All members of a community are vulnerable to HIV infection. More than half of all those who become infected, however, do so under the age of 25 and most die before the age of 35. Children are at high risk of infection in their early sexual experiences, and, as parents die, they also take on increasing burdens of responsibility. Children living in AIDS-affected communities have a right to protection, to prevent themselves becoming infected with HIV, a right to care, and a right to support. Children have a right to grow up without taking sole responsibility for households. They have a right not to be forced to put themselves at high risk of HIV infection, and they have a right to information, education and to express their sexuality. They also have an inherent right to life. Working toward an expanded dialogue with children will give them the control so instrumental to guaranteeing these rights.
Nearly 70 percent of the 34 million people in the world who are HIV positive live in sub-Saharan Africa. In some countries, such as Zimbabwe and Botswana, over 25 percent of the adult population is HIV positive. (UNAIDS, 1999) HIV infection follows deeply ingrained patterns of gender inequity, poverty, displacement and conflict. Cultural constraints and a lack of child-focused services, education and political commitment further increase children's vulnerability. Sixty percent of people currently infected with HIV are aged 15-24 years. 90 percent of infant infections are contracted from mothers.
AIDS-related deaths have also resulted in major social changes, including in household structure. By the end of 2000, a cumulative total of 13 million children will have been orphaned (defined as having lost their mother or both parents) due to AIDS, and 10.4 million of them will still be under the age of 15. (UNAIDS, 1999) Ninety percent of these children will be in sub-Saharan Africa. According to one conservative estimate for instance, 7 percent of all children under 15 years in Zimbabwe are now orphaned. (UNICEF, 1999) This article is primarily based on research I conducted on a commercial farm in Zimbabwe over a period for eight weeks in 1997. The research was supported by Save the Children, SCF (UK). The objective of the study was to understand more about young people's vulnerability to HIV/AIDS and to pilot techniques for working with a small group of children on sensitive issues. Pictures, diagrams, drama and general discussions were used with 8 children every day to understand more about the children's knowledge of HIV/AIDS, their perceptions of its impact on their families and community, and to evaluate the benefits and limitations of previous HIV/AIDS awareness campaigns. Each morning was spent in the village or cotton-picking with the young people. At times, semi-structured interviews were also held with adults. Each afternoon I facilitated a more structured 4-5 hour session with the same children.
Approximately 2 million workers, or 17 percent of the Zimbabwean population, live on the commercial farms in communities of a few hundred to several thousand people. They are of mixed Malawian, Mozambiquan and Zimbabwean descent. Poverty is high, and there is little legal, financial or social security. About 200,000 orphans are estimated to live on the farms, most fostered by relatives. This can often create particular stresses on families.
Problems which Structure Children's Vulnerability to HIV Infection
Early Sexual Activity
In many sub-Saharan countries, including Zimbabwe, first sexual activity usually occurs early, often between 7 and 15 years, and before any formal sex education is likely to have been provided. Many of these early sexual experiences are abusive and forced. In 1997 it was estimated that 86-70 percent of rape cases in Zimbabwe were against those under 13 years. (Elliott 1997) Sexual violence in early years is then often the basis for abusive relationships later in life.
Even when young people choose to enter sexual relations, however, there is an element of coercion because of macro-circumstances. Young people are often disempowered politically and have few ways to demonstrate their ability to make choices. In these circumstances, refusing to go to school, refusing to eat and unsanctioned sexual activities are often powerful ways to demonstrate agency.
Access to Services
Health and education services are often inaccessible to young people. On the commercial farms the official AIDS-awareness programs sponsored by the Farmers' Union explicitly did not target children. Limited access to formal education, particularly because of distance between the farms and schools, quality of the farm schools, farm work, and a lack of commitment from parents limited young people's formal knowledge of reproductive health issues.
Children are rarely treated with respect as stakeholders in society. This denies the large amount of responsibility they often hold in many households. In particular, in households with people who are sick, children often carry the burden of the responsibility for care and support in addition to their large domestic workloads. Denying these children access to services and information denies them dignity.
Children as Decision-Makers
In marginalised communities such as the commercial farms, there are few opportunities to leave the farms, use formal education and earn money. Often a lack of formal education amongst parents and a lack of opportunity to make use of education on the farms undermines children's interest in formal schooling. Many of the boys on the farm were heard to shout at the girls on their way to school:
We don't know why you are going to school we are only going to impregnate you.
In poor communities children find ways to earn their own money. Many of the boys engaged in petty trading and some worked on neighbouring farms. For many girls sex is a strategy used to earn money and material goods such as books, pens, clothes or food. This is often condoned by parents. Said one mother:
The problem is the mothers who accept the money that children bring into the home without questioning it and then worry when the pregnancy is brought home -- but they should have worried earlier.
Older men often have more money, younger men offer more social security. Some girls said:
Girls have no choice about having boyfriends -- they need money and the men lie that they will marry them. (aged 16 years)
Men have HIV -- they want young girls and the girls just want the money, so they don't ask about protection. (aged 14 years)
Some girls complained that girls were earning their own money because their parents did not give it to them since the fathers were giving it to their girlfriends. In these communities, interventions focusing on preventing sexual relations will be insufficient. Children are going to be sexually active and so protection is what is needed. The low social status of both women and the young, however, make the negotiation of safe sex very difficult.
