Every 14 seconds a Child Headed Household is formed. But what exactly is a Child Headed Household? In this picture you see children who have survived the death of their parents from AIDS, little brothers and sisters struggling to stay alive and remain together as a family. A Child Headed Household is defined as a family unit in which the oldest person residing in the household is under the age of eighteen. Since both parents have died, these children are often referred to in literature as double orphans. This is not a new phenomenon to history, but in previous years, most Child Headed Households (from now on referred to as CHH) came about because the parents had died from war. Today there are still CHH being formed by the tragedy of war, but half of all CHH are formed because the parents have died from HIV/AIDS. And there are thousands of "social orphans", i.e., children who have been taken in by family or community members because their parents are unable to care for them due to illness or other circumstances. Orphans of war cry and can tell their story over and over. Children orphaned by AIDS cry, mostly silently behind closed doors. They have no one to tell their story to, and now there are so many that no one wants to know the details, they all know the sickness and the horrible agonizing death of these poor people.

Traditional coping mechanisms are being threatened as communities are overwhelmed with the scale of the problem. These are children who watch their parents die long and agonizing deaths; who watch the mortifying process of physical decline; who observe the family struggling and disintegrating before their eyes; who watch the household food security wither away; who watch the tiny income disappear; who plead for medicines for their mothers and can't get them; who are forced to leave school; who feel forlorn, terrified and abandoned when death claims its victims, victims whom the children loved as only children can love.

"The worst is yet to come," warns a report issued by the UN Children's Fund. The data from UNICEF, UNAIDS and USAID indicates that in sub-Saharan Africa, 14 million children have been orphaned by AIDS-a number higher than the total number of boys and girls under 18 years-old in Canada, Norway, Sweden, Denmark and Ireland combined. That figure is expected to reach 18 million by 2010.

These children, 50 per cent of whom are 10 to 14 years old, will be left without critical guidance, protection and support. The problem is overwhelming and the need is immense, but we can help them.

Three quarters of all CHH are led by girls. Picture 1-2 shows a CHH led by an 11 year old girl who is trying to raise her 2 younger sisters, her 2 younger brothers, and go to school. There are usually three to eight children per household, and these orphaned children try to stick together as much as possible. One study of CHHs in Rakai, Uganda, showed that the number of orphans who had lost both parents and were living on their own increased from 4.4% of all orphans from 1985 to 1989 to an incredible 60% between 1995 and 1999. Their right to support, and to remain in charge of their lives without fear of being split up or sent away, must be protected.

These children encounter frequent illnesses and experience high mortality rates, because many of them are less than five years of age. Most of them are exposed to a poor environment, malnutrition, and lack of medical attention, which further compromises their quality of life. Dr. M.A. Ayieko of the United Nations Development Program has documented that when a husband dies of AIDS in a family, the mother is also often living with HIV/AIDS and dies shortly thereafter, leaving the children as orphans. Even if they are aware of their terminal illness, few parents attempt to make any alternative living arrangements for their children before their death. Many believe the grandparents or extended family members will provide for the children. Most of the dying parents are usually so sick and living in such terrible conditions that they don't have the strength or wherewithal to provide for the future of their children.

Left alone, the children must provide for themselves. They often resort to begging for money for food and clothing. Some girls resort to prostitution to raise money. Fetching water, cooking and cleaning are all tasks that are shared among the children. Such children face threats to their survival and often threats to their security. They have the emotional needs common to children everywhere, but they also have special needs, such as palliative care and something often most of these will never receive: bereavement counseling.

Adolescents from 11 to 15 years of age are in a crucial stage of their social development process, and they need parental guidance. These youth, like the older boy holding his brother in Pic. 1-3, are treated as young adults and expected to behave as mature adults with families. As much as they try to work and provide some leadership for their brothers and sisters, they are still children. They need guidance, time and a chance to be children, to be teenagers and to experience this important stage of human development. The death of a father deprives children of male authority, a status symbol in many communities. But the subsequent death of a mother further deprives the children of crucial emotional and mental security as well.

