour force. To cope with lack of labour for farm work, some elderly grandparents practice share cropping. These grandparents invite neighbours or outsiders to farm their land and then they share the produce. However, some caregivers complained that they have not adopted the idea of share cropping for fear of being swindled of their share during harvesting. Others also complained of a lack of willing share croppers when needed.

3.9.4 Burial Ceremonies

As discussed earlier, people no longer meet at weddings and other social occasions but at funerals. There is limited time for weddings, traditional initiations, and other celebrations because of attending funerals. Despite many frequent deaths, a number of households still feel obliged to dispose of their dead in the traditional way by slaughtering at least one cow to ensure that all relatives who come for the burial ceremony are fed. To serve with the meat, staples and local beer have to be provided for mourners. In the course of showing respect to the deceased, the funeral only worsens the already threatened food security of the bereaved.

3.9.5 Lack of Purchasing Power

HIV/AIDS is one of the most expensive illnesses ever recorded in the history of health in Kenya and in many other countries. The epidemic has made many rich families experience extreme poverty and lack of resources to purchase the basics of life. Although there is an adequate stock of staple foods for sale in rural areas, many families cannot afford to buy them because they have no income. Prolonged droughts and poor harvests have heightened levels of poverty in Kenya. This has weakened the fabric that bonded relatives to provide for each other in times of need. Orphans as a vulnerable group are most affected by this lack of cohesion. Children command a weak position in respect to food distribution within households. Orphans are especially vulnerable to both malnutrition and even starvation due to the weaker position they occupy in households.

Of course, other factors such as lack of knowledge and motivation to raise animals also contribute to food insecurity in the HIV/AIDS affected households. Also, agriculture is concentrated on production for home use only. Such a system does not permit the establishment of reserves of food grains for back-up during shortages. The area also suffers from problems associated with lack of diversification in production.

3.10 HOUSEKEEPING AND FOOD PRODUCTION

3.10.1 Agricultural Production

In most rural households, both girls and boys as young as age 6 and above are encouraged to take part in agricultural production (Ayieko, 1989). Sisters and brothers share the responsibility of producing food for the entire household in 20% (216) of households. In another 21% (237) of households, a living-in relative assumed food production. However, in the majority of households (57%, 629), the caregivers were responsible for agricultural production. As explained above, older orphans contributed a lot of farm labour in their homes.

3.10.2 Knowledge of Agricultural Production

Agricultural work is not a popular activity with many youths. Even rural youth, born and brought up on the farm have to be encouraged by parents to work on the farm. Besides, youths often spend most of their time in school. As such, many parents do not insist on them taking part in the activity except during peak periods when they are compelled to help. Nevertheless, some parents are particularly keen on teaching farm work to their young children.

Table 3.8 Required Agricultural Skills

In this study, youth from 18% (204) of the households had learned about food production from their departed parents and in another 31% (340) of families they received production instructions from grandparents. The rest of the households received their production information from different sources such as uncles, aunts or distant relatives and friends. Orphans were also asked if they knew where they would go to for production information should the need arise. Only 17.6% (194) of households responded in the affirmative. A total of 82% did not have any idea of where to seek production information.

Most households lack information on improved technology for food production. Table 3.8 shows that 79% (875) of households would like to be taught agricultural techniques. Another 13% (143) needed information on land preparation and 16 only needed information on raising animals. This did not mean that the children are knowledgeable in animal production. Raising indigenous animals has always been taken for granted. Most villagers do not use any improved technology. Because the livestock are fairly hardy, they are sustained on minimal forage growing on marginal land. About 42% (512) of families reported they can raise small animals at home. It is a tradition of the villagers to have at least a few chicken kept on free range around the homes, a tradition which could be encouraged to strengthen food supplies.

It is possible for households to be self-sufficient in the basic staples necessary to maintain life in these villages. Although this is a semi-arid area, the agricultural system could be developed further to specifically target caregivers and households headed by children. There are willing and capable caregivers, and older orphans who can be trained and given support to improve the economic situation of households.

Figure 3.3

Figure 3.3 verifies that only 6.7% of the households have adequate knowledge of agricultural production. A number of households raised livestock such as sheep, goats, rabbits and poultry, although these did not necessarily belong to the orphans. Most households could be trained to raise small animals which could be sold to generate income.


3.11 HOUSEHOLD PRODUCTION

Like their departed parents, girls assume mother roles while boys take their fathers' place and become the woman and man of the house at tender ages. Girls begin assuming the role of housekeeping at the time their mothers become bed-ridden by HIV-related illnesses. However, more boys than girls reported housekeeping because most older girls leave the house sooner than boys when both parents die as discussed earlier.

Table 3.9 Distribution of Housekeeping Duties (N = 1101)

Girls as young as nine years assume heavy responsibilities of working in the garden, preparing and serving meals to both younger and older siblings in the households. Boys who take on the leadership role tend to over-exercise their authority and rule with a heavy hand because of ignorance and childhood immaturity. In these circumstances, management becomes fairly difficult and demanding for the young female housekeepers.


