CHAPTER ONE Introduction and Problem Statement

1. Introduction The HIV/AIDS pandemic has been described to be in many ways a / unique family disease with far reaching health, social, psychological and economic

implications

Williams, 1990:3).

(See:WHO/UNICEF

1994:5,

Campbell

and

Although it initially enters the family as a result of

multiple sexual relations of one of the partners, its' mode of transmission is 90% heterosexual

(Campbell

and

Williams

1990:3).

consequence of this mode of transmission in Africa is

The

tragic

that besides

affecting men and women in equal numbers (See: Williams, 1990:3), it is almost a foregone conclusion that in

households in which one parent is

infected, the other often is as well (See:Preble, 1990:678).

Sadly, since all HIV infected persons (parents being no exception) ultimately progress from infection to AIDS and death, usually between 5-12 years after infection (See: Peble, 1990:673; Mukoyogo and Williams, 1991:2), most

HIV/AIDS orphaned children, unlike children of other

calamities; experience prolonged mental trauma and economic as they helplessly watch their parents wither and

hardships

die. (WHO/UNICEF,

1990:7).

Another uniquely tragic consequence of HIV/AIDS pandemic in Africa is its systematic decimation of economically their childbearing years; leaving in its elderly caregivers (See:Daily 1994:5; UNICEF

1990:15 and

productive adults in

wake vulnerable children and

Nation, May 22, 1993; WHO/UNICEF, 1991:2).

Researches conducted

in

sub-Saharan Africa have found that over 85% of persons with HIV/AIDS fall within the 20-45 age group (See: Mukoyogo and Williams, 1991:12; Daily

Nation, May 22, 1993; November 11, 1,992; UNICEF, 1991:5;

Anderson and Kaleeba, 1994:89). This, unfortunately, happens to be the

age bracket with the highest concentration of parents with children to care for.

The Global Programme for AIDS

reported that 0.7 million

(WHO/GPA, 1994:2) for instance,

children were born to HIV positive women in

Africa in 1993. Of these children, between 30-40% were probably infected with

HIV and are therefore destined to face early death (Mukoyogo and

Williams, 1991:2; UNICEF, 190:4; Preble, 1990:673); while infected are expected die by age 5 (Preble,

80% of the

1990:673). For the majority

(60-70%) who are uninfected, they will sooner or later be orphaned.

Accordingly,

among

the

many

daunting

and

unfortunately,

^

unanswered questions concerning children who survive their parents are : who normally assumes the responsibility of them ?

Do they usually find able and willing carers ? What material

deprivations do they death ?

caring and/or providing for

suffer during their parents' illness and after their

To what extent does the traumatic nature of the loss of their

parents impair their psychological development ?

Almost unnoticed, the HIV/AIDS epidemic has created a new, large (/ and especially vulnerable group of motherless children Africa (Michael and Levine, 1992:3-59).

in sub-Saharan

Various independent surveys

estimate the magnitude of country-specific HIV/AIDS orphanhood at 12% ( 0 . 6 - 1 . 2 million) of all Ugandan children under age 15 in 1991 (UNICEF, 1991:4); 160,000 Tanzanian children by 1994 (Bazira, 120,000 Malawian children by1995 (UNICEF,

1994:Abstract);

1991:9); 300,000 Kenyan

children by 1996 (UNICEF, 1991:3; WHO/UNICEF, 1994:52) and 1 1 % of Zambian children under age 14 Overall it is projected

by the year 2000 (UNICEF, 1991:9).

that sub-Saharan Africa will account for between

3.1 y 5.5 million HIV/AIDS orphans by the year 2000; rising to 16 million by 2015 (Valeroy 1991, Cited by Rutayuka, 1994:Abstract).

Besides creating an unmanageable orphan "burden'for families an institutions that offer child care and support, the

growing number of

children losing their mothers to HIV/AIDS is threatening to overwhelm any and all historic institutions

of child care and support

Africa

Consequently, researchers and child-related

(UNICEF,1991:1).

in

sub-Saharan

agencies ought to urgently explore how communities, institutions and governments

can

respond

in order to avert

an

impending

social

catastrophe of enormous proportions and dimensions. Although extended family networks continue to absorb orphaned children in conformity with traditional norms, (Hunter, 1990:683), AIDS observers are increasingly concerned that strands in

with the advent of mass HIV/AIDS orphanhood, some

the extended family

safety net' have become increasingly

frayed, or have snapped altogether (Mukoyogo and Williams, Hampton and Barnett, 1992:124).

