- A few years ago Prof Timothy Quinlan was hearing horror stories about delinquency and abandonment among AIDS orphans that would spell trouble for their future social acceptance.
"The anecdotes were that orphans do less well at school than children who aren't orphans," said Quinlan, research director of the University of KwaZulu-Natal's Health Economics and HIV/AIDS Research Division (HEARD). "Other anecdotes were that orphans often engage in riskier behavior - like smoking, taking drugs or engaging in sexual activity at a younger age than other children - and that they are a particularly vulnerable segment of the child population."
Sub-Saharan Africa continues to struggle with the profound and complex impact of HIV/AIDS, including an estimated 12 million children under the age of 18 who have lost one or both parents to the disease, according to an August report by the UN Children's Fund (UNICEF). By 2010, the figure is expected to climb to 15.7 million, warned the report, 'Africa's Orphaned and Vulnerable Generations: Children Affected by AIDS'.
The 'Lord of the Flies'-like vision of AIDS orphans, of an isolated and forgotten generation, has called much-needed attention to the crisis. But hard data - quantitative evidence from children - has been scarce.
"At the time, there was no research with children - though there was a lot of research on or about children - on their welfare in the context of HIV/AIDS," Quinlan said. "And there was no quantitative research with children to test some of the anecdotal evidence that was emerging with NGOs [nongovernmental organisations] and child welfare advocates."
In 2002 HEARD collaborated with the Center of International Health and Development at Boston University to launch the Amajuba Child Health and Wellbeing Research Project (ACHWRP). From a field office in Newcastle, in South Africa's eastern KwaZulu-Natal Province, ACHWRP is conducting a study to measure the differences in social welfare between orphans and non-orphans in a region with a rampant HIV/AIDS epidemic. The idea is to investigate how children and their caregivers manage changing families, and whether the commonly held assumptions about orphans hold weight.
So far, what they've found is surprising. "According to the first stage of our research, there is no significant difference between children, based on their orphan status," Quinlan said. Orphaned children are doing as well in school and engaging in the same level of risk behavior as their non-orphaned counterparts.
Instead, he said, orphaned and non-orphaned children alike are made especially vulnerable by poverty. "In the context of HIV/AIDS and poverty, the welfare of children is not necessarily going to change just because of HIV/AIDS; the welfare of a child can be very bad just because the parents are poor."
HIV and Poverty Create Problems of Enormous Magnitude
ACHWRP's research is being conducted in the Amajuba District Municipality of KwaZulu-Natal, where a cluster of coal-mining and steel mill towns is located. The area is home to about a half-million people in and around Newcastle, the main urban centre, which, like many South African towns, is steadily urbanising. Yet 56.8 percent of Amajuba's residents live in poverty, according to a 2004 report by the provincial premier's office.
Amajuba is also at the heart of the HIV/AIDS pandemic. Estimates vary, but a 2005 study found 39 percent of women attending antenatal clinics in the area had tested HIV-positive. Orphans are usually taken in by grandparents or aunts or uncles. It's this conflation of poverty and HIV/AIDS that makes Amajuba an important area for research.
ACHWRP's field researchers regularly interview a sample of 725 iziZulu-speaking orphaned and non-orphaned children aged nine to 15, as well as their parents or guardians, in households in semi-urban, informal and rural areas. Researchers ask a battery of questions to assess the child's economic and social welfare, from family income to the amount invested in each child.
The first phase of the study uncovered universally high levels of poverty, but found no significant difference in how the extended kin cared for children in a household, whether or not they had lost a biological parent.
"That makes sense because of the nature of the extended-kin structure, which is set up in such a way that children are taken care of by extended family members," said Dr Busi Nkosi, senior researcher at ACHWRP's Newcastle field office. "One of the stereotypes is to expect this dirty and half-naked kid, and that's not necessarily the case. In looking at orphans and vulnerable children it's hard to give a typical definition, because poverty compounds the whole thing."
While a second round of the study has not been fully scrutinised, Nkosi said early analysis corroborated the initial findings. The results suggest that various notions - including 'poverty' and 'AIDS orphans' - need to be better understood to more effectively coordinate government and NGO responses.
Financial Constraints Impact Child Welfare
Caregivers of orphans as well as non-orphans are deeply affected by the high unemployment and poverty in Amajuba. According to the 2001 government census, 60 percent of households in the district earn US$110 or less per month, and nearly a third of all households had no income whatsoever. For some, government social welfare grants are the primary source of income. Extended families with and without orphaned children often make ends meet with a monthly pensioner's grant of $112 or monthly child grants of $26.
"You find some households solely depending on the grants," said ACHWRP researcher Mandisa Cakwe. "That's how the grandmothers use their money these days. Rather than focusing on themselves, they look after - and share the money with - the grandchildren."
This is the case in the Sibisi household in the rural area of Dicks, about 10km from Newcastle. Eight children live in a cluster of houses with their great-grandmother, mothers and aunts. In all, the household counts on the pensioner's grant of $112.
"It's only grandmother who gets the grant, and that's for food and school fees and clothes - everything," said Jabulile Sibisi, who is raising her sister's and cousin's children with her own.
Sibisi said she and her sisters were careful to show love to all the children, including those who had been orphaned. All the children go to school and everyone eats and lives together.
"It's hard, but I try. Sometimes we have no money, and [the children] want some things [we can't afford]," Sibisi said.
Not surprisingly, the factors that render children orphans often impact on the household's economic welfare. For example, medical bills and funeral expenses can wipe out a family's financial resources. At the same time, Quinlan and others say more research is needed to assess orphans' psychosocial welfare. However, ACHWRP's research suggests that it is difficult to separate HIV/AIDS as a factor in a child's economic and social welfare from sheer poverty.
Integrated Research Framework Has Local Impact
In this context ACHWRP uses what's called a "methodology of integration". In addition to empirical research, the project works with government departments, traditional authorities, NGOs and police to improve interventions for child welfare in the area.
"There's a lot more than we're doing besides conducting research," Cakwe said. Before ACHWRP established an office in Newcastle, the team met with existing organisations dealing with orphans and vulnerable children.
"We wanted to introduce ourselves and get feedback and advice from them," Cakwe said. "That's why we're really successful in what we're doing. We laid the ground really well."
Last year ACHWRP hosted a conference for all groups dealing with child-related issues to minimise duplication or gaps in local services. ACHWRP also created a referral system with local government departments. When a researcher interviews a family that appears to qualify for a government grant, they contact the social welfare department for fast-track assessment.
"It's a small step, but it's making a difference," said Nkosi, who also sits on the Newcastle AIDS Council.
ACHWRP has made a difference in the community's response to orphans' welfare, according to Mbali Kubheka, a social worker and HIV/AIDS coordinator at the Department of Social Welfare office in Madadeni, a township near Newcastle.
Kubheka said the referral service has boosted awareness of government services. "There are two times as many applications for foster care grants this year as compared to last year," she said.
As a social worker overseeing about 280 households, Kubheka acknowledges that she's seen the orphan crisis skyrocket in Amajuba in recent years. However, she emphasised that orphans tended to be well-cared for in their extended families.
"In my caseload, my orphans are studying," said Kubheka. "Of course, there are always the minor problems of your average teenager, but in my experience I've never known an orphan to drop out of school."
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