10 Million Orphans

Even on the mean streets of Homa Bay, a fishing center of 750,000 on Lake Victoria, the children stand out: Kenya has 350,000 AIDS orphans, and 35,000 of them live here. Many of those who have not been forcibly removed to the orphanage are street children--pickpockets and beggars, prostitutes and thieves. To Hamis Otieno, 14, and his brother, Rashid Faraji, 10, the streets of Homa Bay were their last, best hope. Their father had died of AIDS in 1995; their mother turned to prostitution and abandoned them soon after. Relatives, unable to provide for the boys, cast them out. The brothers made their way by bus to Nairobi, 150 miles away, where they stole, begged and worked as drug couriers. But after a year, hungry and alone, the boys went home; hustling promised to be easier on the less competitive streets of Homa Bay. Soon after their arrival, however, they caught what in their world counts as a break: they were picked up and taken by force to an orphanage. There, every one of the children is an AIDS orphan. But then, that is hardly surprising: in Homa Bay, some 50 to 70 percent of the adults are HIV-positive. "So many have died," says Hamis, "so many."

In the nations south of the Sahara, almost two decades of AIDS deaths--2.2 million in 1998 alone, and a still untallied but certainly greater number in 1999--is leaving a sea of orphans in its wake. By the end of this year, 10.4 million of the children under 15 will have lost their mothers or both parents to AIDS. Before the current epidemic, the perennial cataclysms of war and famine orphaned 2 percent of the region's children; AIDS makes that figure look benign (graphic). A generation of orphans threatens to undermine economic development, for children without parents can seldom afford education. And many AIDS orphans end up "roaming the streets, prime targets for gangs [and] militia and creating more child armies like those that participated in massacres in West Africa," says Dr. Peter Piot, executive director of UNAIDS. But worse lies ahead. The number of AIDS orphans in the region is projected to double or triple by 2010.

It is not only the raw numbers that make this orphan crisis unlike any ever seen. The children, who have often watched their parents die alone and in pain, are left in a world where AIDS has unraveled such traditional safety nets as the extended family, and in households where not a single adult is able to earn a living. Josephine Ssenyonga, 69, lives on a small farm in the Rakai district of Uganda, where AIDS has been cutting through the population like a malevolent scythe for 14 years: 32 percent of the under-15 population, a total of 75,000 children, have been orphaned in Rakai. Of the four daughters and nine sons Ssenyonga raised, 11 are dead. Her son Joseph left her with eight children; Francis left four; Peter left three. "At first there were 22, living in that small hut over there," she says. "My children did not leave me any means to look after these young ones. All they had was sold to help treat them." Overwhelmed, she took the children to the hut one day. "I told them to shut the door so we could all starve to death inside and join the others," Ssenyonga says. She changed her mind when a daughter returned home to help, and World Vision provided a three-room house for them all.

Bernadette Nakayima, 70, lives in Uganda's Masaka district, where 110,000 of the 342,000 children are orphans. Nakayima lost every one of her 11 children to AIDS. "All these left me with 35 grandchildren to look after," she says. "I was a woman struck with sorrow beyond tears." But she is not alone: one out of every four families in Uganda is now caring for an AIDS orphan, says Pelucy Ntambirweki of the Ugandan Women's Effort to Save Orphans (UWESO).

When AIDS takes a parent, it usually takes a childhood, too, for if no other relative steps in, the oldest child becomes the head of a household. Yuda Sanyu Kitali was 10 in 1992 when his mother died of AIDS; the disease had killed his father in 1986. Sanyu had to drop out of school, of course, as did his younger brother, Emmanuel Kulabigwo, now 16, and sister, Margaret Nalubega, 15: when their parents died, so did any hope of affording academic fees. "No one came to claim us or toffer help," says Sanyu. A year after the children were orphaned, the grass-thatched house their father had built in the Rakai district collapsed in a heavy rain. "Since I was the oldest, I had to build another house," Sanyu says. He did his best with mud, poles, reeds and banana fiber. The children grew cassavas and greens on the land their parents left them, but they still went to sleep hungry many nights. As Sanyu tells his story Emmanuel nods silently. Margaret sits on a papyrus mat in the corner, staring at a wall and hiding a tear in her dirty brown dress.

