Families and communities

Families and communities

Families, friends, and the wider community are the first line of protection and support for children, providing for their practical and material needs, as well as social, psychological and emotional needs. Yet in countries with a high HIV prevalence, AIDS places an economic burden on families and communities, making it difficult for them to provide and support for their children. The main reason for this is that AIDS normally affects adults when they are most economically productive⁴⁴. Reduced household income combined with increased expenses (for example for treatment, transport, funerals) may push families into poverty, which has negative outcomes for children in terms of nutrition, health status, education and emotional support. Most children (9 out of 10) orphaned by AIDS still have a surviving parent, and if they are put into residential care it is most often due to extreme poverty.⁴⁵

As a family and community centred approach to care for a child affected by AIDS is the most beneficial for a child’s development- experts emphasise that taking children away from their families should be a last resort.⁴⁶ For this reason, social protection schemes that provide external assistance to poorer families in areas where HIV prevalence is high are now seen as a valuable part of improving the lives of children affected by AIDS. By reducing a household’s economic vulnerability, children benefit from better nutrition, the opportunity to go to school instead of work and better access to healthcare. Moreover, children benefit from the emotional support that is provided through the family.

The most simple social protection measure is the cash or income transfer. These are ‘cash disbursements to individuals or households identified as highly vulnerable’. They may be conditional or unconditional. For example, a cash transfer programme in Ghana requires households receiving financial assistance to ‘keep children in school, register with the National Insurance Scheme, and bring children to health facilities for regular check-ups’.⁴⁷ One analysis has found that a cash transfer of $15 per month to the poorest 10% of households in sub-Saharan Africa would cost 3% of the aid to the region pledged at a summit of world leaders in 2005. ⁴⁸

Community and faith based organisations provide much of this support but it is now widely recognised that supporting children affected by AIDS primarily through their families and communities can be done most effectively through a national strategy. A number of sub-Saharan countries (Ghana, South Africa, Kenya, Malawi) have already introduced government–led initiatives that include providing vulnerable children with some sort of external support.⁴⁹

Keeping adults alive and economically productive is essential to providing for children affected by AIDS. Kinship structures are already strong in many African countries where children are most affected; in fact more than 90 percent of children who are infected with HIV or whose parents are infected are living with their extended family.⁵⁰ However, more needs to be done to ensure that these vital sources of protection for children affected by AIDS are supported and strengthened.