For instance, in

HIV/AIDS deaths such as Rakai and Masaka combined total of 24,524 orphans Kagera region of Tanzania 1991:9); the prospect of already

a reality

1991:12;

areas ravaged by

districts of Uganda with a

in 1990 (UNICEF, 1990:15), and the

with 30,000 orphans in 1991 (UNICEF,

an overwhelmed extended family support is

whose evidence

may be observed in the

many

child-headed households, orphan siblings and/or groups surviving on their own, and in the increasing number of homeless street children.

In light of the unfolding scenario in the above named areas,

and

the massive scale of orphanhood predicted for most of East and Central African countries; the possibility of a massive breakdown of the traditional system of adoption is, potential

indeed, a chilling prospect.

Recognizing

enormity of the calamity and the need to initiate

intervention measures, some AIDS observers have searching questions about the scope and extended family support system. which the extended support for

the

institutional

began to

ask

tenacity of the traditional

Of particular importance is the extent to

family system continues to provide care and/or

HIV/AIDS - orphaned children. For instance, where the

extended family fails to provide for the orphaned children, happen to those children ?

what will

Unsurprisingly, UNICEF (1990:15) has aptly predicted that the problem of how the extended family can continue to provide food, shelter, clothing, school fees and beddings; not to mention love and affection for all the children it has to

absorb, may soon become the most important

social challenge, facing AIDS activists and researchers in Africa.

In fact, AIDS observers, widely

acicnowledge that dwindling

extended family support has condemned many HIV/AIDS children and households into a precarious survival (See: Williams, 1991:11 and UNICEF,1990:15).

^'

orphaned

Mukoyogo and

Consequently, hundreds of

thousands of HIV/AIDS orphaned children and caregivers are engaged in a relentless

struggle

for basic needs, i.e. food,

shelter,

clothing,

beddings, and school fees, for love and affection; and against exploitation and discrimination

(Mukoyogo

and Williams,

Anderson and Kaleeba (1994:21) opines that

1991:3).

Accordingly,

caregiving

household

deserve to be supported in their traditional role, for without support, families and

communities may abandon their traditional caring roles.

Resulting in destitution, homelessness and, ultimately

massive social

breakdown.

According to WHO/UNICEF (1994:49), the first step in this process is measuring the scale of orphan problems and needs, in order to crystallize the situation for policy-makers, donors, child-oriented agencies and to also provide the basis

for planned and coordinated responses.

However, since little is known as yet about the magnitude, problems and needs of children and households affected by HlV/AlDS; few governments and child -oriented agencies have initiated programmes and services for children and families in this situation.

Hopefully, the data and information generated from this and other N/ similar researches, will enable AIDS oriented agencies to monitor social, economic, political and demographic breakdowns; and learn how to

ameliorate its effects. It is our view therefore that the foregoing exposition constitute/adequate justification for a full-fledged

exploratory study on

children orphaned by HIV/AIDS.

1.1: Problem Statement

The

plight of children orphaned by HIV/AIDS, otherwise

to as AIDS orphans, has been reported to cause much

referred

psychological

trauma to infected parents before they die. (Hampton, 1990:18; UNICEF, 1993:22; Parents Magazine, No.89, November, 1993:8). Among the many questions often asked by

people with HIV/AIDS (PWAs) are : Who will

care for my children when I am gone? When my wife/husband is gone ?

Will my relatives neglect them just because we died of

But important as they are, the above unanswered magnitude,

since

there

questions,

HIV/AIDS?

unfortunately, remain

is as yet little empirical information on the

problems and needs of children and/or families affected by

the HIV/AIDS pandemic.