According to a report by the Christian-based World Vision, CHH are deprived of love, security, a sense of belonging, acceptance and care. They have no one to turn to and live in very difficult circumstances, without the basic necessities of life. They are usually exploited or taken advantage of, hence the loss of trust in the society that is supposed to protect them. Most of the property left behind by their parents has been taken away by relatives or neighbors. Children in such conditions are deprived of their childhood and the opportunity to go to school. Economic hardships lead them to look for means of subsistence that increase their vulnerability to HIV infection, substance abuse, child labor, sex work and delinquency. The International Community virtually ignored the issue of AIDS orphans between 1991-97. "The fear was that it was a charity issue," said Susan Hunter (formerly of UNICEF & USAID) while speaking at the first conference on AIDS orphans in South Africa in 1998, "... there was no way the North could support all the orphans in the South, so none of the donors or international agencies really wanted to put effort into it. They decided instead to put effort into AIDS prevention. There was a time when we believed that we could stop the epidemic."

The determination of the remnants of these families to stay together was the motivation behind the writing of this book. The CHH can be an emerging positive coping mechanism for affected communities. The term itself, Child Headed Household, emphasizes the resilience and power of children heading families living under these circumstances.

We cannot view these children as helpless! That would send a message to them that their own efforts to cope are not seen as legitimate, or indeed even recognized at all. This lack of acknowledgement of children's own strategies can undermine their ability to act on their situation. It is vital to recognize that children's own perspectives on adversity, and the strategies they employ for their own protection, are critical to coping and resilience.

The following chapters will explain how these children live, eat, study, work, play and laugh and survive despite all odds, and what you can do to help them succeed.

What You Can Do To Help Now!

Say a quick prayer for these children and all who are helping them.

Continue reading this book to learn more; go to the suggested web sites for more information.

Send a check or donate online to an organization that helps CHH.

Send an email to all in your address book explaining the plight of these children.

Chapter Two
Where Do They Live?

With more than 13 million children under the age of 15 orphaned by HIV/AIDS, where are they all living? The girl shown in Pic. 2-1 lives under the blue tarp with her little brother seen on her back. Many, many CHH live in homes of plastic sheeting. Often the children huddle together near the train tracks. One child explained, "When you live near the train tracks, you don't hear the trains go by in the middle of the night no matter how loud they are!" They sleep in caves and huddle with animals for warmth. Those who have found a shelter often sleep on bare floors, many with no blankets. Those that have a bed, often have no mattress. They live in a one-room house; food is scarce, and they sleep on a flour sack resting on the cement floor. There is no running water, and no electricity. No bathrooms, no showers. Check your sewer! Type in "children living in sewers" into Google. You will get more than 2,000,000 hits! These are not all orphans of AIDS, but many homeless children in need of help. 15,000 children live this way in Mexico City, but there may be three times more.

Some children, very few in number, fortunately have been left by their deceased parents a small, but safe and secure house in relatively good condition where they can continue to live. Usually it is a typical concrete block house with metal-framed windows, metal roof, and a dung floor. There are three rooms, a kitchen, sitting room and bedroom. They have a pit latrine away from the house on a corner of their property.

Often when the last parent dies at home, the orphans move from their parents' house to live with grandparents or move in with uncles and aunts. Grandparents and other relatives have absorbed some of the responsibility for caring for AIDS orphans, but family networks are sagging under the weight of the epidemic. Many move in with relatives whose desperate poverty only becomes worse with more mouths to feed.

Most especially when a mother dies of AIDS, orphaned children often go to live with a grandmother, a practice referred to as 'skip-generation parenting'. Orphans are often cared for by grandparents because there is no other relative willing or able to look after the children. Grandparent-headed orphan households are becoming increasingly common as a result of AIDS. For example in Zimbabwe, 125 out of 292 orphan households (43%) were headed by grandparents; in Kenya, 41 out of 152 (27%) were grandparent-headed. Even in New York, 25 out of 43 maternal orphans (58%) lived with a grandmother. Some of the most vulnerable orphans are children of single mothers, especially if the mother was a prostitute. When a single mother becomes sick or dies, her children may be left in the care of grandparents. Because such orphans are from single-parent households, they may be neglected by other relatives who refuse to provide any support to the children because they consider them illegitimate. All too often, a grandparent is already caring for grandchildren from three or four families. The responsibility for orphan care is shifting increasingly to grandmothers who often single-handedly care for 10 to 15 orphans. Many women infected by HIV migrate back to their maternal homes after their husbands have died and they are in the later stages of their illness. Their hope is that the children will find a male authority such as a grandfather or uncle, and social and emotional security with her family. When the mothers eventually die, such orphans are twice disadvantaged by a second trauma of parental death and adjusting to unfamiliar relatives in a foreign place.

