AIDS Care Watch

Tuesday, January 30, 2007

South Africa has most Aids orphans - UN

By,, january 17, 2007

South Africa has the most Aids orphans in the world, according to a United Nations Children's Fund (Unicef) report released this week.

The report focused on data from 2005. It found that a total of 15,2-million children around the world had lost at least one parent to Aids. Most of these children were in sub-Saharan Africa - and
1,2-million were in SA.

These are not the only South African orphans.

Unicef estimated that a massive 2,5-million South African children under 18 had lost at least one parent due to any cause, with about 450 000 having lost both parents.

For those countries with data, only seven had more children who had lost both parents - China, Democratic Republic of Congo, Ethiopia, India, Nigeria, Uganda and Zimbabwe.

Unicef said orphans often lost out on schooling, food and clothing, they may suffer anxiety, depression and abuse, and they had a higher risk of exposure to HIV.

"Orphans due to Aids are not the only children affected by the epidemic.

"Many more children live with parents who are chronically ill, live in households that have taken in orphans due to Aids or have lost teachers and other adult members of the community to Aids."

Unicef estimated that about 240 000 South African children under 15 were HIV-positive, a figure matched globally only by Nigeria.

About 28 percent of these needed antiretroviral (ARV) treatment but only 18 percent of those who needed it were getting it.

About one third of an estimated 250 000 HIV-infected pregnant mothers received ARVs. About a third received ARVs for prevention of mother-to-child transmission, which Unicef said showed progress as this had increased from 22 percent the year before.

Only about 64 000 of the babies born to HIV-infected mothers - about a quarter of them - started cotrimoxazole prophylaxis, to prevent opportunistic infections that can be fatal.

Unicef said the virus progressed rapidly in children, with about a third dying before their first birthday and half dead before their second birthday. In 2006 about 380 000 children died around the world from Aids-related causes.

"The vast majority of these deaths were preventable, either through treating opportunistic infections with antibiotics or through antiretroviral treatment."

The World Health Organisation recommends giving cotrimoxazole to HIV-positive children and to babies born to HIV-positive mothers.

Unicef said South Africa was one of a few countries which had been able to scale up HIV treatment of children by integrating this into sites for adults.

ARVs for children now cost about $60 a year (about R430).

Unicef estimated that five percent of South African boys aged 15 to 24 years and 15 percent of the girls that age were HIV-positive.

About 18 percent of the country's adults were estimated to be HIV-positive.

Unicef said child grants helped.

"In South Africa, for example, the country with the largest number of orphans due to Aids, more than 7,1-million children under 14 living in poverty - 79 percent of those eligible - were
benefiting from the child support grant by April 2006.

"This represents a two-thirds increase since 2004 and a 20-fold increase since 2000.

"More than 325 000 children were benefiting from foster care grants in 2006." - Sapa


ZAMBIA: Shielding children from their HIV status does more harm than good

By, Reuters Foundation, January 29, 2007

LUSAKA - Zambia's attempts to promote paediatric antiretroviral (ARV) drug adherence are being undermined by families and communities who shield children in their care from knowing their HIV/AIDS status, health experts say.

"Disclosing their status to an HIV-positive child is a difficult process and it requires specialised skills in paediatric counselling but, unfortunately, many affected communities and families are lacking such counsellors and skills," Canisius Banda, a spokesperson in the Zambian Ministry of Health told IRIN.

"We are very much encouraging families, wherever possible, to ensure that they involve health workers when working towards disclosing the status to children living with HIV. But it's still a challenge, in that we have very few specialised paediatric counsellors in the country at the moment."

About 40,000 children are born HIV-positive each year in Zambia but only about 5,000 receive ARVs, while UNAIDS estimates that 17 percent of adults are infected with HIV/AIDS, one of the highest rates in the world.

It is easier to counsel adults living with the virus, but families caring for HIV-positive children often hide the truth from the child. "We have had to come up with so many things in our home because we don't know exactly how she will react once she finds out that she is actually HIV-positive, Jonathan Mwambazi, who cares for an orphaned four year-old girl in the capital Lusaka, told IRIN.

