In African countries that had long, severe epidemics, AIDS is generating orphans so quickly that family structures can no longer cope. Traditional safety nets are unravelling as more young adults die of AIDS related illnesses. Families and communities can barely fend for themselves, let alone to take care of the orphans. Typically, half of the people with HIV become infected before they turn 25, acquiring AIDS and dying by the time they turn 35, leaving behind a generation of children to be raised by their grandparents or left their own in child-headed households.

More children have been orphaned by AIDS in Africa than anywhere else. The deep-rooted kinship systems that exist in Africa, extended -family networks of aunts and uncles, cousins and grandparents, are an age-old social safe net for such a children that has long proved itself resilient even to major social changes. Capacity and resources are stretched to breaking point, and those providing the necessary care in many cases are already impoverished, often elderly and might themselves have depended financially and physically on the support of the very son or daughter who has died.

The way forward is prevention and care. The rest of this page is devoted to issues around the care of AIDS orphans in Africa. But what is also important is prevention, preventing more people from becoming infected with HIV in the future, and care to prevent people from dying of AIDS, This will prevent even more children from becoming orphans over the course of the next few years.

As projections of the number of AIDS orphans rise, some calls have been heard for an increase in institutional care for children. This solution is impracticably expensive. In Ethiopia, for example, keeping a child in an orphanage costs between US$300 and US$500 a year, over three times the national income per person. It is also tragic for children to be separated from their siblings, taken out of their communities, and raised in situations which do not prepare them for life as an adult. Institutionalisation stores up problems for society, which is ill equipped to cope with an influx of young adults who have not been socialised in the community in which they have to live.

There are other alternatives available. An example is the approach developed by church groups in Zimbabwe, where they recruit community members to visit orphans in their homes where they live either with foster parents, grandparents, other relatives or in child-headed households. The community members visit weekly or twice monthly, ensuring that carers and children get the material and emotional support they need in order to keep the household together. Households caring for orphans are provided with clothing, blankets, school fees, seeds, and fertiliser as necessary. The communities contribute to activities such as farming communal fields and generating income to support the programme.

Of the many vulnerable members of society, young people who have lost one or both parents are among the most exposed of all. And this is particularly true in sub-Saharan Africa, where few social support systems exist outside of families and where basic social services are largely inadequate.

AIDS orphans are often at greater risk of illness, abuse, and sexual exploitation than children orphaned by other causes. They may not receive the health care they need, and sometimes this is because it is assumed they are infected with HIV and their illnesses are untreatable. Orphans generally are often thought to run a greater risk of being malnourished and stunted than children who have parents to look after them, although some studies have found that orphans are not significantly more likely to show signs of malnutrition than non-orphans regardless of whom is caring of them.

Orphans enduring the grave social isolation that often accompanies AIDS when it strikes a family, are at far greater risk than most of their peers of eventually becoming infected with HIV. Often emotionally vulnerable and financially desperate, orphans are more likely to be sexually abused and forced into exploitative situations, such as prostitution, as a means of survival. Girls are also in greater risk of becoming infected at a younger age than boys, because they are biologically, socially and economically more vulnerable.

Since HIV can spread sexually between father and mother, once AIDS has claimed the mother or father, children are far more likely to lose the remaining parent. Children often find themselves taking the role of mother or father or both - doing the housework, looking after siblings and caring for ill or dying parent(s). The children are plunged into economic crisis and insecurity by their parents' death and struggle without services or support systems in impoverished communities.

Children grieving for dying or dead parents are stigmatised by society through association with HIV/AIDS. The distress and social isolation experienced by these children, both before and after the death of their parent or parents, are strongly exacerbated by the shame, fear, and rejection that often surrounds people affected by HIV/AIDS. Because of this stigma and often-irrational fear surrounding AIDS, children may be denied access to schooling and health care. And once a parent dies, children particularly in the case of girls, may also be denied their inheritance and property.

Efforts to protect children orphaned by AIDS are nearly as old as the epidemic, and many are beginning to show real progress. Several of these encouraging efforts have taken place in Botswana, Malawi, Zambia, and Zimbabwe, 4 of the 10 worst affected countries in terms of HIV prevalence.

