politics

Understand how HIV/AIDS-affected orphans can survive

My name is John Miller, and I’m a Canadian novelist. Like most Canadian novelists, I have a second career. On this Blog Action Day 2008 against poverty, I wanted to share my thoughts on the work I do related to children affected by HIV and AIDS.

Much media attention has been given to the terrible crisis facing orphans in the Global south, orphans who’ve lost parents to HIV and AIDS – to heart-warming stories of orphanages taking in abandoned children. I want to correct the misinformation and shine a light on the real issue facing children affected by HIV and AIDS: poverty.

To grasp this, the first thing we need to understand is that mounting evidence shows that it is families, not the state, not aid groups, and not institutions, which bear lion’s share of the burden of HIV and AIDS. The costs of illness of a parent or child can plunge a family into deep financial crisis from which it is difficult or impossible to emerge, the effect is more severe even than that of war or accidental death. Families are often forced to sell off their most meager assets or they face starvation. They have to pull their children out of school to work because they can’t afford the school fees and they need the extra income. Or, in extreme cases, healthy parents are so poor that they make the agonizing decision to give up their children to orphanages.

Remember how Madonna adopted a supposed orphan who turned out to have a surviving father? It will surprise people to know that most orphans, as defined by UNICEF and other aid groups, are actually not orphans as we understand them in the West. In the mid-90s, the term orphan was defined as a child who has lost one or both parents, not a child who has lost both of his parents. While this inflated the numbers and drew attention to the plight of children, it had a number of unintended negative side-effects. Of the more than 132 million children in Sub-Saharan African who are classified as orphans, only 13 million have lost both parents. Imagine the surviving parent, the shame and invisibility they must feel of having their child referred to as an orphan. UNICEF has recently acknowledged the need to revisit this definition.

Compounding this problem is an ill-informed mass of North Americans and Europeans, disconnected from the aid community, who are busy pumping money into orphanages. Orphanages have proliferated in Africa and Eastern Europe in the last ten years because they’re tangible aid target and they seem a compassionate response. But these donor groups, largely well-meaning church congregations and service clubs, seem to have forgotten why we got rid of our orphanages here in the West. It was because decades of research showed these institutions to have harmful long-term consequences. They cut children off from community and extended family. Children lived without adequate love or attention from a significant adult, leading to attachment disorders. Abuse and bullying was common, with all of their horrible traumatic long-term effects.

The problem is worse in the poorest communities in the world. These orphanages divert money from much needed community services that support surviving parents, extended families, and communities to care for their own children.

Further exacerbating this problem is insufficient aid to nation-states, broken promises of aid, and, where money does exist, restrictive IMF policies that limit social spending on services and cash support to the poor. These prevent countries from developing free and universal health, social service, and education systems that will reach all children, instead of the smattering of programs run by aid agencies, a drop in the bucket. IMF policies tie the hands of countries that want to develop a social safety net. One key program that is showing great empirical results is a type of welfare program being refered to now as cash transfers.

Thankfully, the world is finally waking up to the problem. The bravest of orphanages are transitioning into short term care facilities that provide support to families, aided by their now-enlightened donor groups. Governments and some bilateral funders (the UK for instance, but not yet Canada or the US) are recognizing that poor working families benefit from small amounts of cash support – support that helps them keep their assets, keep their children even. These programs help them buy food for all family members, pay for school fees, and pay for health care. Cash-strapped Swaziland has rolled out an old-age pension that has helped grandparents to care for their grandchildren. Mexico is celebrating a decade of success of Oportunidades, an innovate program that provides cash support to the poorest families (it gives the money directly to women, who are shown to be more likely to spend money on their children than men do). Kenya and South Africa are experimenting now with cash transfers to families, and many other nations are taking note.

It takes courage to implement these programs, because they fly in the face of right-wing ideology that fears cash support to the poor, and they push back against IMF policies that restrict social spending. It takes courage to stop the flow of funding to orphanages and to redirect donor money to other community services. But these changes must happen fast. If we recognize that with money and community support, all family members can avail themselves of services, health care, anti-retroviral treatments, and education, children who are infected and affected by HIV and AIDS will have a much better chance not just to survive, but to thrive.

© 2008 Defining Canada.