The girl, whose parents died of an AIDS-related illness in 2004, has been on antiretroviral therapy for two years and constantly asks why she has to take so many drugs, Mwambazi said. "At first, we told her she had a prolonged cough, but when she later protested against taking the drugs [ARVs] after recovering from the cough, we had to convince her that, according to the doctor, her heart would start enlarging, but she doesn't seem to believe a thing."

He said the family even monitored the television, to ensure that the child was not given clues about her HIV-positive status. "We don't allow her to watch TV alone, just in case she stumbles on some programme that may make her suspect the drugs she is taking could be AIDS-related. In fact, all of us in the house have agreed to always change TV channels whenever we see an HIV advert or just any programme on HIV/AIDS."

Mulenga Kapwepwe, a culture anthropologist and consultant on child affairs in the government's youth ministry, said most Zambian families failed to disclose their status to infected children because of cultural norms that encouraged elders to "sieve" the information passed to children.

"While our colleagues in Western countries promote a culture of open communication about many issues, we tend to be more cautious, especially when we feel the information might break the child emotionally. The major problem is that, at first, society started by stigmatising HIV/AIDS as the deadly or incurable pandemic and equated it to a death sentence, maybe to deter others from indulging in risky behaviours that may expose them to contracting the virus," Kapwepwe said.

"Therefore, it has now become difficult to convince people otherwise, despite AIDS being manageable. Before breaking the news to a child, it's like we all have to wonder how the child would take it, considering that society still views HIV/AIDS as the deadly pandemic, and this is why people prefer to tell a child lies or deny the child any possible access to information on the disease."

According to Annie Kamwendo, a child protection officer at the United Nations Children's Fund (UNICEF) in Zambia, "it is advisable, as early as possible, to make the child fully aware of the fact that their life entirely depends on the life-long drugs they are taking. Instead of just bombarding them with drugs and telling them lies, it is important that children understand the truth - it will help them to accept the status, become responsible and adhere to the drugs.

"When children find out on their own that you have been hiding the truth from them, which unfortunately is bound to happen at some point, they get hurt, lose trust, begin to live in isolation or slip into depression and may eventually die," she said.

A host of humanitarian organisations, including UNICEF and the Federation of Red Cross and Red Crescent Societies, have embarked on intervention programmes promoting HIV/AIDS awareness to combat the approach of non-disclosure taken by many families with HIV-positive children in their care.

UNICEF is providing specialised training in child counselling, because "we want these community members to understand at what point they should tell the child the truth, and how best they can help the children who need to know their status," Kamwendo said.

The Zambian Red Cross Society has set up youth-friendly corners in their branches across the country, specifically to address the issue of HIV/AIDS among young people and children.

"Our aim is to ensure that children develop a keen interest in knowing their HIV status. The training we are offering to young people will enable them to go into communities and hold peer-to-peer meetings to share information and experiences," said James Zulu, a spokesperson for the society. "We want to take our youth programmes closer to the communities, because our existing OVC [orphans and vulnerable children] support groups have mostly been concentrating on the children ... who are also on ARVs."

Zulu said the youth-friendly corners would encourage discussions about sexual matters and encourage more HIV testing among young people. "We have realised that finding out the status is the starting point to a child ... [adhering] to [ARV] drugs, so that even if the guardian leaves the child in the custody of another person it won't disturb the drug uptake programme."



Tuesday, January 16, 2007

THAILAND: Burmese migrants excluded from AIDS treatment

By, IRIN PlusNews, January 15, 2007

BANGKOK - Zaw, 30, from Yangon, the former capital of Myanmar (Burma), came to Thailand eight years ago in search of job opportunities unavailable in his impoverished homeland. He found work on construction sites and, more recently, in a sawmill in Khao Lak, a beautiful coastal area where new hotels have been springing up in response to Thailand's booming tourist industry.

While being treated for tuberculosis around a year ago, Zaw learned he was HIV positive. After losing his appetite and becoming increasingly sick and weak, he began taking life-prolonging antiretroviral (ARV) drugs provided by the charity Medicins Sans Frontiers (MSF) in November 2006.

Although still frail and battling multidrug resistant tuberculosis, Zaw's strength is returning and he is now able to work two or three days a week. Small bags of pills attached to a home-made calendar hanging on the wall of his room in the workers' barracks at the sawmill remind him to take his ARV medication every day.

"I feel so relieved that I am getting treated," he said. "I feel that I will get better amd I am confident about the future."