Unsurprisingly,

AIDS observers, among them, UNICEF

1991), and WHO/UNICEF (1974),

have voiced their sceptism

reliability of whatever available information on East

Africa.

orphanhood

For is

one,

derived

WHO/UNICEF, 1994:64).

most from The

empirical the

rural

likely

(1990; over the

HIV/AIDS orphanhood in information

areas

on

(UNICEF,

HIV/AIDS 1991:20;

rationale for this bias is the

assumption that a majority of HIV/AIDS orphans are found in rural areas, since reverse are

(urban-rural) migration by PWAs and/or orphan relocation

seen as common responses in most sub-Saharan African towns

(Bennet, 1987:534; Mburugu, 1993:13-14; WHO/UNICEF, 1994:77). However,

Preble (1990:672-73) and UNICEF, (1991:12) appears

consider the assumption illogical since HIV infection higher in urban areas.

to

rates are invariably

v

The question as to whether a majority of HIV/AIDS orphans are found in rural or urban areas is a moot research issue. primary concern in the present study is that information on HIV/AIDS orphanhood in

However, our

paucity of data and

urban areas is hampering the

formulation of approaches for use in urban environments, where cases of HIV/AIDS orphaned children without extended family carers are perceived to be fairly common (See:WHO/UNICEF, 1994:64).

Moreover, Kenya with a projected population of 300,000 HIV/AIDS orphaned children by 1996 (See: Dr. Abduallah, in Parents Magazine, No.89, November, 1993; UNICEF, 1992:3; WHO/UNICEF, 1994:52), rising to 600,000 by the year 2000 (National Development Plan, 1994-96:262); has the second highest HiV/AIDS orphaned population in East Africa. After Uganda with an estimated 0.6 - 1.2 million orphans in 1991 (Hunter, 1991:681); and ahead of Tanzania with 160,000 orphans in 1994 (Bazira, 1994: Abstract) and an estimated

500,000

by the year 2000 (Mukoyogo

and Williams, 1991:4).

Ironically though, besides UNICEF's (1994) consultancy reports coauthored by Saoke and Mutemi, there has not been any other significant study

of HIV/AIDS orphanhood problem in Kenya.

available empirical information on the three initial AIDS

In fact, whatever

problem is largely derived from

epicentres; namely, Rakai and Masaka districts of

Uganda, and the Kagera region of Tanzania (See, among others, Hunter 1990; Muller, et al. 1990;

Mukoyogo and Williams,

1991; Kamali,

ef.a/,1992; and Mutembei,1992). Unfortunately, in the absence of up-todate empirical information on the numbers, needs of children orphaned by

distribution, problems and

HIV/AIDS, organisations addressing the

needs of HIV/AIDS orphaned children in Kenya are inevitably, working in an

information and policy vacuum. Accordingly, measuring the scale of

orphan problems in Kenya would serve as an important stepping stone for policy makers, donors and child - oriented

organizations, as well as

providing a basis for planned and coordinated responses.

1.2: Justification and Study Objectives

The study aims at interviewing orphan caregivers and adolescent orphans in Kisumu and its peri-urban environs with a view to finding out the nature and scope of their problems and needs; socio-economic status; type and level of extended family support; and non-family assistance. The motivation to conduct this particular research emanates from the fact that no significant study on HIV/AIDS orphanhood has been conducted in

/

Kenya to date in spite of persistent concerns by dying (HIV/AIDS-infected) parents over the welfare of their children, and despite

the large and

increasing number of children orphaned by HIV/AIDS. The number of HIV/AIDS orphans in Kenya, for instance, are expected to double in the four years between 1996 and the year 2000 from 300,000 to 600,000. Consequently, children

organizations

operate

tackling

problems

and

needs

of

these

largely in a policy vacuum for lack of upto

date

researched information on the numbers, distribution, problems and needs of children orphaned by HIV/AIDS.

Accordingly, the present study expects to document demographic, socio-economic and sociological factors relating to orphan caregivers and their wards with a view to establishing: 1.

the impact of HIV/AIDS orphanhood on the socio-economic status of the affected children and households;

2.

the extent to which the traditional extended family provides child care and support to HIV/AIDS orphans;

3.

the

nature

and

magnitude

of

problems

and

needs

of

HIV/AIDS orphans and their caregivers; 4.

the type and level of non-family assistance received by orphan households;

5.

salient

caregiving

and

support

patterns

which

may

be

./

/

incorporated

into

assistance

programmes

for

HIV/AIDS

affected children and households.

The above stated objectives are primarily aimed at answering the following questions. (i)

Who normally assumes the responsibility of caring and/or providing for HIV/AIDS orphaned children? Do HIV/AIDS orphans find able and willing caregivers?

(ii)

Will traditional extended family support be sufficiently elastic to absorb orphans of the HIV/AIDS pandemic?

