She was presenting her research findings at the 4th South African AIDS Conference in Durban this week.
By 2005, some 802,000 South African children lost a mother to HIV-AIDS and by 2008, more than 3.4 million children under the age of 18 have lost either a mother or a father, or both parents, according to the Actuarial Society of South Africa. Almost 70% of all orphans in 2004 were 'paternal orphans': i.e. whose fathers had died, but whose mothers were still alive that year. see
Giving orphaned children the legal rights of adults:
And to help this growing army of orphans run their own households more efficiently, South Africa is currently also rewriting many of its laws -- giving orphans the responsibilities and judicial rights usually only granted to adults, such as the right for such children to access public housing and social-care grants. see
In the popular imagination, Katherine Hall says, 'the face of the AIDS epidemic in southern Africa is often an orphan who has lost both parents to the virus and is now fending for him or herself in a household made up solely of other children."
Many child-headed households certainly exist in South Africa, but the commonly held wisdom, reinforced by the media and foreign aid-agencies, that extended families cannot absorb any more orphans, and that the number of child-headed households has been rising steeply in recent years due to the HIV/AIDS epidemic, has never been backed up by solid data, she noted.
The Institute estimates that AIDS orphans account for 37
percent of all the orphans in South Africa, and that 80
percent of those have a surviving parent. The parent might not always be around, however: dad or mom may be migrant workers...
By analyzing data from 22 national government household and labour surveys between 2000 and 2006, Hall and her colleagues have found that the registration of child-headed households in South Africa had not increased in that period -- remaining below one percent.
However, a note of caution must be sounded here as these official records may not be an accurate reflection of the reality on the ground: it also is very difficult to register AIDS-orphans' birth certificates once the mother has died: the mother has to be present to obtain the child's birth certificate under South African law, and 'alternative forms of identification' are thus far, hardly ever accepted, thus leaving many children in permanent limbo. see
At the moment however, Hall says that the official records show that orphans who had lost both parents accounted for 8 percent of child-headed households - and most such households were located in three largely rural provinces: Limpopo, KwaZulu-Natal and the Eastern Cape.
No child-headed households were recorded in the more urban provinces housing cities such as Gauteng's Pretoria and Johannesburg.
Hall argued that the focus on HIV as the main cause of child-headed households has masked other social realities, such as the need for many parents in rural areas to migrate to cities to find work.
She says this has skewed the authorities' interventions which were set up to address the problem.
“The existence of living parents in the majority of cases suggest it’s inappropriate to conceive of these households as permanent arrangements requiring intervention or dissolution,” she said.
Authorities often hinder when abandoned children need help:
While it is widely recognized that the most effective interventions for orphaned or abandoned children are those that support family members to care for them, bureaucratic requirements for accessing such support have tended to hinder rather than help this process, she also warned.
No birth certificates, no government aid:
Sonja Giese also presented findings from research she conducted on behalf of the Alliance for Children’s Entitlement to Social Security
(ACESS) into obstacles to obtaining birth registration documents for children.
Without them, caregivers are unable to access social grants and other forms of government assistance such as public housing.
"Registering a child’s birth requires the presence of the mother, who must present her own identification document. There are no alternatives for children living with other caregivers," she said.
11-million children on $20 per month...
Yet the need is dire, she warns: about 48.5% or 21.9-million of the South African population live below the national poverty line of R354 ($35) per month.
And some 60% (11-million) of all children in South Africa live in dire poverty on less than R200 ($20) per month.
Approximately 30% of the country’s population suffers from ' food insecurity ' in which they can only afford two hot meals a week. For many children this means starvation.
From the 22 infant deaths per 1,000 in 1994, the country's infant mortality rate had dropped to 45 per 1,000 average -- and the death rate for under-fives to 59 per 1,000 by 2008.
And mainly due to HIV/AIDS, the under-5 mortality rate is expected to double by the year 2010 to 99.5 per 1,000
. Right now in South Africa, one in every ten children is infected with a chronic illness.
"Many children use pit latrines for toilets. Twenty-four percent of schools have no clean water within walking distance and an average of one toilet per 20 learners. And 11.7% of schools have no sanitation at all.
According to South Africa's Education Atlas, approximately 1.2 million children of school-going age are not attending school, and some 40,000 children attend on a part-time basis only.
In March last year, Acess
sued the Department of Social Security in the Pretoria High Court for information, to be supplied within six months, on the number of applicants for the child support grants which were denied and approved due to the lack of a birth certicate. They also sued the director-general to change its rules by accepting 'alternative forms of documentation' in order to get all the undocumented children into the government's child-grant system. see
This ruling is still pending.
Enormous costs of ARVs:
Meanwhile, South Africa's Acting Health Minister Barbara Hogan said at the closing ceremony of the AIDS Conference in Durban on Friday, that she was concerned about the high costs of scaling up South Africa's HIV/AIDS treatment programme to meet the enormous need. Some provinces showed serious budget overruns and she was dispatching teams of financial experts during the course of the year to find out why, she said.
And, with her re-election as health minister in a new cabinet
, formed after the April 22 elections still uncertain, Hogan nevertheless remains committed to get 80 percent of the country's more than 6-million HIV-infected people on antiretroviral treatment by 2011.
That's why the budgets had to be controlled properly, she said: "We cannot afford to run out of stocks of ARVs," -- referring to such a crisis last year in the Free State Province. "Whilst we may say ARV treatment is expensive, we have no other option; any other option would be far more expensive."
Extremely-drug-resistant Tuberculosis - a growing danger:
She also emphasised the need for border-crossing, interactive health policies when it came to identifying and controlling Extremely-Drug-Resistant Tuberculosis cases. More than six percent of all the thousands of TB-cases in South Africa were diagnosed as drug-resistant, and this clearly is a rapidly-growing danger. see
. The World Health Organisation last year identified South Africa as the epicentre for XDR-TB, but it is now spreading very rapidly throughout southern Africa. See
and also see
Hogan urged employers of migrant workers, especially mining companies -- which have actually been running health checks for TB on all their workers for a great many years in South Africa in conjuction with her health department -- " to start investing in better TB prevention and treatment."
She also wants a system of cross-border referrals for TB and HIV, she said.
"It would be foolish to think we can scale up in isolation from our neighbours," she said. "Health knows no borders." Also: [see
Africa is the global epicentre of AIDS pandemic...
Indeed: Prof Linda-Gail Bekker of the Desmond Tutu HIV foundation, who chaired the Fourth AIDS conference, said "sobering reports continue to identify Africa as the global epicentre of the AIDS pandemic. It is highly diverse and especially severe in southern Africa where some of the epidemics continue to expand," she said.
"Even where epidemics are levelling off in this region, they are doing so at exceptionally high levels. An estimated 22.5 million adults and children in sub-Saharan Africa were living with HIV in 2007. By April of that year, (only) 1.3 million people in the region were receiving antiretroviral therapy."
And this is a global problem, Prof Bekker notes:
'Globally antiretroviral drugs reach only one in five (patients) who need them. Currently only 9% of pregnant women living with HIV in the developing world are provided with drugs to prevent the virus being transmitted to their babies."