Distorted Image of AIDS and Orphaning in Africa

Pasted below is a response that I sent recently to the Washington Post newspaper concerning an article describing the horrific impacts that AIDS has had on a family in Kenya. The response was prompted by what I see as a distorted image that has been generated by most of the news coverage in the US on HIV/AIDS in Africa. The statistics and many tragic stories have been covered, but the responses that people are making at community level to protect and care for orphans and other vulnerable children have largely been ignored. It seems that this lack of recognition of the capacity in Africa makes it more difficult to convince US donors of the importance of strengthening family and community capacities, which are the first line of response to the impacts of HIV/AIDS.

I would be interested to know what others think about the nature and consequences of media coverage in north America, Europe, and Africa about HIV/AIDS in Africa. If distorted impressions have been given, are there any efforts to correct these?

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The August 13 Washington Post article, "A Generation Orphaned by AIDS," by Emily Wax conveyed powerful images of the horrific human costs of AIDS. What troubles me, though, about this kind of article, of which there have been many in the US media, is that it gives an incomplete and therefore distorted picture of the situation. Consequently, this kind of story can encourage inappropriate action or, because the situation seems so hopeless, no action at all.

The impression that many (I suspect most) Americans have about AIDS in Africa is that most of the adults in the prime years for work and child-rearing are dead or dying. Surviving Africans, faced with the scourge or HIV/AIDS, are seen has being helpless -- unable to help themselves or the children and elderly, who are left to cope on their own. What this article does not convey, nor have I seen others present, is the heroic efforts I've been privileged to see, where people (most of them poor) come together in villages and urban communities to do what they can to help children and adults worse off than themselves. Such people and extended families are the first line of response to HIV/AIDS, and what is done by governments, NGOs, religious groups, international organizations, donor agencies, and others will make significant impact in the long term only if it supports and strengthens the ongoing, daily efforts at family and community level.

The truth is that there is great capacity in Africa and the situation is not hopeless. Most adults, even in the countries with the highest HIV prevalence, are HIV negative. Most of the people who are HIV positive are healthy and able to work during most of the years that they live with HIV. The large majority of orphans in Africa live with a surviving parent or within their extended family and communities (albeit often with great hardship), and it is probably a very small minority who have slipped through these primary social safety nets and end up on the street, in villages without any support, or in orphanages.

But this is not the impression that most Americans have. Consequently, many, if they do not just shake their heads and turn away, assume that the only constructive approach is to build orphanages or new villages for the survivors. For many reasons, building more such institutions is not a good idea. The money it consumes (from about $500 per year per child in some African countries, much more in others) could help many more children stay in families if it were used to strengthen the capacity of families and communities. The costs of keeping one child in an orphanage could enable six or more to live with a family in their own community.

Also, the long term developmental consequences of growing up in an orphanage or children's village tend to be negative. Children who are not able to form a strong attachment with a specific adult, which necessary to fulfill their basic human need for connection, can have lifelong difficulty trusting people and maintaining relationships. Cut off from normal cultural opportunities, they may not learn how to behave and do the things that people normally do within the society. Those who have visited an orphanage where there are small children may have had the experience of children wanting to hold their hand. While it feels to the visitor as an affirming gesture, for the child its a symptom of an attachment deficit.

The normal response for young children is to be wary of a stranger.

Another problem with building new orphanages is that they become a very expensive and inefficient way to fight poverty. The more places that are created in orphanages or children's villages in areas under severe economic stress, the more children are likely to be pushed out of households to fill them, because someone else is willing to assume responsibility for providing a roof and food. Building more orphanages begins a never ending and ultimately futile cycle.

By the time they reach adulthood, some children raised in an institution have become, not by their own choice, professional orphans who have learned by what they have lived that someone else must be responsible to provide for all their basic needs. They may not have the connections to an extended family that forms the primary social safety net for most adults in time of need. Some even lose the ability to speak their mother tongue.

There are better alternatives for the children whose own families fail them. Foster family care, which is more like adoption than it is like foster care in the United States, has been shown to work in Africa. The major problem is that these programs are severely under-resourced. Local adoption can also work if the resources are provided to develop it. Some organizations have developed and supported family-type groups integrated in communities. Some local orphanages have recognized that they cannot accommodate an increasing number of orphans and have begun to provide day support or outreach to orphans and other vulnerable children living with families. Also, teens sometimes prefer to live on their own in small groups if they can be given some support and training as they learn how to live on their own. Child-headed households may benefit from support from extended family members, neighbors, and NGOs. Institutional care is not the only alternative to the street if children are without family care, but these other approaches need to be greatly expanded. Resources are needed to do that.

The primary responses that should be supported are those that will help children to remain within their families and communities. The five strategies from Children on the Brink 2002 (USAID, UNICEF, and UNAIDS) provide a basic framework for what needs to be done to improve the lives of orphans and other children affected by AIDS and to keep the number of children without family care to an absolute minimum:

1. Strengthen and support the capacity of families to protect and care for their children.
2. Mobilize and strengthen community-based responses.
3. Strengthen the capacity of children and young people to meet their own needs.
4. Ensure that governments develop appropriate policies, including legal and programmatic frameworks, as well as essential services for the most vulnerable children.
5. Raise awareness within societies to create an environment that enables support for children affected by HIV/AIDS.

Action in these areas need support. These strategies reflect the fact that there is capacity and hope in Africa. This is a message that needs to be conveyed along with the images of intense human suffering that the pandemic is causing.

Best regards,

John Williamson

j.williamson@mindspring.com