3.12 INCOME AND PROPERTY OWNERSHIP

1. Income for Families

Most people living with HIV/AIDS in these rural villages often die poor after spending most of their assets on large medical bills. Hence, the caregivers are rarely left with enough savings or dependable sources of income to support families. It is ironic that the caregivers who are also elderly grandparents have to provide economic support for the orphans. This is unexpected because the grandparents in the past depended on the children's parents for financial assistance during their old age. They have to figure out again how to generate money to raise grandchildren. It is noted that only 6 of the households in this study reported having been left with some money for support of the children. The departed parents, despite having known that they had limited chances of recovering from their illness, did not instruct their surviving dependents about the family properties. This is mainly brought about by fear of talking about death. Fear has led many HIV-infected people to die intestate and thus lose a lot of their hard earned income and properties. Such financial resources are often not accounted for and are lost not only to the trustees but also to unethical family friends, work colleagues and relatives who take advantage of the unsuspecting and naive survivors.

Table 3.10 Main Sources of Income

Elderly grandparents often do not have the capacity to follow up on their deceased children's rights due to advanced age, ignorance, fear of being intimidated while pursuing the wealth, and feelings of helplessness for having lost a financial supporter. Lengthy procedures and red-tape for recovering personal assets has led many able bodied relatives to decline requests from caregivers for assistance in recovering assets.

3.12.2 Land Ownership

Siaya and Kisumu districts have been demarcated for issuance of title deeds. However, only 58% of the households said that they have title deeds for the plots of land they own. The rest of the households did not either legally own the land they were living on, had not bothered to collect the deeds, or were not sure of the status of the land they call theirs.

By tradition, many families have lived on their ancestral land for many generations and took ownership for granted without legal documentation. This has led many families to lose properties unknowingly to other people. In many parts of the country, court cases have been reported where female spouses or sons have taken to court male heads of households for having sold the only land the family owned. Such cases are becoming common, where husbands sell off their land to raise money for medication in the belief that on recovery they will be able to buy other land and settle their families on it.

Cases of discouraged male spouses selling family land for selfish reasons were also reported. A terminally ill patient who had not accepted the fact that he was suffering from HIV-related illness narrated how he sold a large piece of land at a very low price to meet his medical expenses while in the hospital. Due to frequent illnesses and absence from his work place, he lost his job and could no longer support his family nor raise money for his heavy medical bills. He convinced his family to sell land while he was hospitalised. He died a few weeks later. Cases of people living with HIV and AIDS who sold their properties to enjoy the money before dying were also reported. A typical case is that of John reported above in Profile 3.5.

3.12.3 Property Ownership

Orphans also live in desperate conditions not only because they were born in poverty stricken families but because they are still too young to manage properties left for them by their departed parents. Many of these properties fall apart due to the lack of financial and entrepreneurial ability of surviving family members. Others get repossessed by the financiers due to lack of debt repayment. The 4.9% of the families who own business facilities do not necessarily run those businesses (Figure 3.4). Most of these were not functional at all at the time of our visits. A few could be salvaged with minimal effort. The other 10.4% of families who said that they own land as a property actually have a separate piece of land apart from the one they lived on. These parcels could be used for economic development projects for the orphans.

Figure 3.4

It is unfortunate that many of these economically viable properties get abandoned soon after the death of the owners. About 78% of households reported that they have had to abandon some properties due to a lack of management capacity. Some orphans have attempted running their deceased parents' businesses but with little success. With some training and business management counselling, most of the activities could be maintained to sustain the orphans in the rural areas. A total of 2.4% (26) of families reported having at least one person among the siblings taking care of the deceased parents' businesses however difficult it seemed. It is clear that the orphans have a desire to keep the businesses going except for their tender ages, lack of training and experience.

3.13. LEADERSHIP IN THE HOUSEHOLDS

Few orphans have adults from the extended families for leadership. Most of them only realise for themselves what had happened to their parents and that they are on their own long after burial. The fresh mounds of soil in front of their houses only bring more questions to their young minds. In this survey, only 13% (142) of families had their children informed of the expected death in the family. Orphans in these households were given some basic instructions on what to do when both the parents die. Although Figure 3.5 below indicates that fewer girls provide leadership than boys, field observations suggested that they actually do most of the household chores and decide on the major operations from day to day. By seeing the girls being more efficient in housekeeping the boys rely on them to do most of the chores alone around the home. Traditional gender roles favour males for leadership in the home whether they provide it or not. As such, more boys than girls were recorded as leaders. Of course, children living under caregivers depend on them for leadership.

Figure 3.5

3. 13 JOB SKILLS AND EXPERIENCE

Although the Kenyan education system is supposed to prepare youth for self employment after 8 years of education job skills are lacking among youths in the rural areas. Most of them do not have job skills or work experience that can enable them to earn a decent living in the rural areas (Table 3.11). This is attributed mainly to lack of educational facilities in the villages. This has contributed to the movement of youth from the rural areas to the urban centres in search of employment opportunities.

Table 3.11 Job Experience, Skills and Information Learnt from Parents by Area of Technology