In Botswana, UNAIDS have estimated that 69,000 children had lost their parent(s) to AIDS by the end of 2001. The government in Botswana encourages communities to provide care for orphans and to rely on institutional care only as a last resort. Orphans in Botswana are still usually absorbed by the extended family. Their caretakers are predominantly women.

A National Orphan Programme was established in April 1999 to respond to the immediate needs of orphaned children. The programme is run by various government departments, NGO's, CBO's and the private sector. The programme's objectives are to review and develop policies, build and strengthen institutional capacity, provide social welfare services, support community-based initiatives and monitor & evaluate activities. A major goal of the Programme is to develop a comprehensive National Orphan Policy, based on the Convention on the Rights of the Child.

In the rural subdistrict of Bobirwa, district authorities have contracted out to the Bobirwa Orphan Trust the delivery of essential government services to orphans in the area. The Trust is made up of community volunteers and local extension staff - government paid employees, including social workers and family welfare educators. The members of the Trust identify and register orphans in the district, and through home visits, schools and churches, screen orphans using established criteria to identify the type of assistance they need. They also initiate community-placed foster placement, and identify local groups who purchase food and clothing and distribute them to orphans. Needy orphans are assisted with food, clothing, blankets, councelling, toys, bus fares to and from school, school uniforms and other educational needs.

But there are still many obstacles and challenges to overcome. Firstly, the country's high-level officials have only recently begun to speak about the problem and to make it a national priority. Because initial government response to the crisis was slow, AIDS has already done significant damage to previous progress in social development. Secondly, responsibility for AIDS within the Government is not well defined. Thirdly, there is no strong tradition of NGO's working in the area of childcare and rights. Finally, existing child protection laws and policies are fragmented and outdated.

Malawi has been struggling with high levels of HIV infection. Also the incidence of tuberculosis has more than tripled since the late 1980's, largely due to HIV. The AIDS crisis has had a crippling impact on the country's children and UNAIDS estimated that Malawi has 470,000 children orphaned by AIDS as of the end of 2001.

It was recognised early on that because communities are in the best position to assess their own needs, they would play an important role in addressing the AIDS orphan crisis. One of the Government's main strategies, therefore, has been to promote and support community based programmes. As early as 1991, the Government of Malawi established the National Orphan Care Task Force. The Task Force was made up of various representatives and organisations, which are responsible for planning, monitoring and revising all programmes on orphan care. One year later, in 1992, National Orphan Care Guidelines were established. The guidelines serve as a broad blueprint to encourage and focus subnational and community efforts. The Task Force has also established a subcommittee that is reviewing existing laws and legal procedures to provide greater protection to vulnerable children.

In rural and urban areas across Malawi, communities are developing a variety of ways to cope with the growing crisis of AIDS orphans. Village orphan committees have been established in many villages to monitor the local situation and to take collective action to assist those in need. Anti-AIDS clubs have also been created to educate communities about HIV/AIDS transmission and prevention, as well as to address the needs of those infected with the virus. In Namwera village, for example, the local school has formed an anti-AIDS club where pupils carry out AIDS-prevention activities as well as help needy orphans. After children in one family lost their parents to AIDS, and their house and living conditions rapidly deteriorated, one group of students built the orphans a kitchen for their home

Lack of administrative capacity at the national level coupled with inadequate resources has made it difficult for the Government to keep up with the growing epidemic. At the same time, research and data collection need to be improved in order to assess the severity and scope of the problems presented by large number of orphans and respond effectively. The dedication and solidarity of community members across the country have been a major factor in the progress that has been achieved so far.

The AIDS epidemic has had a devastating impact on communities in Zambia. The estimated amount of children orphaned because of AIDS is 570,000. Many families already worn out by widespread and extreme poverty are stretched beyond their capacity. Many of the rural population is considered to be living below the poverty line and large numbers of families are forced to rationing food, which in turn affects child development. The crisis is eroding the Government's ability to provide services, whilst at the same time increasing demand for them. Zambia's primary health care system used to be one of the best administered and most decentralised among all African countries, but now, with increasing household poverty, external debt obligations, and demand placed on health services by HIV/AIDS, the system is breaking down.

Zambia has several policies that pertain to children, but no national orphan policy. Although many ministries have included AIDS issues in their planning the Government has been slow to respond to the AIDS Orphan crisis. As in many countries, NGOs, CBOs and religious institutions have tried to fill the gaps. In the last few years, the number of groups dealing with AIDS issues has grown. Most of these organisations recognise that orphaned children should be cared for by the community rather than by institutions. As a result, much of their work focuses on strengthening families and extended families.

