Who are vulnerable children?

The difficulties experienced by children, caregivers and families living in communities affected by
AIDS are increasing dramatic as the epidemic matures and deaths increase. The worst affected
children experience multiple losses, including:
• health and vitality, through infection, inadequate nutrition and poor health care;
• economic support through the collapse of livelihoods resulting from the illness and death of
breadwinners and other adults in the extended family who were previously engaged in economic
support and subsistence activities;
• parents and other primary caregivers to illness, death and abandonment;
• families, as they are parted from caregivers and siblings following bereavements and poverty induced migration;
• connections to social institutions as a result of stigma in the community and withdrawal from
school because of poverty, work and/or care obligations in the home;
• human right to development in an environment that supports their basic needs for health,
education, care and protection;
• opportunities to learn from caregivers and play with other children because parents may be
too ill, because of stigma leading to exclusion, or demoralisation in the family environment;
• hope and opportunities for the future.
Large numbers of children are affected by the HIV/AIDS epidemic, in different ways. They include
the following groups.
Children indirectly affected by the AIDS pandemic
Many children in sub-Saharan Africa are vulnerable irrespective of the HIV/AIDS epidemic due to
such factors as child labour and lack of access to health and education
. In addition there are children with disabilities, street children, working children, children in institutions and children in conflict zones who may all be considered to be vulnerable children living in especially difficult circumstances
HIV/AIDS indirectly affects large numbers of these already vulnerable children because social
institutions and services are weakened when teachers, health service providers, civil servants and others become ill or are distracted by their responsibility for sick and dying relatives.
Children in households that foster children
The mainstay of the response to orphaned and vulnerable children is family fostering, a practice
common throughout Africa that predates the AIDS epidemic. Children who live in poor households
that foster vulnerable children face similar hardships because resources in receiving households are stretched to accommodate additional dependents.
Children living with chronically ill adults
Children living with chronically ill adults endure severe economic and psychosocial effects, but
remain generally invisible to service providers. When caregivers are ill, children may not only
suffer compromised parenting and childcare, but the diversion of income and assets to pay for the
treatment of sick adults deepens poverty. In addition, caring for sick and dying relatives imposes a physical and psychological burden on children. The impact of chronic parental illness on children is one of the most poorly understood and neglected difficulties faced by affected children.
Children living with HIV/AIDS
Deaths from poverty-related diseases account, for the most part, for the extremely low life
expectancy of children living with HIV/AIDS (CLHA)1 in sub-Saharan Africa. For this reason, public health measures to promote the general health and wellbeing of all children in communities
affected by HIV/AIDS are as important in extending and improving the quality of the lives of CLHA
as the delivery of paediatric antiretroviral treatment in a child-appropriate manner.
There are also major psychosocial challenges facing children living with HIV/AIDS and their
caregivers, including stigmatisation and the pain and distress of chronic illness.
Children orphaned or abandoned as a result of AIDS and other causes
Loss of a mother, father or other parenting figure is an extreme and ongoing challenge for a young child. This is especially true when the experience is repeated when more than one parenting figure dies. The order, spacing and nature of death experiences have a bearing on the effects on children, as it does on the support of kin and the closeness of family networks.
Adult mortality due to HIV/AIDS is causing a new and precipitously increasing form of orphaning
– but it is not the only cause; others include war, violence and accidental death. “AIDS orphan” is a particularly stigmatising, and even objectifying, term; despite its charitable appeal, efforts should be made to stop its use.
1 The term “Children living with HIV/AIDS” (CLHA) is preferred to “infected children” or “paediatric AIDS” because it links children to the rights-based PLHA (People Living with HIV/AIDS) movement.
Where the heart is: Meeting the psychosocial needs of young children in the context of HIV/AIDS
The impact of the AIDS epidemic on children and families is frequently illustrated by the increase
in orphaning, often referred to as the third wave of the epidemic – following infections and AIDS
deaths. The proportion of children being orphaned by AIDS is cumulative, creating a “long wave”,
and many children are losing both parents.
Figure 2 shows three curves. The first curve shows HIV prevalence and, because of the long
incubation period, adult AIDS illness lags behind infection by 5–10 years. People with AIDS require treatment and care and will die unless dramatic changes occur in the effectiveness, availability and cost of treatment.
The third curve shows the impact of AIDS on vulnerable children, resulting from the death of young adults with consequent orphaning, loss of work and livelihoods and deepening poverty.
Figure 2: Curves of the epidemic: Prevalence, AIDS illness and impact

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