132 million children in the developing world have lost one or both parents. 25 million children will be orphaned by HIV/AIDS alone by the year 2010. One billion children are currently living in poverty, over 9 million children are dying annually of preventable diseases and malnutrition and 77 million children are out of school, 44 million of these are girls.
Orphans and vulnerable children (OVC) face a number of challenges, including finding money for school fees, food, clothing, and access to basic healthcare. Their desperation makes them more vulnerable to abuse and exploitation, ultimately making them more susceptible to contracting HIV. Less than 15 percent of OVC receive any kind of international support – the majority of the support they receive comes from their own communities. Effective responses to the challenges facing these children must strengthen the capacity of families and communities to continue providing care, protection, and assistance to them in, at minimum, meeting their basic needs.
What is an orphan? What are the risks for an orphan?
Namibia’s National Policy on Orphans and Vulnerable children defines “orphan” as “a child who has lost one or both parents because of death and is under the age of 18” and a “vulnerable child” is “a child who needs care and protection.”
As one can imagine, the loss of a parent (or both parents) profoundly affects a child economically, psychologically and socially. UNICEF’s Unite for Children Unite Against AIDS’ Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS enumerated the following effects of sickness and death of a parent upon children:
- Economic hardship – As parents succumb to sickness, they become unable to provide for their child financially and what little savings are available goes towards health care costs. As a result, children’s needs, such as school fees and clothing, aren’t able to be met.
- Lack of love, attention and affection – While children of all ages need emotional support and stimulation, young children may be left without responsive care, stunting the child’s emotional development and sense of wellbeing.
- Withdrawal from school – Oftentimes, children become the care takers of a sick parent and are unable to attend school. Financially, families may no longer be able to afford school fees, supplies and uniforms as sickness devours the family’s finances.
- Psychological distress – Children suffer from the fear of loss once a parent has been diagnosed with HIV/AIDS as well as the stigma that accompanies the disease in many regions of the world.
- Loss of inheritance – In many countries around the world, property and inheritance laws do not protect the rights of orphans and widows and they are prohibited from claiming what is rightly theirs. Even when inheritance laws are on the books they are often not enforced.
- Increased abuse and risk of HIV infection – Without parents to look out for their best interests, children can fall pray to sexual exploitation and child labor in order to provide for their needs. Because of the high-risk behavior in which they may be forced to engage, orphaned and vulnerable children are at an elevated risk for contracting HIV. Visit the Ecumenical Advocacy Alliance for more information about children living with HIV and AIDS and what you can do to help.
- Malnutrition and illness – Orphaned children are at an elevated risk for malnutrition and illness in addition to a lack of access to health care.
- Stigma, discrimination and isolation – When they are orphaned by HIV/AIDS, children must oftentimes leave their familiar surroundings and may not be as readily accepted by extended family members. Even when children remain in familiar surroundings, they may become victims of discrimination or isolation due to common misunderstandings of the disease and how it is spread.
When children are orphaned, they become vulnerable to a whole host of dangers in the name of supporting themselves and their siblings. Children who have been orphaned often drop out of school to provide for themselves and to pay for food and school fees for younger siblings. Orphaned children often fall prey to sexual exploitation and possibly prostitution, they may be co-opted into joining militias or armed groups or forced into domestic servitude. UNICEF noted some staggering statistics regarding the affects of being orphaned upon children:
- In the United Republic of Tanzania, the school attendance rate for children living with at least one parent is 71 percent; for double orphans it is only 52 percent.
- In Tanzania, over half the children working full time in mining are orphans.
- In Addis Ababa, Ethiopia, more than 75 percent of child domestic workers are orphans.
- In parts of Zambia, 65 percent of children engaged in commercial sex and 56 percent of children living on the streets are orphans.
What is the Current Situation?
In sub-Saharan Africa, AIDS is the leading cause of death among those aged 15-59 years old. 80 percent of all the children who have lost a parent to AIDS in the developing world are living in this region. Even once the HIV infection rates stabilize or begin to decline, the number of orphans will continue to grow or remain high for many years due to the time lag between HIV infection and death. 