What Happens When Parents Die?
When the adults in a household become infected with HIV the household income is immediately reduced. Moreover, the household and even the children within it can also become stigmatised by other members of the community. Studies in Zambia (Webb, 1999), for instance, show that when parents finally die, most children are sent away from the household to stay with relatives.
Staying with extended family members may not, however, always be in children's best interests. In Zambia two thirds of AIDS orphans were separated from their siblings, despite wanting to stay together. Orphans sent to stay with extended family members are often treated as domestic laborers. Their work remains invisible within their new households and they enjoy few legal rights. The diagram above shows the large workload of a 13-year old girl living with her uncle after the death of her father. Abuse is common.
One thirteen year old explained:
If (my father) was still alive I would not be working. Another child commented:
She is the first one up in the morning and does everything while the adults just go to the fields. Her own parents would help her more.
If children stay in their parents' household they often have other relatives such as uncles or grandmothers who come and stay with them. These people rarely move in, however, because of a primary interest in the children's best interests. Often they themselves are poor and merely help create another type of vulnerable household.
Some children remain in sibling groups, known as child-headed or adolescent-headed households. Their main problems are financial, legal and social insecurity. The priorities for these children are economic independence, meeting their needs for food and clothes, and remaining socially connected. Agricultural production will be difficult and the oldest girls in the household rarely continue at school because of domestic and childcare duties. The common assumption, especially among development agencies, is that these households are the weakest structures and worst options for children. However, this view is not necessarily supported by the evidence. Childheaded households can be supported by the wider community with labor and food at difficult times. Children are also very adept at building up their own networks to create social security and job opportunities. These networks could be strengthened and built upon if children remain in their own communities. Generalized notions of family and affection structures need to be critically examined. Doing so may help us realize that in some circumstances children and young people will be better off with each other and their peers rather than with adult relatives.
Targeting AIDS Orphans
In recent years, increased attention has been given to AIDS-orphans and to the creation of special programs that "target" such children. These children often face great difficulties, including coming to terms with the loss of their parents and their social and economic insecurity. However, this targeting approach may marginalize many other children who are faced with similar economic and social problems but are not orphaned by AIDS.
Targeting may have long term negative consequences, not only for these children but for others in the community. If infant formula is promoted to limit mother to child HIV transmission, for example, the practice could lead to a general reduction in breastfeeding, with its own well-known harmful consequences. By targeting AIDS-orphans with extra resources, stigmatisation and resentment against them could also increase.
In this context it is clear that resources cannot be given to individual households when whole communities are resource-poor. It is naïve to think that the resource would remain in these households. Community-level interventions which use wider criteria of vulnerability to identify those households most in need are called for.
We all have a responsibility to work together to guarantee children's rights in AIDS-affected communities. We must decrease the stigma around HIV/AIDS and increase information, education and dialogue. This must be the first step to increasing children's sense of control over their own lives, allowing them to accept their sexuality and helping them to make less risky decisions.
Adults spend too much time telling young people what to do, and too little time hearing what young people have to say. Adults need to listen, to share opinions and to connect with young people in a way which is loving, caring and respectful. Programmes will be made more effective if children are treated as stakeholders and engaged in meaningful dialogue about the real constraints and opportunities in their lives. It is not enough to insist on abstinence alone and continue to deny the reality that many children and young people are sexual beings and engaged in sexual activity.
To understand children's decision-making and its context we must work with them directly. This needs to be done in the context of challenging the gender-based violence, social discrimination and poverty that underlie the transmission of HIV and the vulnerability of young people.
References & further reading
Ledward A. (1997). Age, Gender and Sexual Coercion: Their Role in Creating Pathways of Vulnerability to HIV Infection. University College London: MSc thesis unpublished.
Ledward A. & Rajani R. (1999). Placing Children at the Center of Analysis; HIV/AIDS Programs in the Interests of Children. UNDP: HIV and Development Programme. Issues Paper.
Save the Children (UK). (1997). Overview of the Vulnerability of Young People in Zimbabwe to HIV/AIDS and STDs. Unpublished. Elliot L.
UNAIDS. (1998). AIDS in Africa, 30 November.
UNAIDS. (1999). AIDS Epidemic Update. December.
UNAIDS. (1999). Call to Action for "Children Left Behind" by AIDS. A plea for communities, governments, civil society, the private sector and international partners to vigorously address the plight of children who are affected by the AIDS epidemic.
UNICEF. (1999). The Progress of Nations.
Webb D.; Foster G.; Kamya H.; Nampanya-Serpell N. (1999). Children affected by HIV/AIDS: Priority Areas for Future Research. Unpublished.
I would like to thank the children on the commercial farm for their time, trust and honesty. The research in Zimbabwe would also have been impossible without the support of Save the Children (UK) in Harare, in particular Chris Saunders, and the dedicated and high level translation skills of Ms. Kiyasi Matutu.
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