Most orphans are taken in by their extended families, if they are taken in by anyone, but the sheer number of these lost children fills orphanages, too. Ethembeni House, run by the Salvation Army in downtown Johannesburg, has 38 children 5 or younger. All of them have tested HIV-positive. All were abandoned: a vagrant found the newborn Moses, now 3, in a dumpster; a woman handed days-old Simon, now 2, to a street vendor and never returned. The rooms in Ethembeni, lined with cribs, are clean and decorated with pictures of clowns and dolls. Other pictures, of children who died here, line the mantel. Moses points to one: "He's gone," he says. When a stranger enters the room, the children turn expectant faces to her: "Mama, mama," they cry.

In times past it was usually war or neglect or famine or poverty that brought abandoned or orphaned children to the Sanyu Babies Home in Kampala. Now the caseload of 26 is almost entirely AIDS orphans, many of whom have lost not only parents but all their other adult relatives, too. Patricia Namutebi, 3, was brought in as a 1-year-old by a thin, sickly man who said he was her neighbor and that her mother had died of AIDS. Patricia has been sick with one opportunistic infection after another; today she restlessly drags a chair to and fro and swings on the curtains, apart from the other children. Workers at the Babies Home suspect that the man was her father, but it hardly mattered. When they trace abandoned children back to their families, says Joyce Lolindya, administrator of the home, the survivors seem to feel that "it is hard to look after an AIDS victim, and then also the children of that victim, when you know they will all die." Especially when AIDS carries with it such a social stigma. Unless abandoned AIDS orphans reach an institution like hers, they risk getting sucked into what Godfrey Sikipa of UNAIDS calls "a vicious circle." He adds: "In many cases the orphans, unless we prevent them from going into deeper poverty, will become prostitutes." The fortunate ones become child brides, or the plaything of a sugar-daddy. They can only hope that the men will not be among the millions who believe that sex with a virgin cures AIDS.

When an extended family cannot afford to educate all the children in its care--virtually everywhere in Africa governments charge school fees--it is the orphan who is the likeliest dropout. In Zambia, a study cited by the UNAIDS report found, one third of urban children with parents enroll in school, but only one quarter of orphans do. "I wish I could go all the time," says Ben Sengazi, 13, one of Ssenyonga's grandsons. But when the family cannot scrape up the fees, the school turns him away.

Compared with children with parents, AIDS orphans are at far greater risk of malnutrition and of not receiving the health care they need. The little girl named Forget was 4 when her mother died of AIDS last November and she went to live with her grandmother in a village southeast of Harare. Her small body has recently developed ugly lesions, which she scratches constantly. Her grandmother says the causes of the plague are a mystery to her. Although she is doing what she can for Forget, the assumption by many caregivers is that the orphan, too, is infected with HIV, and that her illness is untreatable. Perhaps that explains one of the puzzles of the AIDS orphans. In 1995 Uganda had 1.2 million of them; based on the number of AIDS deaths and other factors, there should be 1.5 million now, butthere are "only" 1.1 million. That is, Uganda is missing 400,000 AIDS orphans. "Either the babies were born [HIV-] positive, or they died from a lack of care," says UWESO's Ntambirweki.

Government and private programs do what they can for AIDS orphans. In Botswana, nongovernmental and community-based organizations provide services ranging from day care to food, clothing and bus fare to and from school. Villages in Malawi have organized communal gardens. Charity groups and orphanages teach the older children AIDS prevention, hoping that the cataclysm that befell the parents will not be visited on the children. World Vision built Sanyu's family a four-room house, paid for his sister and brother's schooling and trained Sanyu in bicycle repair. And after Harriett Namayanja, now 17, lost her parents to AIDS, a loan from a private agency saved her and her eight brothers and sisters. Harriett used the money for sisal grass, from which she weaves doormats. She sells them in Kampala, and with the money, she says, "I am able to look after my younger siblings" and even pay school fees for her brothers. But she and Sanyu are exceptions. Funding has not kept up with the needs of so many orphans, and institutions are stretched almost to the breaking point.

Some 6,000 men and women in sub-Saharan Africa will die of AIDS today. Six thousand more will die tomorrow, and the next day. For the children they leave behind, the tragedy is only beginning.