Mail and Guardian, 4 October 2002, A lost generation, Belinda Beresford
South Africa's future is being eroded by the suffering of its children as the Aids epidemic takes away their hope along with their parents.
Children are traumatised by losing those who should be nurturing them, first to illness and then to death. They also lose their chance of a secure future as Aids drains the financial resources of the family, pushing them out of schooling and into the role of carer.
A road map of this slide into desperation and poverty is given by the findings of a soon-to-be-released survey by Abt Associates of 771 households in four South African provinces. The survey was commissioned by the United States-based Henry J Kaiser Family Foundation. The researchers examined the social and economic responses of households where at least one adult was Aids sick, rather than just HIV-positive. Their results show not only the human suffering, but also the developmental losses that HIV/Aids is triggering.
Of the households in the study, 72% were headed by women, of whom one in five was a pensioner. But 31% of the household heads were either Aids sick or chronically ill, suggesting undiagnosed late-stage HIV infection.
The average time from becoming Aids sick to death was about a year, implying that within the next 12 months or so almost a third of the families surveyed could lose the household head and this is likely to be followed by the disintegration of the family unit.
Most of the Aids sick women and men in this survey were in their productive and reproductive prime -- the average age for women was 33, and for men 37.
More than a fifth of the children in these households had been orphaned by Aids. One in 12 children (8%) looked after an Aids sick adult. Combine this with the fact that many households did not have access to proper sanitation or running water, and this puts children at physical and psychological risk. Death from Aids is often prolonged, traumatic and unpleasant, frequently involving vomit, faeces, open wounds and blood. This exposes carers not only to HIV but also to microbes causing the opportunistic infections that will eventually kill the patient.
The child-nurses also have to cope with the mental trauma of caring for a sick and probably incapacitated relative, possibly already having seen someone die of the virus, and knowing what the future brings.
For some of the children in this study, their lives had already been severely dislocated more than once by HIV. One in eight people interviewed said financial or physical strain had led them to send children elsewhere to live. More than a third of these displaced children were sent to live with another parent, and 35% were sent to grandparents.
And many of the households interviewed, particularly those in rural areas, contained children of a number of different parents who could no longer care for them.
Without social safety nets, caring for the additional children pushes families towards greater poverty, and even those children whose immediate family is not infected may be affected by having to share resources with offspring of the extended family.
The survey revealed that the safety net of the extended family was still largely holding, and only 2% of non-resident children were living in institutions. More worryingly, the same percentage had effectively been lost in that the family no longer knew where they were.
But sometimes children are left to fend for themselves.
One of the people interviewed was Siyathemba. "I am 16 years now. In 1999 my life started changing when my father passed away. In August 1999 my mother vanished. She went seeking a job and never came back. I don't know whether she's alive or dead. I wish she could come and stay with us. When the day comes to go to school I go look after cows of other people so I can get money for me and my sister and brother to go to school. My other sisters and brother take the money from the neighbours. For looking after cows I get R100, that is, R3 a day. I am in standard nine and I was suspended because my school fees are not paid. I go to the forest with cattle every day at sunrise."
The toll of HIV/Aids is not just in the statistics or development indicators like increasing numbers of child-headed households or falling numbers of children in school. The impact is also in the soul of youngsters not only facing stigma and discrimination, but who are also deprived of the nurturing they need to develop into socialised adults.
One woman detailed how she tried to protect her HIV-positive four-year-old son socially. She didn't have enough food for the two of them, but nonetheless said: "I give out some so they can accept us and be friends with my son."
Hunger was a hazard for half the families interviewed, with children suffering from lack of food, as well as adults. Even disregarding the distress felt by unfed children, malnutrition is clearly linked to physical and mental damage in developing bodies.
One of the great development challenges has been to improve the lot of females in the many societies worldwide where males are considered more important. Often this requires active policies, in particular to encourage the education of girls, which, in turn, should encourage later child rearing and improve their economic clout. But the priorities of households under strain in this survey reinforced the gender bias -- almost twice as many girls (roughly one in 10) as boys were out of school.
Of the children not attending school, 2% of girls and a slightly higher percentage of boys had never enrolled.
Children are an investment, both for their families and for the country. An indication of the importance families ascribe to education was the fact that only 4% said they had cut spending on school fees as a result of Aids. But lack of uniforms and books was also keeping children out of school.
However, an indication of the relative importance of education for girls and boys was the fact that families knew the schooling status of all boys who had been sent to live with other relatives, but almost a quarter didn't know whether non-resident girls were at school.
Ominously, the second most common reason for girls leaving school was pregnancy. Early child-bearing not only restricts the lives of the young mothers, but also tends to consign their children in turn to poverty.