While HIV/AIDS has dramatically increased the number of orphans worldwide, it is not the only disease leaving orphans in its wake. Malaria and Tuberculosis have had a large impact throughout the world as well. Two million people die annually from Tuberculosis, 90 percent of these deaths occur in the developing world. Malaria claims more than one million lives per year, most of them children.  Sub-Saharan Africa bears the brunt of the malaria death toll – nearly 90 percent of the world’s malaria deaths occur in this region, amounting to nearly 3,000 deaths per day. Funding must not fixate solely upon children made vulnerable by HIV/AIDS, but rather, it must focus upon all vulnerable children and orphans, regardless of the cause.
The United States has taken leadership in the fight against HIV/AIDS in some of the hardest-hit countries. The President’s Emergency Plan for AIDS Relief (PEPFAR) has served as one of America’s strongest goodwill ambassadors in recent years, as the acronym has become synonymous with “life-saving help” in many parts of the world. As of September 30, 2008, PEPFAR supported life-saving antiretroviral treatment for more than 2.1 million men, women and children living with HIV/AIDS around the world. Nearly 9.7 million people affected by HIV/AIDS in PEPFAR’s 15 focus countries had received compassionate care, including nearly 4 million orphans and vulnerable children. It is safe to say that as of December 1, 2008, the U.S. also has met the goal of supporting care for 10 million people affected by HIV in the focus countries. Globally, the U.S. is supporting care for over 10.1 million, including over 4 million children.
In addition, nearly 240,000 babies have been born free of HIV, due to the support of the American people for programs to prevent mothers from passing the virus on to their children.
It is a significant step that the U.S. has allocated 10 percent of global AIDS funding for OVC with additional support for pediatric HIV/AIDS. It is important to use this commitment as leverage with other donor nations and ensure that they provide funding to match their commitments.
On July 30, 2008, President Bush signed into law H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act. In 2003, President Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR) to combat global HIV/AIDS – the largest commitment by any nation to combat a single disease in human history. The new legislation will dramatically increase the financial commitment to this fight – authorizing up to $48 billion to combat global HIV/AIDS, tuberculosis, and malaria. Under this legislation, the next phase of the American people’s commitment to those suffering from HIV/AIDS will support treatment for at least 3 million people; prevention of 12 million new infections; and care for 12 million people, including 5 million orphans and vulnerable children. If PEPFAR is funded at $48 billion over the next five years, OVC programs would receive roughly $3 billion.
In addition to PEPFAR, the U.S. supports OVC through the funding of other mechanisms, such as via different U.S. agencies and by supporting The Global Fund to Fight AIDS, Tuberculosis and Malaria. That being said, less than 15 percent of OVC receive any kind of international support – the majority of the support they receive comes from their own communities.
What is Needed?
Support for Communities: Extended families and communities care for the vast majority of double orphans in sub-Saharan Africa. Funding and programming for OVC must reflect this fact and include support for caregivers so that children may be raised by their community versus being institutionalized in an orphanage where often there is a far lower care-taker to child ratio and where children simply do not fare as well. Linear growth failure is common, with children losing one month of growth for every three months in institutional care[l1] . Community-based programming, such as neighborhood care points, church volunteer networks and comprehensive support given to needy families, better addresses the needs of each individual population and provides more effective care and support for its vulnerable children.
Caretaker Support: Support for the caretakers is an essential step in ensuring that children receive proper care and attention. In many cases, orphans are taken in by grandparents who no longer work and, therefore, no longer earn a wage. Even when the caretakers do have money coming into the household, they were often in an impoverished situation before the addition of dependents to the household. The combination of chronic poverty and the HIV/AIDS epidemic have greatly stressed and drained community resources.
Holistic Programming: Holistic programming is also an important aspect to the support that is necessary to care for AIDS orphans. According to Unite for Children, Unite Against AIDS, the needs of children in the AIDS epidemic have been overlooked in prevention and treatment, policies and budgeting. Care for vulnerable children must extend beyond mere material need, as the AIDS crisis affects children psychologically and socially as well.
