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AIDS: a medical and social epidemic

by Cesar Chelala

The rapidly increasing number of AIDS orphans worldwide is one of the most serious consequences of the AIDS epidemic today. It is estimated that more than 13 million children currently under 15 have lost one or both parents to AIDS, mostly in sub-Saharan Africa. In Asia, the rapid spread of the infection in China is having a devastating impact on that country’s children, and threatens to become an epidemic with significant social and demographic repercussions due to the rapid rise in the population of AIDS orphans.

Many rural Chinese villages that up to now have had very few orphans have seen their rates soar following the AIDS-related deaths of their parents as a result of contaminated blood transfusions. Until recently, relatives used to take care of such children. But because in many cases those relatives are now affected by HIV/AIDS, they become unable to provide basic support to children in their extended families.

Although Thailand has the largest number of AIDS orphans — usually defined as children under 15 who have lost their mother or both parents to AIDS — their number is fast increasing in other Asian countries. Thailand has seen significant reductions in the number of new infections thanks to effective health-promotion and disease-prevention strategies.

In Cambodia, Malaysia and India, the number of AIDS orphans has increased by 400 percent from 1994 to 1997. This rate of increase is similar to that of countries such as Namibia, South Africa and Botswana. Although proportionally the number of AIDS orphans in Asia is much lower than in sub-Saharan Africa, in absolute numbers there are more orphans due to AIDS in Asia than in Africa. Worldwide, it is estimated that by 2010 106 million children will lose one or both parents, and 25 million of them will be orphaned because of AIDS.

According to Nils Daulaire, a senior USAID adviser on children and women’s health issues, “we are talking about something that has never been seen before, which is countries with one-sixth to one-quarter of all children without one or both parents. It means that those countries would be permanently crippled in terms of their own ability to grow, to integrate with the global society, and to make their countries work. This is wreaking havoc on the social structure of the countries, and on the economic future of entire regions.”

Children orphaned because of their parents’ death by AIDS are likely to be malnourished and unschooled, and are at greater risk of becoming HIV-infected themselves. At the same time, because they are emotionally vulnerable, they may tend to engage in risky sexual behavior that draws them into a vicious circle of abuse and exploitation. What makes this situation specially worrisome is that the number of orphans will continue to rise for at least the next decade, since it takes approximately 10 years between HIV infection and death from AIDS. That is why, even in a country where HIV prevalence has declined, the number of orphans will continue to be high.

According to Peter Piot, executive director of UNAIDS, “This orphan crisis is a major reason for introducing treatment for adults on a wider scale.” A new project implemented by Columbia University in New York called MTCT-Plus will guarantee that 10,000 mothers in eight countries will be provided with necessary medicines for life to keep them alive and in good health.

Recently, the Chinese government has taken some actions that show its willingness to deal with the AIDS situation in a more realistic way. Among those actions are stronger laws to protect the blood supply, an increase in funding to combat the infection, pilot programs aimed at slowing the spread of the virus and a new five-year plan to deal with the infection. These actions should be complemented with effective policies for helping children orphaned by HIV/AIDS.

In the past, China has been severely criticized for its lack of proper care for orphaned children. To help AIDS orphans it is necessary to strengthen the capacity of extended families to protect and care for orphaned children, and to develop community-based responses that address these children’s special needs. It is also critical to develop new government policies including legal, education and labor frameworks that will ensure the health and well-being of orphaned children. Their future, and their societies’ future, is at stake.