(iii)

What material deprivations do the affected children suffer during their parents* illness and/or death? socio-economic

differentials

between

Are there any

orphaned

children

supported by widowed parents and those supported by aged grandparents and other relatives? (iv)

Do most HIV/AIDS

orphaned children drop out of school at

the time when their parents are too ill to participate in productive work, or after the parents' death? (v)

Do children absorbed in caregiving households work for their livelihood,or

they

are

adequately

provided for

by

their

guardians?

1.3. Summary of Chapters

This thesis is divided into six broad chapters.

In chapter one, the

problem of HIV/AIDS orphanhood is introduced and formulated.

It is

explicitly stated that the present study focuses on HIV/AIDS orphanhood as a social predicament which originate^from HlV/AlDS, but which is not directly associated with HIV/AIDS the biomedical condition itself. A study of this problem, it is argued, is justified on account of

inter alia : its

geographical scope and magnitude, and its negative implications on the survival chances, welfare status, and psycho-social adjustment of the

v

affected and infected children. Furthermore the study's key objectives are outlined, and sun^mary of chapters made.

Chapter two, provides the empirical grounding and the theoretical model adopted in this thesis. Empirical

information is presented in form

of background information on HIV/AIDS orphanhood at the global, subSaharan Africa and Kenya context, and in form of a thematic review of literature relating to the study objectives.

The themes explored revolve

around caregivers' socio-economic status; demographic characteristics of HIV/AIDS orphans, scope of extended family care/support; problems and needs of HIV/AIDS orphans and their caregivers; type and level of nonfamily support to orphans and their caregiving households.

In the absence of a general sociological theory of HIV/AIDS orphanhood, this study sought to explain the phenomenon using the clanship system model developed by Ankrah (1993). thesis in this model is that beyond

The substantive

the changing and/or weakening

traditional African family is a network of people, most of whom are connected by kin or blood relationships, termed the clanship system. Patterns of family treatment and care are deeply embedded in this wider kinship system.

Hence, the clanship system could become the locus of

AIDS activity designed to ensure the well-being and continuity of the family where its leadership undertakes to sustain, to reorganize, or to create wholly new families or structures among populations being devastated by; AIDS.

New associations based on common emotional bonds of caring

beyond kinship ties will be necessary to support vulnerable members. However, for such to prove durable in the troubled socio-economic context of sub-Saharan Africa, these will need strong links to; or derive their legitimacy from the resilient traditional social network: the African Kinship System.

/ ^

In chapter three, a case is made for the collection and use of

^

primary field data, and for the choice of Kisumu town and its environs as the study site.

A detailed data collection strategy is presented.

In

particular, this strategy stipulate the mode adopted in the selection of study respondents, community

mobilisers and key informants.

The

methods of data analysis and problems encountered in the course of data collection

are specified.

In addition, operational definitions

variables and concepts is also made.

of

key

The data on which this study is

|

based is primarily drawn from 214 HIV/AIDS orphan caregivers and 47 adolescent

orphans.

This is augmented by documentary

data and

information elicited from key informants and FGD participants.

Maps are

also provided alongside to acquaint the reader with the site of study.

The study's findings are presented in chapters 4 and 5. Those in chapter 4 are isolated from the analysis of descriptive data, while those presented in chapter 5 are derived from the tested hypotheses.

Several key findings were isolated from the five themes covered in chapter four.

One, a high degree of regional and ethnic homogeneity;

gender bias and orphan caregiving was observed among the study respondents. 82 percent were female members of the Luo community : a majority ethnic group in Nyanza province. The mean family size was 7.5, with a range of 2-19 persons per household.

The mean number of

orphans per caregiver was 4.5, with a range of 1-13 orphans.

It was

therefore concluded that the problem of AIDS and by implication, that of AIDS orphanhood, is related to local socio-cultural factors and that AIDS orphanhood is aggravating the problem of role conflict among an already over-burdened female gender.

Two, orphan caregiving was found to be highly selective of poor individuals and households.

85 percent of the respondents fell into low

income categories; 60 percent lived in crowded 1-2 roomed houses; 81

10

v

percent were either unschooled or had some basic primary education; 84 percent

had

no dependable

gainful

employment;

while

74

percent

identified lack of school fees and other educational expenses as a major impediment

to orphan

schooling, as compared

to 20

percent

who

prioritized basic needs problems. Overall, 90 percent of them identified low and/or inadequate income as the leading impediment to orphan caregiving.