Flexibility: Programming must also be flexible, taking into account the realities of the people being served. According to UNICEF, decisions about resource allocation should be based on internal assessments of each country’s unique circumstances and needs. Global figures suggest that 12% of all HIV/AIDS resources should go towards supporting OVC, and that more than 9/10ths of the 12% should go to sub-Saharan Africa. Furthermore, the needs of children vary depending on the age when they were orphaned. This fact should be taken into account when planning programming. According to UNICEF, older orphans are at risk of missing out on education, being subject to exploitative labor and being exposed to HIV, while younger orphans are the least resilient and greatly need physical care and nurturing.
Cash transfers are another way to provide flexible support that is community based. In 2007, UNICEF evaluated cash transfer programs in Malawi, South Africa and Zambia. A community based committee selected households most in need of a monthly stipend of approximately $7.50 to $10. As a result of the stipend, research showed that food consumption increased even during a drought period, illness in parents and children decreased and school enrollment increased slightly.
In some situations, families are too poor to participate in microcredit loan programs (small loans to start tiny businesses), as they have no one to watch their children or lack sufficient funding for transportation to the city. Cash transfers can allow them to begin participating in these loan programs and eventually become self-sufficient entrepreneurs.
Learn more about why cash transfers are a vital part of child health interventions in this Lancet report published June 2009.
Government collaboration: Government support is necessary to carry out necessary legal reforms and to enforce existing mandates concerning property rights, birth registration and equitable access to education. Unite for Children, Unite Against AIDS advocates for birth and death registration to become common practice because currently it is often difficult for children and extended family members to obtain records to prove that they are widows or orphans. Without proper documentation, children are often considered ineligible for food aid and medical care. In sub-Saharan Africa, two-thirds of births go unregistered. Also, many orphans suffer due to a lack of inheritance rights or a lack of enforcement of said inheritance rights. Orphans and widows cannot claim what is rightfully theirs.
Standardization, Indicators and Monitoring and Evaluation: A lack of widely agreed upon indicators exists when considering the plight of AIDS orphans and vulnerable children. As noted by UNICEF, there is a need to strengthen and expand the knowledge base on the status of OVC in order to improve the response to challenges faced by orphans and adequately address their needs.
Goals for the Future
Uphold the G8 Commitment: When the “Group of Eight” met in 2005 in Gleneagles, Scotland, it promised to increase annual foreign aid by US$50 billion from 2004 to 2010, to a level of $130 billion ($35 billion was to come from G8 nations and the remainder from non-G8 donors). Unfortunately, G8 aid has increased by only 14 percent of the total committed.
When the G8 met at the 2007 Summit in Heiligendamm, Germany, G8 leaders further pledged to prevent “twenty-four million new [HIV/AIDS] infections, and to care for twenty-four million people, including 10 million orphans and vulnerable children.” Global Action for Children (GAC) calls on the G8 to fulfill its previous commitments and to devote 12 percent of overall HIV and AIDS funding to the treatment, care and protection of Orphans and Vulnerable Children (OVC).
Fully Fund Global AIDS, TB and Malaria: In 2008, the President’s Emergency Plan for AIDS Relief was reauthorized, with the goal of supporting 5 million orphans. Global Action for Children calls on the U.S. Congress to fully fund the fight against global AIDS, TB and Malaria at $48 billion over the next five years with $3 billion for orphans and vulnerable children through PEPFAR.
Fully Implement Public Law 109-95: The U.S. also made a specific promise to support orphans and vulnerable children with the 2005 enactment of the Orphans and Other Vulnerable Children in Developing Countries Act (Public Law 109-95) introduced by Senators Lugar and Boxer and Representatives Lee, Hyde and McCollum, which authorized the first-ever comprehensive strategy to address the challenges faced by the world’s orphans and vulnerable children. Unfortunately, due to a lack of funding, these promises have still not been fully implemented and vulnerable children worldwide have been left waiting. During these times of global financial stress, these programs that protect children are needed more than ever.