Also available in PDF format.
Worldwide, as many as 15 million children and youth have been orphaned or made vulnerable by the HIV/AIDS epidemic. In addition, parental deaths from all causes have left 143 million orphaned children and youth across 93 countries in sub-Saharan Africa, Asia, and Latin America, including 79 million ages 12 through 17.1 As orphans approach sexual and physical maturation, they are at increased risk of HIV. Their orphaned and vulnerable status can also leave them more vulnerable to sexual abuse, exploitation, illness, and homelessness. Many engage in risky sexual behaviors in order to survive.
Many organizations focus on the protection and care of orphans and vulnerable children (OVC). However, programs have largely overlooked adolescents and neglected the special emphasis and tailored programs needed by this population. Yet, a few programs do provide adolescents with the support and skills they need to survive and to become healthy adults.
HIV Risk Factors for Orphans and Vulnerable Adolescents
- Older children, especially girls, are more likely than their younger siblings to have to drop out of school to take care of a terminally ill parent or to support their family. Then, too, youth orphaned by the HIV/AIDS epidemic often leave school because of discrimination, emotional distress, or because they can no longer afford school fees.
- In Uganda, a quarter of adolescents ages 13 through 18 whose parents have HIV or AIDS have dropped out of school. In that country, a student who drops out of school is also three times more likely to become HIV-positive by his/her twenties than are more educated peers.
- Increased economic and emotional strain, common amongst the orphaned and vulnerable, may lead to risky behaviors, including exchanging sex for food or shelter and using drugs and alcohol.
- Orphaned and vulnerable adolescents often lack role models and social support systems – vital to healthy development, particularly in relation to education and livelihood.
- Adolescents orphaned by the AIDS epidemic are at added risk of sexual exploitation and coercion. Of about two million sex workers in India, 20 percent (400,000) are under age 15 while about half (one million) are under age 18. In Abidjan, Cote d’Ivoire, up to70 percent of adolescent sex workers are HIV-positive.
Young Women Are Particularly Vulnerable due to Biological and Socio-Cultural Factors
- One study of young orphaned and vulnerable women age 15 to 18 in Zimbabwe found that they were more likely than their non-orphaned peers to be HIV-positive (three versus zero percent). They were also more likely to have experienced pregnancy and common symptoms of sexually transmitted infections (STIs), to have received no secondary school education, and to have initiated sex and married at a young age.
- A young woman’s developing reproductive tract increases her vulnerability to STIs, including HIV when compared to her male peers.
- Older men often coerce very young women into sexual relationships by offering much-needed school fees and financial support in return for sex. A study in Botswana found that one in five out-of-school female teens had found it difficult to refuse to exchange sex for money or gifts.
- Wars often result in the rape or abuse of young women. During the 1994 Rwanda crisis, between 250,000 and 500,000 women were raped. During rape, women are usually unable to protect themselves against HIV, other STIs, or pregnancy.
Framework for the Protection, Care and Support of Orphaned and Vulnerable Adolescents
In a joint report, UNAIDS, UNICEF, and USAID identified five important points for protecting and supporting OVC:
- Strengthen families’ capacity to protect and care for children by prolonging the lives of parents and by providing economic, psychosocial, and other support.
- Mobilize and support communities in efforts to provide immediate and long-term assistance to vulnerable households.
- Ensure OVC’s access to essential services, including education and health care.
- Protect the most vulnerable children through improved policies and laws and by channeling resources to communities.
- Raise awareness at all levels of society to create a supportive environment for children affected by HIV/AIDS.
Orphaned and vulnerable adolescents (OVA) need these and also access to:
- Reproductive health services, including HIV education, testing, and counseling;
- Livelihood and life skills training; and
- Adult mentors to assist youth in creating positive relationships and in building good interpersonal and communication skills.
Programs that Work for Orphaned and Vulnerable Adolescents
A few programs target orphaned and vulnerable adolescents. They provide models of what can be done to protect, care for, and support orphaned and vulnerable adolescents.
- CARE’s Rwanda Nkundabana project provides child- and adolescent-headed households with support from community volunteers who coordinate youth’s access to psychosocial support, emergency assistance, and health care, including HIV counseling and testing and peer HIV prevention education.
- The Children in Distress project in Cambodia trains youth advocates to identify families with chronically ill parents and children needing help. The youth provide assistance and support to the families. The youth advocates, who receive a small daily stipend, thrive in the positive structure of teamwork and concrete contributions to community life.
- Adolescents (age 12 through 17) orphaned or made vulnerable by AIDS in Mozambique and other countries receive farming and life skills training through the Junior Farmer Field and Life Schools. Participating youth learn farming skills and HIV facts and prevention strategies. The project also promotes positive psychosocial development through dance and theater.[10,11]
- The AIDS Support Organisation (TASO) in Uganda offers the AIDS Challenge Youth Club for young people affected by the AIDS epidemic. The club builds self-efficacy as it provides facts regarding HIV/STIs, promotes psychological and social support between members, and offers life skills training. The Club uses peer education, dialogue, and outreach to help youth achieve self-respect and positive attitudes and behaviors for a healthy life.
Clearly, policies and programs must recognize the developmental differences between children and adolescents. In order to succeed in the battle against the HIV epidemic, communities, NGOs, and governments must arm the world’s orphaned and vulnerable adolescents with the information, services, and support they need to make a healthy transition to productive adulthood.
- UNAIDS, UNICEF, USAID. Children on the Brink 2004: a Joint Report of New Orphan Estimates and a Framework for Action. New York: United Nations, 2004.
- UNICEF, UNAIDS, World Health Organization. Young People and HIV/AIDS: Opportunity in Crisis. New York; UNICEF, 2002.
- UNAIDS. 2006 Report on the global AIDS Epidemic: a UNAIDS 10th Anniversary Special Edition. Geneva: UNAIDS, 2006.
- UNAIDS. Children and Young People in a World of AIDS. Geneva: UNAIDS, 2001.
- Gregson S et al. HIV infection and reproductive health in teenage women orphaned and made vulnerable by AIDS in Zimbabwe. AIDS Care 2005; 17:785-794.
- Eng TR, Butler WT, ed. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press, 1997.
- Amnesty International. Making Violence against Women County: Facts and Figures: a Summary; http://news.amnesty.org/index/ENGACT770342004; accessed 3/27/2007.
- CARE. A Model for Community-Based Care for Orphans and Vulnerable Children: Nkundabana. Geneva: Author, 2004; http://www.crin.org/docs/Rwanda%20Nkundabana.pdf; accessed 3/27/2007.
- Daileaer Ruland C et al. Adolescents: Orphaned and Vulnerable in the Time of HIV/AIDS. [Youth Issues Paper, no. 6] Research Triangle Park, NC: Family Health International,.2005.
- FAO, WFP. Junior Farmer Field and Life Schools; http://www.fao.org/hivaids/publications/jffls.pdf; accessed 3/27/2007.
- FAO. Responding to the Orphan Crisis. May 2005; http://www.fao.org/newsroom/en/focus/2004/49923/article_49928en.
html; accessed 3/27/2007.
- AIDS Support Organisation. The AIDS Youth Challenge Club; http://www.tasouganda.org/youth.php; accessed 3/27/2007.
Written by Kathy Osborn
May 2007 © Advocates for Youth