Zaw's story is far from common. Thailand has won accolades for its commitment to providing ARV drugs to all Thai citizens who need them, but the policy does not extend to the Burmese migrant workers who play a crucial role in the economy.

An estimated two million people have fled poverty, lack of opportunity and oppression in military-ruled Myanmar to work on Thai construction sites, fishing boats, farms, factories and in kitchens, often taking dirty, dangerous or dull jobs that Thais are unwilling to do. They are highly vulnerable to exploitation, frequently paid less than the legal minimum wage and live in constant fear of deportation or abuse by Thais harbouring deep-rooted prejudices against migrants from Myanmar.

The Thai government began registering the Burmese migrant workers several years ago, granting them access to public health services in an effort to improve their legal status.

So far only about half those believed to be working in Thailand have come forward for registration; the rest are thought to be deterred by their employers' refusal to formally sponsor them, the cost involved, or fears that the authorities in Myanmar would learn of their flight to Thailand and punish their families.

Although those who are registered have the right to access public healthcare, ARV drugs are not part of the package: only pregnant women receive the drugs necessary to prevent transmission of the virus to their babies.

The Thai authorities argue that workers from Myanmar are simply too transient to start a course of treatment that must be monitored and taken regularly to avoid drug resistance; health activists counter that the migrants are often no more mobile than many working-class Thais who do seasonal work.

"They [Thai authorities] say that they cannot follow up, that they [migrants] move often, change their names and the area where they live," said Suksri Saneha, coordinator of an MSF project in Khao Lak.

According to Saneha, local health workers frequently urged migrant workers found to be infected with HIV, whether registered or not, to return to Burma; advice that few heeded, given the lack of jobs or basic medical care in their home communities.

It is impossible to say how many Burmese migrant workers are living with HIV in Thailand, but Myanmar has one of South-East Asia's most serious AIDS epidemics. UNAIDS estimates adult HIV prevalence at between 1.3 and 2 percent, with up to 570,000 people infected in a population of 47.3 million, and treatment largely unavailable.

Migrant workers are constantly fearful of arrest and deportation by Thai police, who often pay little attention to whether they are registered, and are unwilling or unable to organise themselves into social support groups or press for access to ARV treatment.

Prejudice against people from Myanmar has also impeded prevention efforts. In the coastal areas of southern Thailand, where tens of thousands of migrants work on construction sites and in the fishing industry, MSF wanted to use local community radio to broadcast Burmese-language programmes about how HIV is transmitted and how to protect against it. Local authorities refused, saying broadcasting programmes in a foreign language constituted a "national security threat".

Saneha, a Thai national, said she sometimes encountered outright hostility in her efforts to address the problem of HIV among the workers from Myanmar. "They say, 'why do you care for migrants? Why not care for Thai people?' They don't think it's a disease that can spread from Burmese to Thais that has to be controlled."

Efforts by MSF and groups representing the Burmese workers to provide them with ARV treatment have met resistance, not only from Thai authorities but also from the migrants themselves, many of whom are poorly educated about the disease.

"They have a very low knowledge about antiretrovirals," said Saneha. "They want to go for the traditional drugs or to see the magic doctor. They don't believe in ARVs."

With the assistance of a Burmese translator, MSF has nevertheless begun providing ARV drugs to a few willing migrant workers in the Khao Lak area. Part of MSF's strategy is to encourage Thai health workers to view Burmese migrant workers the same as other HIV patients, and treatment is being delivered at the local hospital.

However, progress has been painfully slow. The MSF team is monitoring around 70 HIV-positive Burmese, about half of whom would benefit from starting treatment. Only two have begun taking ARVs so far, and two others died after starting treatment too late.

According to Saneha, the perception of many patients "is that they will die anyway - they have no example of somebody who takes ARVS and gets stronger and lives", but she believed this attitude would eventually change as treatment reached more Burmese workers, and gave others hope.


Monday, January 15, 2007

Male participation crucial to reducing gender violence and HIV

By, IRIN PlusNews, January 5, 2007

NAIROBI - Activists are calling on Kenyan men to become more involved in campaigns to end the widespread physical and sexual abuse of women and girls, a problem that is putting millions of women at greater risk of contracting HIV.

Gender-based violence (GBV) is endemic in Kenya but few cases make it to the courts, while many women suffer a lifetime of abuse in silence.

