CHAPTER 1

INTRODUCTION

Robyn Pharoah

Published in Monograph No 109, December 2004

A Generation at Risk?
HIV/AIDS, Vulnerable Children and Security in Southern Africa

Edited by
ROBRYN PHAROAH

With an estimated 38 million people living with HIV/AIDS worldwide,1 the virus is acknowledged as a significant humanitarian and developmental challenge. It is also increasingly seen as a security issue, with implications for the well-being of individuals, households, communities and states. As argued by the Centre for Strategic and International Studies (CSIS):

HIV/AIDS can be so pervasive that it assaults, as surely as prolonged armed conflict, the essence of the nation-state: secure fa mili es and communities; economic and political institutions; mili tary and police forces. Children are orphaned, communities are decimated, fields go untended, and the risk of famine grows. The long-term effects of HIV/AIDS on macro-economic growth, productivity, food supply, and nutrition—and the precise interlinkages among these factors—are not yet well understood. What is clear is that the pandemic is reversing developmental gains achieved through major investments over the last 50 years.2

The problem of children left orphaned and vulnerable by HIV/AIDS has received particular attention. Increasing numbers of organisations are involved in researching, advocating for and supporting such children. Yet even as the global community has acknowledged the human tragedy that orphaning on the scale heralded by the HIV/AIDS epidemic represents, it has been speculated that large numbers of orphans may themselves represent a security challenge.

The impact of HIV/AIDS

In contrast to most other infectious diseases, HIV/AIDS does not impact most on the weak, the very young and the elderly. Individuals are most likely to contract HIV in their late teens and 20s, and due to the lag between contracting HIV and developing the symptoms of AIDS, are likely to become ill and die in their 30s and early 40s. In South Africa, for example, it is estimated that the average age of those dying as a result of AIDS is 37 years.3 This has several implications, not least of which is that individuals fall ill and die at a stage of their life when they should be contributing most to the household and national economy. They also fall ill during the years they are most likely to be having children, leaving them at risk not only of infecting their progeny but also being unable to care for and raise them.

The implications of this are diverse and are as yet being understood, but it is speculated that by debilitating and killing large numbers of parents, workers, civil servants and politicians, AIDS will increasingly undermine the foundations of human and economic development. In the absence of accessible, comprehensive responses to the epidemic, it is argued that Southern Africa and other hard hit regions of the world will experience growing socio-economic problems: the wealth and assets of many affected households will be reduced, economic productivity will decline, the quality, reach and responsiveness of government institutions and service delivery will be reduced, fa mili es will be broken up and the demographic structure of populations skewed. Such impacts, in turn, will affect households, communities and societies in a range of ways. Key consequences could include increased poverty, vulnerability, inequality, and declining life chances and choices for the generations to come.

Most relevant to the discussion at hand, it has been argued that by reducing the resources available to children and destabilising the institutions on which they depend—such as the family, school and community—HIV/AIDS may severely affect children’s development. This may not only result in increased child mortality, morbidity and school drop out but also increased victimisation and exploitation of children.

Moreover, by reducing the financial and emotional resources available to children, causing trauma and alienation and effectively limiting the realistic aspirations of the youngsters affected, it is feared that the epidemic may create generations of disenfranchised and potentially dysfunctional young people who lack the socialisation necessary for constructive social engagement. In the words of Barnett and Whiteside:

We are talking about unsocialised, uneducated, and in many instances unloved children struggling to adulthood. The costs to them remain unmeasured. The costs to the wider society are potentially enormous ….4

Orphans, crime and instability

According to the literature, growing numbers of marginalised children may impact on stability and security in two ways. First, such children may become not only victims but also perpetrators of crime. Schonteich, for example, maintains that increasing numbers of children with fewer life chances and less support may lead to higher levels of crime. He argues that growing levels of poverty and vulnerability, the emotional trauma associated with AIDS-related parental death, reduced levels of parental guidance and control and the loss of positive role models may encourage not only victimisation of children but also delinquency and criminal behaviour. Schonteich also argues that an over-representation of young people, especially young men, between the ages of 15 and 24 in high-prevalence countries may create an environment conducive to higher levels of violent crime and group-based aggression.5 Citing an American National Institute for Justice paper on violent crime, Schonteich notes that:

Age is so fundamental to crime rates that its relationship to offending is usually designated as the ‘age–crime curve’. This curve, which for individuals typically peaks in the late teen years, highlights the tendency for crime to be committed during the offender’s younger years and to decline as age advances.6