A Kenyan study found that whereas families living below the poverty line tended to foster children, wealthier relatives, whom one might expect to be more able to foster relatives' children, maintained minimal links with orphans.

Many of these children then move again to new localities to live with relatives and family friends. Often in situations where many sleep in the same hut or a single room, the young girls are abused by the men. This is often the reason many women prefer not to accept the orphan daughters of their own family. Some run away in an effort to find a more suitable living arrangement for themselves. When both parents have died and no relatives accept the children, the CHH usually leave their home town or village and head to a large city. When they arrive in the cities, the CHH often end up living on the streets and are at extremely high risk of exploitation and HIV infection. Nowhere are the problems more acute than in KwaZulu Natal (KZN), South Africa, an area with the highest rates of HIV/AIDS infection and orphanhood in the whole country. Durban attracts the highest number of street children of any city in Southern Africa.

In nearly every sub-Saharan country, extended families have assumed responsibility for more than 90 per cent of orphaned children. But this traditional support system is under severe pressure-and in many instances has already been overwhelmed, increasingly impoverished and rendered unable to provide adequate care for children. Most worryingly, it is precisely those countries that will see the largest increase in orphans over the coming years where the extended family is already most stretched by caring for orphans.

During her mother's illness, her mother would request her every night to heat water on the open fire and to wash her mother's feet with the heated water. She knew that her mother was very sick and needed her, but her mother advised her during her illness to live with an aunt, as she said that Sakhisiwe's older sister would take care of her. She feels guilty that she had left her mother during her mother's last few living days, and that is the reason she claims she misses her mother even more. According to Sakhisiwe, when her mother was alive her mother was able to provide everything and even basics like soap to bathe with. Currently there are days when not even soap is available to either bathe or wash their clothes with. She trusted that her mother would provide everything that she needed although currently her grandmother provides for them if and when money is available. She remembers her mother especially when she is provoked while playing with other children. Sakhisiwe Myeni is a 12 year old grade four schoolgirl.

One study in Blantyre, Malawi, found that, of the 65 orphans they interviewed, 22 had experienced multiple migrations, some as many as five. Many AIDS-affected children in southern Africa engage in migration when household members fall sick or die from AIDS, or because they are sent to assist relatives. Despite this, little attention has been paid to the consequences of these movements for children's lives. Research, conducted in Lesotho and Malawi, reveals that children sent to live with kin commonly move over long distances and between urban and rural areas. They are generally not consulted or informed about these migrations and face a range of associated difficulties, particularly with integrating into new families and communities. Severed family ties exacerbate the difficulties faced by children who end up in institutions or on the streets.

This paper advocates that policy approaches for those affected by AIDS should be children-centered and take into account the implications of migration at three levels. 12 First, many of the difficulties children face could be overcome if they were familiar with the place and people they were moving to. Second, children would be better able to cope with new situations if they were included in family discussions with decision-makers regarding their migration preferences. Third, maintaining ties with kin would ensure that children do not become distanced from their family and cultural heritage, which is essential for post-institutional support.

The fact that orphans are now being fostered by maternal rather than paternal relatives, especially in peri-urban areas, is symptomatic of the decline of traditional extended family practices. Most often when the last parent dies, the extended family, if unable to take care of the orphans, will stay away from them. This is extremely painful for the children and they can't understand why and often put the blame on themselves. Psychological help is also greatly needed for these children, but it is highly unlikely that they will receive it at this present moment. Frequently the children may desire to stay together as a family group rather than be split up between various relatives, or wish to stay living at their own residence in familiar surroundings, rather than change school, friends, home and neighborhood. They may resist attempts of relatives to foster them in the relative's household, fearing maltreatment or because the relative only agrees to foster younger siblings. The main reasons children say they prefer not to live with extended family members are:

Most of their relatives are very poor and financially unable to support them or are already supporting large extended family members

They do not want verbal abuse

They do not want to be exploited for work

They want to continue their schooling

They feel that they are better off on their own.

(Continues...)

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Excerpted from AIDS ORPHANS RISING by Mary Elizabeth Lloyd Copyright © 2008 by Sister Mary Lloyd, M.P.F, Ed.D.. Excerpted by permission.
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