Zambia does not provide free primary education to children and with high national poverty rates, parents and guardians are finding it increasingly difficult to pay for the school fees; uniforms and books needed to send their children to school. For the AIDS orphans and their guardians the situation is even worse. A study in urban areas has revealed that 32 per cent of orphans are not receiving formal schooling, compared with 25 per cent of non-orphans. In rural areas, the figures for children not enrolled in school were a staggering 68 per cent of orphans compared with 48 per cent of non-orphans.

The Community-based Orphan Support Programme was designed to strengthen the communities' capacity to address the growing number of orphans and to create awareness about the problems these children face. The Programme provides education and health services, facilitates local income-generating projects, conducts HIV/AIDS prevention among vulnerable children and links up local communities with agencies working with orphans outside the community.

Communities are remaining at the forefront of care for orphans in Zambia. Although NGO's, CBOs, churches and other volunteer organisations are making significant contributions in strengthening local communities, they have a long way to go before making an impact nationally. A number of factors make it difficult for these institutions to scale up existing interventions. Firstly, their responses are not consistent and there is little co-ordination between them. Secondly, government involvement is severely limited at the present time. Thirdly, the funding is totally inadequately to address the issues on a large scale. Finally, institutions are overwhelmed responding to the immediate needs of these children and families. With little funding and relying heavily on volunteers, many institutions are stretched almost to breaking point. However, the activities of these organisations do mitigate the suffering of the orphans and supporting these efforts is crucial in the monumental task of assisting families and communities in Zambia to care for the country's orphans.

Zimbabwe has one of the worst AIDS epidemics in the world. The epidemic has so far left behind an estimated 780,000 AIDS orphans. The orphan crisis first came to national attention in July 1992, when Zimbabwe's Department of Social Welfare co-ordinated a national conference on orphans. It was recognised that compared to institutionalisation community based care was cost-effective and kept children in a familiar social, cultural and ethnic environment and reduced their distress. In 1995, the Government of Zimbabwe developed a national Policy on the Care and Protection of Orphans, which was finally approved by the cabinet in May 1999. The Policy reaffirmed the position that orphans should be placed in institutions only as a last resort.

Farm workers in Zimbabwe are multiethnic. Many are immigrants or the children of immigrants, and many more are Zimbabweans who have moved from their native villages. Families are often isolated from their extended family networks and so children are often left with no one if their parents die. In 1986, the Farm Orphan Support Trust (FOST) of Zimbabwe was set up as a community response to the situation of orphans in commercial farming areas. FOST aims above all to keep sibling orphans together, within a family of the same culture and in a familiar environment. It operates foster schemes on farms, using farm committees to train caregivers, establish monitoring procedures, and raise community awareness. All the farms register orphans individually and send information to a centralised computer bank. This procedure helps with the tracing of relatives.

FOST promotes five levels of orphan care. It's preferred care is within the extended family. If that is not possible, orphans are placed within substitute families. The third choice is for small groups of orphans to live together on a farm, looked after by a caregiver employed by the farm for this purpose. The next most preferred type of care is an adolescent child-headed household with siblings remaining together, preferably in the family home. Here they are cared for by the eldest child with regular supervision and support provided by the farm's Child Care Committee, the community and the local field officer. Finally, FOST will arrange for temporary care in an orphanage, until a better solution can be found.

It is very difficult to estimate the number of children orphaned by AIDS each year. Whatever the figures, it is clear that there is an enormous problem. Millions of children have already lost at least one parent to the epidemic, and millions more will do so in the years to come. The need now is to help, care and protect these children and this can be only done with increased financial support and commitment.

* UNAIDS defines as orphans children who before the age of 15 have lost either one or both parents to AIDS in 2002. UNAIDS changed their definition of AIDS orphans from children who before age of 15 have lost either their mother or both parents to AIDS in. However, the new definition still provides a few difficulties. The definition does not distinguish between children who had two parents and who have lost one and still have one parent left to care for them and those who only had one parent who has died or two parents both of whom have died when there is no parent left to care for them. Secondly, the definition excludes the age group of 15 to 17 years olds.