The point that poorly supervised, traumatised and marginalised children may be more likely to become involved in both crime and ‘anti-social’ behaviour is also made by Steinberg and his colleagues, who argue that:

Many orphans will grow up as street children or will form child-headed households to avoid being separated from siblings. Others will be brought up by grandparents with limited capacity to take on parenting responsibilities. All will have been traumatised by the illness and death of parents, and often by separation from siblings. Trauma will be exacerbated by stigma and secrecy … that hampers the bereavement process and exposes children to discrimination in their community or even extended family. Orphans will probably be more susceptible to becoming HIV-infected through abuse, sex work or emotional instability leading to high-risk relationships. As children grow up in these pressurised circumstances, without adequate parenting, support and opportunities, they are at high risk of developing antisocial behaviour and of becoming less productive members of society. The consequences for affected children and society as a whole will be profound.7

The links between growing vulnerability and criminal behaviour are also highlighted by Oni and colleagues in their examination of the likely economic implications of the epidemic for rural households in South Africa ’s Limpopo province. They write that:

Many of these children [orphans through HIV] may become destitute, hungry, exploited, and in some cases left completely vulnerable to all sorts of crime, including child prostitution and drug abuse.8

Second, they may provide a ready recruitment pool for individuals and organisations wishing to challenge the existing status quo. Considerably less has been written on this aspect of the orphan issue and the authors that do tackle this subject generally draw on the experiences of countries in Central and West Africa. Cheek, for instance, argues that orphans who are disconnected from social, economic and political support structures may constitute “‘an extra national’ population group, who could easily become tools for ethnic warfare, economic exploitation, and economic opportunism”. He gives the example of Sierra Leone, where children marginalised by war were recruited into the Revolutionary United Front (RUF) with promises of food, alcohol, drugs and a sense of community—boys as ‘child soldiers’, girls as sex slaves to male fighters. Cheek writes that uneducated, malnourished and purposeless children represent “a potential army in search of a leader”, which if exploited, could effectively destabilise most countries in Southern Africa.9

Zack-Williams, referring to his study of child soldiers in Sierra Leone, draws similar conclusions. He notes that where societies are under stress and governments have little to offer, orphaned children may easily take up arms, be recruited by millenarian cults or fall prey to unscrupulous politicians.10

As with many other analysts, Cheek also emphasises the threat posed by increased numbers of street children. Indeed, although his paper highlights the dangers presented by growing numbers of unsupported, disenfranchised children, there would seem an implicit assumption that the majority of these children will end up on the streets. Describing the implications of the epidemic for society Cheek argues:

The implications for children are staggering. Those living with grandparents rarely attend school regularly. Many are malnourished. Those living on the streets lead nearly wild lives. Starvation, violence, crime, and sexual exploitation are ‘normal’ activities. Having already experienced death and the reality of survival on the streets, life for these children is short, harsh, and cheap. They exist in a world where money is begged or stolen, food is unreliable, education is irrelevant, and survival of the fittest is the norm. Their ties to civilisation and society are being eroded by the need to survive on terms they can not control.11

Later, describing the potential for children to be recruited into mili tant groups, Cheek writes of South Africa that:

While no potential leader currently exists in South Africa, latent bitterness over economic disparity and ethnic/racial tensions provide adequate tinder in search of a spark. Even without a formal leader, [the prospect of] hundreds of thousands of street children terrorising Soweto/ Johannesburg, the Cape Flats/Cape Town, and Durban is frightening enough to draw international attention.12

Questioning the assumptions

Inherent in virtually all of these arguments is the idea that orphanhood, and AIDS-related orphanhood in particular, will often leave children in precarious circumstances; children will be damaged by the trials and tribulations they experience and will ultimately be less equipped to contribute meaningfully to or run healthy societies in the future. As argued by Bray in her critique of prevailing predictions of the consequences of orphanhood in Southern Africa:

The logic is presented as a direct causal relationship that runs something like this: parentless children will grow up without role-models, and hence will lack social skills, a moral framework and discipline. Large numbers of children and young adults who do not have these qualities will precipitate a breakdown in the moral order and social fabric.13

Bray notes that underlying such supposedly causal relationships are a number of assumptions, including that: AIDS mortality rates will produce high numbers of orphans; these orphans will not live in social environments that will adequately equip them for adult citizenship; the experience of such children will be qualitatively different from that of other children; poor socialisation will result in them not living within societies’ moral codes (becoming street children or delinquents) and that large numbers of ‘asocial’ children will precipitate some kind of societal breakdown.14 To this list I would add the assumption that children raised in difficult circumstances will almost inevitably suffer negative psychological, social and behavioural outcomes.