It was therefore

concluded that the problem of

orphanhood is inextricably linked to low socio-economic

AIDS

status; and that

caregiver poverty is the main explanatory variable to orphan destitution.

Three, HIV-infected fathers

(or male partners) were found to

\/

predecease their wives (or female partners) regardless of differences in socio-cultural and geographical factors.

75 percent of the orphans were t

paternal, as compared to 43 percent maternal and 34 percent orphans.

Furthermore, a strong negative correlation obtained between 1

being orphaned and access to schooling.

Of the 807 orphans aged

between 5-18 years, 43 percent did not pursue any schooling or training activity.

Unfortunately, limited schooling, or the lack of it, impacts

negatively on the life chances of orphaned children.

Four, all (100 percent) the 807 orphans were supported by family members.

J -

double ' •

Thus suggesting resilience of the traditional extended family

fosterage system. However, for the vast majority of orphan caregivers, 50 percent of whom were surviving widowed mothers, the locus of material and psycho-social

support tends to shift away from the

husband's

extended family segment (in-laws) to their respective agnates upon the husbands demise.

Infact, maternal relatives, as opposed to paternal

ones, maintained a higher level of social contact and material assistance to orphan households by 17 and 31 percentage points respectively.

Lastly, absence of a formal institutional framework for tackling the problem of AIDS orphanhood was quite evident at the study site. Only 25

11

percent

of orphan households

material assistance.

reported ever having

received

some

Even then, all (100 percent) the assistance came

from community-based agencies, namely: the extended family: 60 percent, neighbourhood friends: 28 percent; NGOs: 7 percent; local groups: 5 percent.

religious

It is however observed here that persistence of

institutional apathy and/or indecision; rampant AIDS orphanhood, and previous donor support, have goaded some individuals and PVOs in Kisumu, Kenya, to initiate some spontaneous intervention activities aimed at mitigating the plight of HIV/AIDS orphans. Among these initiatives were : 5 informal schools; 2 community orphan homes and 6 community Pharmacies.

In chapter five, specific hypotheses were tested for

statistical

significance of association. In particular, the Chi-square (X^) statistic was

V'

used to ascertain the extent to which relationships between the dependent and

the

independent

association.

variables

depart

substantially

from

chance

Among the key findings are that an orphan's access to

schooling/training is closely related to the surviving parent's/caregiver's socio-economic status, rather than his/her demographic characteristics; that

orphan

caregiver's

priority

needs preferences

economic and demographic

are influenced

by both the

variables; that a caregiver's

choice to take up orphan caregiving is always a moral one and does not depend on the economic well being of the family or caregiver; and that, a caregiver's

subsequent

inclination

to

surrender

orphan

upkeep

responsibility to another carer tends to be influenced significantly by his/her economic, rather than social or cultural factors.

Chapter six is devoted to summary discussion, conclusions, policy recommendations and suggestions for further research. essentially

a synthesis

of the theoretical

information

The chapter is reviewed

and

empirical findings on HIV/AIDS orphanhood in Kisumu, Kenya. Among the key conclusions are ; that institutional orphan care/support programmes

12

v/

are not sustainable caregiving models for Kenya, and sub-Saharan African countries in general; that orphan support agencies should recognise and built on people's strength or own capacity to cope with AIDS orphanhood; that there is an urgent need for an integrated multi-sectoral structure and strategy to co-ordinate orphan responses; that all orphan intervention programmes should base their strategies and action plans on data derived from Focused Ethnographic Studies (FES) of the target communities; that orphan assistance agencies should identify vulnerable children as early as possible

in

programmes

the

cycle

of

parental

should seek to assist

loss;

that

orphan

intervention

HIV/AIDS- affected children

and

families equally, and should as a rule not isolate AIDS orphans from other orphaned children; and that there are no model responses to the problem of AIDS orphanhood.

This is because AIDS orphanhood is a dynamic

problem whose severity varies in space, time and community.

The present study therefore recommends a mix of responses to be applied

selectively,

singly

circumstances may warrant.

or

in

varying

combinations,

as

the

The recommendations consist of specific

structural changes that should be undertaken in order to bolster the country's capacity to tackle HIV/AIDS orphanhood; together with a wide range of assistance initiatives that target orphaned children and/or their caregivers. Finally, specific issues in need of further clarification in future orphan researches are identified.

13