The link between GBV and HIV is real; rape is a big contributor to HIV/AIDS," said Kennedy Otina, coordinator of Men for Gender Equality Now Network, a project of the African Women's Development and Communication Network (FEMNET).

"Many men have been brought up thinking that a woman has no right to determine what kind of sex she is to have with a man, and that suggesting condoms is not a woman's job but the man's preserve," he added.

FEMNET has designed programmes to raise men's awareness of their potential contribution to ending GBV. They encourage men to be more sensitive to women's needs and become involved in women's health issues. "Men play a very vital role. If any meaningful change is to happen then they are the ones that should bring this change," Otina said.

A 2003 survey revealed that about half the country's women had experienced some form of violence in their lives, while a study by Kenya's National AIDS Control Council in 2002 found that the first experience of sexual intercourse for 25 percent of female respondents aged 12 to 24 was forced.

A sexual offences bill passed in June 2006 has yet to significantly increase the number of prosecutions. In some instances, abusers and rapists were able to avoid the courts by paying off the girl's family, and the stigma attached to sexual violence also prevented families from reporting incidents.

The fact that women and girls carry the larger share of Kenya's AIDS burden has been linked to the pervasiveness of GBV in the country: women are twice as likely to be HIV positive than men, with young women being especially vulnerable. According to the latest figures from UNAIDS, women aged 15 to 24 are five times more likely to be HIV-infected than their male peers.

Carole Nyambura, a programme officer for the Coalition on Violence Against Women in Kenya (COVAW), told PlusNews that women's greater vulnerability to HIV/AIDS had a direct impact on their lack of power in relationships with men.

"GBV and AIDS are twin epidemics of sorts, and they must be handled together if they are to be stamped out," she said. "GBV is a cause of HIV through rape, and is also an effect of GBV - women are often beaten when it is suspected that they may have HIV or may have infected a spouse."

A report by UNAIDS in 2006 pointed to cultural practices such as female genital mutilation, polygamy, early marriage and widow inheritance - in which the wife has to marry a male relative of her deceased spouse - as factors that increased women's risks of contracting HIV - all of them the result of Kenyan women's lack of social power.

Moves to strengthen the position of women in their communities and empower them to be able to refuse sex would need to begin with changing men's attitudes, said Nyambura. "Men have not reached the point where they look at gender-based violence as their concern; they still primarily look at it as a women's issue, when in fact it is an issue that affects society as a whole."

Lack of understanding by men of the consequences and dynamics of GBV initially frustrated FEMNET's work on the issue, said Otina. "But with the right information the men open up. GBV does not just affect women; if we don't bring changes ... we will all suffer."

Nyambura advised organisations wanting to enlist the support of men in ending GBV to tread carefully. "There is a tendency for groups that advocate for an end to GBV to antagonise men, which is not useful; they can be involved without being blamed," she said.

The UNAIDS report recommended more support for male-focused initiatives, and suggested bringing awareness-raising campaigns to places where men felt comfortable, such as bars, churches and at work. According to the report, changes in attitudes should begin with fathers being encouraged to "raise their sons and daughters with the self-respect to prevent violence in the next generation."

Nyambura pointed to a greater openness about the issue of GBV as evidence that some progress was being made. "We are all talking about this issue today - men, women and policymakers," she said. "That in itself is a very big step forward in the battle to change people's perception of GBV."



Inequality, gender-based violence raise HIV/AIDS risk for women

By, IRIN PlusNews, January 8, 2007

ADDIS ABABA - Efforts to address the plight of women infected and affected by HIV/AIDS are lagging behind in Ethiopia's profoundly conservative society, while they continue to bear the brunt of the epidemic.

"Women are more vulnerable to HIV/AIDS in Ethiopia, mainly due to a lack of know-how and control over how, when and where the sex takes place, particularly in the rural areas, where culture and religion dominate the rights of women," Alemu Anno, in the advocacy department of Ethiopia's Federal HIV/AIDS Prevention and Control Office (FHAPCO), told PlusNews.

According to FHAPCO's latest report, of the estimated 1.32 million people living with HIV/AIDS in 2005, 55 percent - or 730,000 - were women. They also accounted for 54.5 percent of AIDS deaths and 53.2 percent of new infections in that year.

