Summary: A response the author sent 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 the author saw as
a distorted image that has been
generated by most of the news
coverage in the US on HIV/AIDS in
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
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
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
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:
Strengthen and support the capacity of families to protect and
care for their children.
Mobilize and strengthen community-based responses.
Strengthen the capacity of children and young people to meet
their own needs.
Ensure that governments develop appropriate policies, including
legal and programmatic frameworks, as well as essential services
for the most vulnerable children.
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.
Owner: Displaced Children and Orphans Fund of USAID, John Williamson