Yet, can we make such assumptions? Many of the arguments highlighted above are openly speculative in nature, are based on limited empirical data and would seem part of a growing body of advocacy-oriented literature aimed at raising awareness of HIV/AIDS as a potentially significant security (as opposed to health) issue. This they do admirably, but in the process do they perhaps paint an overly pessimistic and insufficiently nuanced picture of what HIV/AIDS may mean for children and society in the future? Will orphaning as a result of the HIV/AIDS epidemic necessarily result in large numbers of children being left in uncertain circumstances?

In a region where millions of children already live in varying degrees of poverty and vulnerability, and care arrangements seldom resemble the ‘ideal’ nuclear or extended family, will the experience of children affected and orphaned by HIV/AIDS be qualitatively different from that of other children? Will the epidemic necessarily result in large numbers of scarred and marginalised children, and what may make some children better able to weather the hardships created than others?

The objective of this monograph is to begin answering some of these questions. It is by no means a definitive analysis of the issues, but aims to contextualise the above arguments by exploring both the context in which AIDS orphaning is occurring and the likely developmental implications of both parental illness and death. In so doing it seeks to better understand both what it means to be a child in Southern Africa and the factors affecting the interplay between HIV/AIDS, poverty and vulnerability.

To this end, Chapter Two examines the psychosocial implications of HIV/AIDS for children, particularly the impact of parental loss and stressing of care and support systems. Chapter Three explores the characteristics that make some children better able to withstand adversity than others. It looks at the factors that are associated with risk and resilience and, given the experience on which the risk and reliance literature is based, discusses the likely consequences of the epidemic for children and the societies in which they live. Chapter Four considers the support environment available to children in Southern Africa. It focuses on the interplay between informal mechanisms provided by the family and the community and formal support mechanisms provided by the state and the non-governmental organisation (NGO) sector, the implications of various models of care and how statutory agencies can strengthen family and community safety nets to cope with orphans and other children made vulnerable by HIV/AIDS. Chapter Five examines key issues that policy makers should be aware of in designing interventions to support children made vulnerable by HIV/AIDS. It then goes on to highlight programmatic responses used successfully to date in the region, before finally bringing together the lessons learned from such programmes. Chapter Six draws together the key lessons illustrated in the four papers, their contribution to the debate and main policy issues for the future.

Notes

1. UNAIDS, Report on the global AIDS epidemic, Geneva, 2004.
   
   

2. M Schneider & M Moodie, The destabilizing impacts of HIV/AIDS, Centre for Strategic and International Studies (CSIS) HIV/AIDS Task Force, May 2002, p 5.
   
   

3. Families tipping into destitution, Mail & Guardian, 27 September 2002.
   
   

4. T Barnett & A Whiteside, AIDS in the twenty-first century: Disease and globalization, Palgrave Macmillan, Hampshire and New York, 2002, p 210.
   
   

5. See M Schonteich, AIDS and age: SA’s crime time bomb, AIDS Analysis Africa 10(2), 1999, pp 1–4; M Schonteich, A generation at risk: AIDS orphans, vulnerable children and human security in Africa. Paper presented at a conference on Orphans and Vulnerable Children in Africa, Nordic Africa Institute, September 2001; R Pharoah & M Schonteich, AIDS, security and governance in Southern Africa: exploring the impact, Insititute for Security Studies Paper, 65, ISS, January 2003; M Schonteich, HIV/AIDS, policing and crime in South Africa: exploring the impact. Draft working paper for the CSIS Task Force on HIV/AIDS, CSIS, February 2003.
   
   

6. A Blumstein, cited in R Pharoah & M Schonteich, op cit.
   
   

7. M Steinberg, A Kinghorn, N Soderlund, G Schierhout & S Conway, HIV/AIDS: Facts, figures and the future, South African Health Review, Health Systems Trust, 2000, Chapter 15.
   
   

8. S Oni et al, cited in R Bray, Predicting the social consequences of orphanhood in South Africa, CSSR Working Paper, 29, Centre for Social Science Research, University of Cape Town, February 2003.
   
   

9. R Cheek, A generation at risk: Security implications of the HIV/AIDS crisis in southern Africa, National Defence University, Institute for National Strategic Studies, Washington DC, 2000.
   
   

10. A Zack-Williams, cited in R Bray, op cit.
    
    

11. R Cheek, op cit, p 3.
    
    

12. Ibid, p 5.
    
    

13. R Bray, op cit, pp 6-7.
    
    

14. Ibid.