Women and girls often have less information and access to services, especially in rural areas. Girls make their sexual debut early - either through early marriage or sexual abuse - and their partners are typically much older men. According to the United Nations Children's Fund (UNICEF), marriage at the age of seven or eight is not uncommon in Ethiopia.

The results are usually premature pregnancies, which cause higher rates of maternal and infant mortality, and increased vulnerability to sexually transmitted infections, including HIV/AIDS.

"Ethiopian culture puts great emphasis on virginity, but young girls do not have the chance of talking about sex, reproductive health and its consequences," Alemu said.

Physical and sexual violence within marriage are also common, and women have little room to negotiate the use of condoms or to refuse sex to an unfaithful partner. A 2005 World Health Organisation (WHO) multi-country study on women's health and domestic violence revealed that in a one-year period nearly a third of Ethiopian women reported being physically forced by a partner to have sex against their will.

"This high rate of forced sex is particularly alarming in the light of the AIDS epidemic and the difficulty that many women have in protecting themselves from HIV infection," WHO said.

Berhane Kelkay, coordinator of the National Association of Positive Ethiopian Women, said female genital mutilation, practiced almost universally in Ethiopia, widow inheritance - in which the woman has to marry a male relative of her deceased spouse - early marriage and rape all contributed to making Ethiopian women more vulnerable to HIV/AIDS.

"Women in Ethiopia have the larger AIDS burden because of factors like economic dependence and difficulty in meeting basic needs, insufficient proper knowledge of prevention, lack of enough access to prevention, and lack of proper information about sex and sexuality," Berhane added.

Although there were organisations to support women and raise awareness of gender-based violence, Berhane said they lacked support for their activities, particularly in rural areas, where women's rights were largely ignored.

"Mobilisation of local resources and indigenous knowledge, as well as the promotion of women's creativity and productivity, can be vital tools in the prevention and control of HIV/AIDS amongst women," said FHAPCO's Alemu.

The WHO report called for programmes to include activities to promote the prevention of sexual violence, and address the issues of sexual consent and coercion.



ZIMBABWE: New law set to bring hope to abused women

By, IRIN PlusNews, January 10, 2007

HARARE - 2006 ended on a good note for many women's groups and activists in Zimbabwe, when the House of Assembly finally passed legislation aimed at stamping out growing levels of domestic violence.

The Domestic Violence Bill, which now awaits President Robert Mugabe's signature to become law, generated energetic debate throughout the country. Perhaps most controversial were statements made by opposition parliamentarian Timothy Mubhawu, who urged the national assembly not to pass the "dangerous" bill because women were inferior to men.

In the wake of disclosure by gender and women's affairs minister, Oppah Muchinguri, that over 60 percent of all murder cases in Zimbabwe were linked to domestic violence, his remarks sparked spontaneous protests.

Activists had grown frustrated by the continued delays in getting the bill, first mooted a decade ago, approved. "The Bill's progress has been rather slow," said Varaidzo Munyika, a counselling programme officer with the Musasa Project, an organisation addressing violence against women. "For all the noise that has been made, [it] still seemed to be dragging."

At least one in four women in Zimbabwe has been beaten up by her partner, while one in five has been threatened with physical violence, according to studies by the Musasa Project.

"The bill has created a platform where domestic violence is brought to the fore," said Sithokozile Thabethe, a programme officer with the Zimbabwe Women Lawyers' Association (ZWLA). "If we didn't have it, we wouldn't take the time to reflect on problems caused by gender-based violence (GBV), and strategies to combat it."

Many Zimbabwean women have come forward to share their painful experiences of domestic violence - among them Tendai Muboko (not her real name), now in her thirties. She participates in a support group for domestic violence survivors, run by the Musasa Project, where she talks matter-of-factly about how her husband has constantly beaten and threatened to shoot her if she left the house during their 10-year marriage. "I am married, but it's just a title," she added calmly.

Tendai finally obtained a court order, also known as a peace order, against her husband, who has now stopped physically abusing her. Her four-year-old son died of an AIDS-related illness in January 2006, and she is also HIV positive, so she still lives with her husband because she relies on him for financial support.

