Orphans and vulnerable children: The evolving challenge

Approximately one in six adults in South Africa has HIV.[1] At the current rate of infection, the probability of the current cohort of 15 year old South Africans dying before the age of 60 years is approximately 51% for women and 62% for men.[1] By 2005, one in six (15.9%) South Africans between 2 and 18 years of age had lost a parent (5.3% maternal; 12.4% paternal orphans). 2% of children < 18 years were double orphans. These estimates translate into at least 370,000 double orphans, close to a million maternal orphans and nearly two million children without a father. 13.3% of 2-14 yr olds and 21.0% of 15-18 yr olds had lost at least one parent.

Although the epidemic has peaked – both in terms of prevalence and mortality, the epidemic is so severe that the number of orphans will continue to rise by over 100,000 per year until 2014, when the number of maternal orphans will exceed 2 million.[1]

Many of these children are being looked after by grandmothers (gogos). Economic and social dependency on grandparents has increased, putting further pressure on the coping capacities of extended families. To date, much of the focus has been on securing subsistence needs for younger orphans, with relatively little attention paid to adolescents. Older orphans are particularly vulnerable to sexual abuse, perpetuating the cycle of HIV infection, particularly in households without adults. Hunger, late payment of grants and school dropout are significant problems that could be addressed if community members were looking out for children and teenagers at risk.[1]

[1] Shisana O. et al (2005). Nelson Mandela Foundation/ HSRC Survey of HIV/AIDS in South Africa: AIDS prevalence, incidence, behaviour and communication
[1] Dorrington RE, Bradshaw D, Johnson L, Budlender D (2004). The Demographic Impact of HIV AND AIDS in South Africa. National Indicators for 2004. Cape Town: Centre for Actuarial Research, South African Medical research Council and Actuarial Society of South Africa
[1] Projections of the Actuarial Society of South Africa, 2000

Lessons so far:

1. loveLife has recognized the importance of care and support for orphans and vulnerable children and teenagers as a primary vehicle for HIV prevention. Food insecurity, school dropout and sexual abuse contribute significantly to HIV infection. Through the efforts of grandmothers – and working with the respective Government departments and institutions, an integrated model for prevention care and support has been created, both at household and institutional levels.
   
2. goGogetters can play an important role in ensuring efficiency and targeting of social grants. They act as a link between social services and households affected by HIV/Aids. In some instances, this has led to animosity where caregivers have been misusing child care grants for orphaned children. In these situations, the network of goGogetters has proved important in enabling individuals to stand up and defend the interests of the child.
   
3. Although grandmothers bear an increasing load as a result of HIV/Aids, they have often felt demoralized and demeaned by officialdom. Positioning them as prime champions on behalf of OVC has elevated their status. Further, grandmothers are relatively well-placed to challenge male attitudes and behaviour that contribute to HIV infection. While such challenge is not without personal risk to them, their mobilization has created both ‘safety in numbers’ and greater influence.
   
4. The use of grandmothers has significant advantages, but also poses specific challenges to programme implementation. The advantages include: community respect and recognition for elders (in general); wisdom and experience of raising children; and pragmatic determination to prevent HIV among their grandchildren. Challenges include higher levels of illiteracy, ill health and morbidity – which need to be taken into account in the design of training, support and programme monitoring.
   
5. It is often not possible or desirable to single out orphans for special care. In the vast majority of cases, orphans are assimilated in extended family structures. Often, the sister of the deceased - who may herself have HIV or Aids – cares for her own children and her orphaned nephews and nieces. One exception may be the rapid extension of child care grants to 16-18 year olds who are orphaned, to provide urgent support to those in need most dire.