With more than 13 million children under the age of 15 orphaned by HIV/AIDS, where are they all living? The girl shown in Pic. 2-1 lives under the blue tarp with her little brother seen on her back. Many, many CHH live in homes of plastic sheeting. Often the children huddle together near the train tracks. One child explained, “When you live near the train tracks, you don't hear the trains go by in the middle of the night no matter how loud they are!” They sleep in caves and huddle with animals for warmth. Those who have found a shelter often sleep on bare floors, many with no blankets. Those that have a bed, often have no mattress. They live in a one-room house; food is scarce, and they sleep on a flour sack resting on the cement floor. There is no running water, and no electricity. No bathrooms, no showers. Check your sewer! Type in “children living in sewers” into Google. You will get more than 2,000,000 hits! These are not all orphans of AIDS, but many homeless children in need of help. 15,000 children live this way in Mexico City, but there may be three times more.1

Some children, very few in number, fortunately have been left by their deceased parents a small, but safe and secure house in relatively good condition where they can continue to live. Usually it is a typical concrete block house with metal-framed windows, metal roof, and a dung floor. There are three rooms, a kitchen, sitting room and bedroom. They have a pit latrine away from the house on a corner of their property.

Often when the last parent dies at home, the orphans move from their parents' house to live with grandparents or move in with uncles and aunts. Grandparents and other relatives have absorbed some of the responsibility for caring for AIDS orphans, but family networks are sagging under the weight of the epidemic. Many move in with relatives whose desperate poverty only becomes worse with more mouths to feed.

Pic. 2-1: Sleeping under the blue tarp is better than the street

Most especially when a mother dies of AIDS, orphaned children often go to live with a grandmother, a practice referred to as ‘skip-generation parenting’.2 Orphans are often cared for by grandparents because there is no other relative willing or able to look after the children. Grandparent-headed orphan households are becoming increasingly common as a result of AIDS. For example in Zimbabwe, 125 out of 292 orphan households (43%) were headed by grandparents; in Kenya, 41 out of 152 (27%) were grandparent-headed. Even in New York, 25 out of 43 maternal orphans (58%) lived with a grandmother. Some of the most vulnerable orphans are children of single mothers, especially if the mother was a prostitute.

When a single mother becomes sick or dies, her children may be left in the care of grandparents. Because such orphans are from single-parent households, they may be neglected by other relatives who refuse to provide any support to the children because they consider them illegitimate.3 All too often, a grandparent is already caring for grandchildren from three or four families. The responsibility for orphan care is shifting increasingly to grand-mothers who often single-handedly care for 10 to 15 orphans.4Many women infected by HIV migrate back to their maternal homes5 after their husbands have died and they are in the later stages of their illness. Their hope is that the children will find a male authority such as a grandfather or uncle, and social and emotional security with her family. When the mothers eventually die, such orphans are twice disadvantaged by a second trauma of parental death and adjusting to unfamiliar relatives in a foreign place.

Pic. 2-2: Grandmothers are burdened beyond belief

A Kenyan study found that whereas families living below the poverty line tended to foster children, wealthier relatives, whom one might expect to be more able to foster relatives' children, maintained minimal links with orphans.6

Many of these children then move again to new localities to live with relatives and family friends. Often in situations where many sleep in the same hut or a single room, the young girls are abused by the men. This is often the reason many women prefer not to accept the orphan daughters of their own family. Some run away7 in an effort to find a more suitable living arrangement for themselves. When both parents have died and no relatives accept the children, the CHH usually leave their hometown or village and head to a large city. When they arrive in the cities, the CHH often end up living on the streets and are at extremely high risk of exploitation and HIV infection. Nowhere are the problems more acute than in KwaZulu Natal (KZN), South Africa, an area with the highest rates of HIV/AIDS infection and orphanhood in the whole country. Durban attracts the highest number of street children of any city in Southern Africa.8

Pic. 2-3: Sick of abuse, these girls take off for town

In nearly every sub-Saharan country, extended families have assumed responsibility for more than 90 per cent of orphaned children. But this traditional support system is under severe pressure—and in many instances has already been overwhelmed, increasingly impoverished and rendered unable to provide adequate care for children. Most worryingly, it is precisely those countries that will see the largest increase in orphans over the coming years where the extended family is already most stretched by caring for orphans.9

During her mother's illness, her mother would request her every night to heat water on the open fire and to wash her mother's feet with the heated water. She knew that her mother was very sick and needed her, but her mother advised her during her illness to live with an aunt, as she said that Sakhisiwe's older sister would take care of her. She feels guilty that she had left her mother during her mother's last few living days, and that is the reason she claims she misses her mother even more. According to Sakhisiwe, when her mother was alive her mother was able to provide everything and even basics like soap to bathe with. Currently there are days when not even soap is available to either bathe or wash their clothes with. She trusted that her mother would provide everything that she needed although currently her grandmother provides for them if and when money is available. She remembers her mother especially when she is provoked while playing with other children. Sakhisiwe Myeni is a 12 year old grade four schoolgirl.10

One study in Blantyre, Malawi, found that, of the 65 orphans they interviewed, 22 had experienced multiple migrations, some as many as five.11 Many AIDS-affected children in southern Africa engage in migration when household members fall sick or die from AIDS, or because they are sent to assist relatives. Despite this, little attention has been paid to the consequences of these movements for children's lives. Research, conducted in Lesotho and Malawi, reveals that children sent to live with kin commonly move over long distances and between urban and rural areas. They are generally not consulted or informed about these migrations and face a range of associated difficulties, particularly with integrating into new families and communities. Severed family ties exacerbate the difficulties faced by children who end up in institutions or on the streets.

This paper advocates that policy approaches for those affected by AIDS should be children-centered and take into account the implications of migration at three levels.12 First, many of the difficulties children face could be overcome if they were familiar with the place and people they were moving to. Second, children would be better able to cope with new situations if they were included in family discussions with decision-makers regarding their migration preferences. Third, maintaining ties with kin would ensure that children do not become distanced from their family and cultural heritage, which is essential for post-institutional support.

The fact that orphans are now being fostered by maternal rather than paternal relatives, especially in peri-urban areas, is symptomatic of the decline of traditional extended family practices.13 Most often when the last parent dies, the extended family, if unable to take care of the orphans, will stay away from them. This is extremely painful for the children and they can't understand why and often put the blame on themselves. Psychological help is also greatly needed for these children, but it is highly unlikely that they will receive it at this present moment. Frequently the children may desire to stay together as a family group rather than be split up between various relatives, or wish to stay living at their own residence in familiar surroundings, rather than change school, friends, home and neighborhood. They may resist attempts of relatives to foster them in the relative's household, fearing maltreatment or because the relative only agrees to foster younger siblings. The main reasons children say they prefer not to live with extended family members are:

• Most of their relatives are very poor and financially unable to support them or are already supporting large extended family members
• They do not want verbal abuse
• They do not want to be exploited for work
• They want to continue their...