Economic dependency often forces women to stay in abusive households. Cultural dynamics, where the extended family is used to solve domestic disputes, are another barrier to leaving an abusive relationship. "Women never want to use the law - they will exhaust all other social avenues to resolve their differences. We are not going against culture, but we are saying these women, as a last resort, should be able to use the law," Munyika commented.

Nearly 60 percent of Zimbabweans living with HIV are women, and Munyika hoped that when the Bill became law it would spur discussion on the role of violence in raising the risk of HIV infection in women.

"You don't talk about the violence and you don't talk about sex, therefore, you don't talk about HIV. But there is no thin line between violence and HIV; you just can't separate them," she said.

Although Tendai was optimistic about the effect the new law could have, she expressed concern at the harassment women often suffered at the hands of police officers, when reporting cases of gender-based violence. "Women officers tend to be very patronising and unhelpful," she said and called for awareness campaigns in the police force.

ZWLA's Thabethe said there was a need for more consultation with the public, and for the complex legal language of the new law to be made more accessible to people.



Friday, January 12, 2007

Aids, the great unknown

By, Belinda Beresford, Mail & Guardian online, January 12, 2007

Prediction is very difficult, especially of the future, said Nobel Prize-winning physicist Niels Bohr. His quote is particularly appropriate looking at the future impact of HIV/Aids in South Africa because the country faces a situation as yet unknown in human history.

Historical, social and biological factors have conspired to create an epidemic that has two unique features: it kills adults, and it is disproportionately affecting women. The result is a change in the size, growth and structure of South Africa's population, falling life expectancy, increased mortality, especially among adults between 20 and 49 years, and a growth in the number of orphans.

The social repercussions of those changes are unknown, and to a large degree unresearched. Another unknown factor is the impact of migration, especially the thousands of illegal immigrants who live below the radar.

The long latent period of HIV means that the number of current infections is still building, and will accumulate until prevention campaigns start working effectively. For example, the estimated 500 000 people believed to have become infected in 2006 will only start falling ill from 2012 on. Estimates vary, but it is generally accepted that about 11% (5,3-million to 5,5-million) of South Africa's adult population is HIV-positive.

Professor Alan Whiteside, co-author of Aids in the 21st Century, points out that South Africa is becoming a country with a large number of orphans. This has wider psychological and social repercussions and represents a loss of social capital.

"We are in what is, in effect, a massive social experiment. The biggest problem with Aids is we have too narrow a focus. We don't look [at it] how we should -- as the product of anthropological, social, psychological, economic and political dynamics," he said.

Life expectancy in the region is now lower than it was 30 years ago -- a child born in South Africa today will live for just 47 years, although this does not take into account the potentially life-saving effects of mass antiretroviral therapy (ART). But significant numbers of people need to be on ART before the gains are felt at a population level.

Demographic effect
The direct demographic impact of Aids can only be estimated by models. One of the most oft-cited of these is that created by the Actuarial Association of South Africa (ASSA), which estimates that without ART there would have been half a million Aids-related deaths in 2010. According to the same model, if 90% of the people who need ART received it, by 2015 more than two million people would be recipients.

The model predicts that from 2011 South Africa's population will grow by 0,5% per year. This means that by 2015 South Africa will have a population of more than 50-million people. Just more than six million people will be HIV-positive, and 800 000 sick with Aids. The number of Aids deaths is estimated to reach 5,4-million by 2015, and there will be about 2,5-million orphans under the age of one.

For the next few years rising HIV prevalence is not necessarily bad news -- if it results from fewer deaths among HIV-positive people because of proper treatment. It will be bad news if rising prevalence continues to be driven by high rates of new infection.

How long the current ARV drugs will remain effective on a mass scale is still unknown because clinicians don't know how long it will take before drug resistance becomes a serious problem. New drugs are in the pipeline, but they are likely to be costly. The golden hope -- a vaccine against HIV infection -- is likely to be two decades off. The development of microbicides and chemical condoms is likely to be a little bit faster.

It's difficult to isolate the effect of HIV/Aids on the economy. Certainly the impact on macroeconomic indicators is thought to be small. This is in part because South Africa has such high levels of unemployment and many HIV-positive people are not formally employed, or else are in jobs where replacements can be found fairly easily. Research by the Stellenbosch University-based Bureau for Economic Research in 2006 found that on average the impact of HIV/Aids on GDP would be a decline of 0,4% to 0,6%.

