The current Aids death rate of adults means that in just one year there are about 200 000 children who are orphaned.
December 1 marks World Aids Day and the spotlight shines on children who have lost parents to Aids. It is a social crisis and it is going to be an even bigger crisis in a few years’ time.
”The consequence of this rate of orphanhood is historically unprecedented. Today there are 2,2-million maternal orphans and by 2010 there will be 5,5-million orphans who will need love, healthcare, education, care and support,” says Macharia Kamau, United Nations Children’s Fund (Unicef) head of office.
Another shocker is the rate of infection of children: each year about 300 000 HIV-infected mothers give birth and about 85 000 babies are born HIV-positive. About 100 000 children will test HIV-positive every year if prevention of mother-to child transmission (PMTCT) programmes are not effective. Another 20 000 children will be infected with the virus through breast milk.
Evidence shows that programmes for the prevention of mother-to-child transmission are not working effectively in South Africa because too few women get tested for HIV, receive antiretrovirals (ARVs) or practise exclusive breastfeeding. Ironically, even in the HIV context, it safer to breastfeed — but it must be exclusive; mothers cannot mix breast and bottle feeding.
”There is urgency to the situation. They all need to get on to ARVs sooner or later,” says Kamau. But there’s more. ”Once children lose their parents, they lose their access to healthcare, education, love and shelter. They tend to be socially alienated and may even turn out to be social misfits and turn to violence or even self-destructive behaviour. Parents are the bedrock of the transference of morality. Without parents the task of moral regeneration, a key strategy of government, grows ever more difficult,” says Kamau.
”The imperative is clear. If the nation is to be saved from the consequences of historically unprecedented death rates and orphaning, everyone in society, and not just government, will need to put their heads together to stop the pandemic from unravelling the society. These millions of children who may very well grow up to be alienated and ÂÂbitter adults need special, urgent and sustained attention.”
Kamau notes that South Africa is successful in terms of industry, business and science and technology. Not only is the country cultivating scientists ”who are discovering new planets”, the nation also has world-class financial managers and entrepreneurs with great skills and savvy. ”South Africa has been an incredible success story but less so on the social aspect of fighting the medical and social consequences of the Aids epidemic,” says Kamau.
There has not been the same level of attention to HIV and Aids, yet there are ”world-class capabilities”, and the challenge is to tap into the excellence that exists, the intelligence and the technology to control the great epidemic of HIV and Aids, he says.
Kamau is not all gloomy. He has praise for the Minister of Social Development, Zola Skweyiya, whom he calls an ”excellent champion”.
”[Skweyiya] has gone out of his way to create a safety net for children, and he has even put himself on the line to do this. This is the type of leadership we need to change things around.”
Equally important, Kamau says, is the new drive we are witnessing from the Deputy President, Phumzile Mlambo-Ngcuka. ”This gives reason for great hope.”
Indeed, a turnaround in government strategy seems evident.
At the core of this new strategy must be an integrated approach that captures all mothers and children with consistent messaging, routine testing and integrated provision of maternal and antenatal health services.
On World Aids Day, the government is to announce a new strategy to combat the pandemic. This should positively affect the sector in society most vulnerable and most acutely affected — the children.
The strategy aims to treat more people with ARVs (650 000 people will receive drugs by 2011), see the distribution of about 500-million condoms, and promote mutual faithfulness among the sexually active.
It is also encouraging to note that the terms of reference for the next phase of government’s Khomanani Campaign puts children at the centre of its mass media and social mobilisation efforts.
Mark Heywood, of the Treatment Action Campaign (TAC), says: ”We are hopeful that the recent statements by the deputy president and the deputy minister of health are indications of real change.
”But the real test will be within the next month or so. When we work together on the overall integrated plan, we will see if they are committed to the targets. If government balks at the necessary targets, it will show that it was just lip service.”
The TAC has established a working relationship with these ministers — ”It’s altogether much better than it was,” says Heywood. He adds that the NGO wants ”an end to the conflict” with the government, as this does nothing to assist the struggle against HIV and Aids.
Heywood says that children have been the most neglected in terms of treatment, prevention and care; they are now part of the submissions for the new strategic plan.
The global picture: what’s missing today
The understanding that HIV and Aids also has a child’s face; it is not just a pandemic of adults.
Focused efforts to increase interventions for children with HIV and Aids, including the increase of orphans because of the disease.
Parenting: 15-million children have lost their mothers or fathers to Aids.
A future: children are missing a future because they can’t attend school, as with parents gone they have to step into adult roles and provide for families.
Information: about 70% of children lack the information, skills and services necessary for prevention. For example, millions of children cannot name a way to protect themselves from infection and millions of young intravenous drug users are unaware of the dangers of sharing needles.
Options: girls in particular lack the power to demand that their partners wear condoms.
Medicine: 99% of infected children do not have access to the drugs that will keep them alive.
Protection: most orphans and vulnerable children are missing protection, care and support, so they drop out of school.
Your voice: ask the government what it is doing to help, talk to friends and colleagues about the pandemic or support an institution that cares for Aids orphans.
The Department of Social Development with Unicef launched the Unite for Children, Unite against Aids campaign in April this year. The campaign focuses on four main areas: primary prevention; prevention of mother-to-child transmission; paediatric treatment; and protection, care and support. It emphasises the need for partnerships in taking action to save children’s lives.
There are many creative interventions taking place around the country. This World Aids Day feature focuses on some of these initiatives and their progress, such as the Coronationville HIV children’s clinic’s work with HIV-positive children and Sparrow’s Rainbow Village, where abandoned HIV-positive babies are being cared for.
Another successful initiative is the Harriet Shezi Clinic, based at Chris Hani Baragwanath hospital. Then, of course, there are children’s homes such as Cotlands and Nkosi’s Haven, among others. Lastly, there are individuals, such as Zola, who are making a difference.