Before I went to South Africa, I wasn't too, too worried about AIDS orphans. While it's horrible to lose your parents, I expected neighbors and relatives to help.
Instead, in my trip to South Africa for the 2000 International AIDS Conference, I found that orphans were actually mistreated. The stigma of AIDS is so great that neighbors were shunning them, not sending over plates of food. Relatives were converging to steal property -- including the houses where the orphans lived. I couldn't believe that people could treat children like this -- children.
The only time I've cried during seven years of working at Positively Aware was at the International AIDS Conference two years earlier, in Geneva. During a presentation, a doctor from India talked about the lack of medicines for her patients. One was a baby girl found by an orphanage in the garbage. When they realized she had HIV, they put her back in the garbage. The doctor showed a slide of a beautiful, smiling little girl, now 4, petting a cow. The thought of this baby being put in a garbage can sent tears rolling down my cheeks for the rest of the presentation.
I had another shock during my trip to South Africa -- education is not free. Families must pay to have their children attend school. Orphans must come up with money to remain in school, as well as for their school books and endless other fees. How can they do so? They usually can't, and end up without the education they need to become strong adults.
Nor is there free public health care, no county hospitals. No social safety network -- no food stamps, welfare, or public housing. Government programs and other assistance do exist to some extent. But not like here -- not universal social welfare, not in every country.
One report raised an issue I hadn't even considered -- how do you even find an orphan household in order to help them? That's a lot of work in the trenches. There are not just large rural areas to cover, but crowded, impoverished townships throughout Africa. What about the other continents? The number of orphans numbs the mind -- it's in the millions.
Moreover, households with AIDS orphans may also exist incognito, not allowing the community to know exactly what happened.
No doubt many neighbors and families help (and many cultures demand it). Two photos from the exhibit "Broken Branches" during the International Conference astounded me. In one you see an elderly woman with the five orphaned grandchildren she is raising. In the next photo, it is three years later and you see her with nine orphaned grandchildren. As for younger aunts and uncles, many of them have died of AIDS too. Other times there are just too many children for one household to take in. Or siblings may be sent to separate homes.
Consider some other details. Children may be orphaned while their parents are still alive, due to illness that turns them into caregivers. Then there is the trauma of watching your parents die. Because most people with HIV/AIDS in the Third World are heterosexual, there are even more orphans and potential orphans. Also, advocates find that AIDS orphans are subjected to more exploitation and abuse than other orphans, and have a higher risk of becoming infected themselves. (The vast majority are HIV-negative.)
Last year, at a meeting on the orphan crisis, UNICEF executive director Carol Bellamy said, "Almost without exception, children orphaned by AIDS are marginalized, stigmatized, malnourished, uneducated, and psychologically damaged. They are affected by actions over which they have no control and in which they had no part. They deal with the most trauma, face the most dangerous threats and have the least protections. And because of all this, they too are very likely to become HIV-positive."
Once again, the stigma alone kills. Some child advocates tell us not to even say "AIDS orphans," because that marks the children. If you're trying to help them, just say your program is for orphans. Otherwise the families that come to your offices are marked by AIDS. One organization gets around it by saying they help "orphans and other vulnerable children in regions severely affected by the HIV/AIDS epidemic."
Others don't like the idea of orphanages. AIDS orphanages also stigmatize children, and isolate them. It's better to offer community-based services, including home care. Well, sure, but orphanages are necessary in every country on the planet, and not just because of AIDS.
It's no wonder that when protecting orphans, advocates go back to the basics -- stop the stigma. Promote education and awareness. As Archbishop Bonifatius Haushiku declared at the opening of Catholic AIDS Action in Namibia, an organization that helps orphans, HIV/AIDS is a disease, not a sin.
Work to establish voluntary counseling and testing, especially for pregnant women. Provide Viramune (nevirapine) or other medicines to prevent mother-to-infant transmission. Provide triple combination therapy to adults and children.
By all means, fight for prevention and treatment. Keep all family members alive and healthy.