Now social scientists are looking to the developmental and intergenerational effects of HIV/Aids and are finding corrosive and long-term impacts that are difficult to measure quantitatively. But one recurring finding is the need to develop the human resources of the country. It is the impact on women, who tend to have an overwhelming role in child rearing, as well as being workers in the formal and informal sectors, that is likely to have profound repercussions on South African society.

In 2005 30% of women attending public antenatal clinics were HIV-positive. It is estimated that young women are four times more likely to be HIV-positive than their male peers. Ten years ago the highest mortality rate for women was in the 70 to 79 demographic. Five years ago it had shifted to women in their late twenties and early thirties. The result has been the rise of "skipped generation" households, with grandmothers caring for grandchildren.

Thursday, January 11, 2007

Malawi: HIV/Aids Leaves Young People Struggling to Survive

By, UN Integrated Regional Information Networks, January 8, 2007

Chisomo Jonasi, 12, who lives in Lirangwe, on the outskirts of Blantyre, Malawi's second city, lost both his parents to AIDS-related illnesses 18 months ago. He now spends most of his time doing odd jobs in people's gardens to support his three siblings, the youngest of which is five.

Were it not for HIV, he said, his parents would be alive and he and his two sisters and brother would have continued their education. "As the situation is now, our future looks gloomy."

Like most other families in the area, Chisomo's relatives are too poor to take them into their homes. Instead, the children have remained in the grass-thatched mud house left by their parents. "It is not easy, but we are surviving. My hope now lies in those who wish us well," said Jonasi.

According to government statistics, only an estimated 8.6 percent of the two million young people eligible were enrolled in government secondary schools in 2005. Twaina Hare, 18, also dropped out of school to care for her two younger sisters when their parents died of AIDS-related illnesses. She and her sisters farm a small patch of land they inherited, but Hare worried that it was not enough to live on. "Life is becoming unbearable," she said.

Young girls orphaned by HIV/AIDS are often pushed into early marriage in the belief that their husbands will take responsibility for caring for their younger siblings.

"This is what is happening now - HIV and AIDS has reached a stage where most of us are going into marriage, thinking that we will find solace, forgetting that there may be more problems in the marriage than we anticipate," said Layiti Robert, 24, a primary school dropout who was himself an orphan.

The lack of testing facilities in rural areas means most orphans do not know their HIV status. Only those sick enough to be taken to Mlambe Hospital, 45km away, are tested. Antiretroviral (ARV) treatment is available at Mlambe Hospital, but the cost of transport is beyond the means of most orphans.

UNAIDS estimated in 2005 that 91,000 people out of 940,000 living with HIV in Malawi were children under the age of 15, and 550,000 children had been orphaned by HIV/AIDS. The organisation has also estimated that stigma and discrimination are relatively high among young Malawians, with only 30.8 percent of females and 29.7 percent of males aged 15-49 years expressing positive attitudes towards those living with HIV.

Most of the orphans IRIN/PlusNews talked to complained of suffering stigma and discrimination. Many said they lacked food and clothes but, most importantly, parental love.

"Since I lost my parents in 2004, my relatives no longer want me close to them," said Gertrude Malizani, 15, as tears trailed down her cheeks. "I am called all sorts of names, as if I chose to be an orphan."

Organisations like the Malawi Red Cross Society (MRCS) and the local Chivumbe AIDS Support Group are assisting HIV-affected or -infected children and their families in the Lirangwe area with home-based care and education about how to prevent HIV transmission.

Funding from the Royal Netherlands Embassy has enabled MRCS to implement an integrated HIV/AIDS programme in many districts, to improve access to treatment, care and support for orphans and vulnerable children. According to Red Cross Programme Officer Joseph Namagonya, the initiative is up and running in 25 villages outside Blantyre.

"When the project started we identified about 50 chronically ill patients, most of whom were young people who had not gone for HIV tests but were clearly suffering from AIDS-related illnesses," Namagonya said.

About 33,000 orphans and children made vulnerable by AIDS have been identified by home-based care groups operating in the district. A number of groups, funded by the Red Cross, are constructing centres and providing the children with food and clothing.

The young people are also encouraged to join youth clubs, where they are trained to support those affected by ill-health or food shortages in their communities.

[Produced in partnership with the International Federation of Red Cross and Red Crescent Societies:]