Kimberly Vrudny

Mistreatment of Vulnerable Persons

In 30/30 HIV/AIDS Structural Drivers, Elderly, HIV/AIDS, Orphans, Public Health, South Africa on August 11, 2010 at 2:15 am

Elders and Orphans

In 1993, the Henan provincial health council in China decided to establish blood collection networks in order to supply blood plasma to biomedical companies, who used it in the manufacture of medicine. More than 200 stations were established throughout the province. However, an unknown number of illegal stations also operated throughout much of the rest of the decade. Peasants were paid the equivalent of $5.00 (U.S.) for 400cc of blood. The Japan Times reported that illegal stations “collected at one time from a number of donors who share[d] the same blood type. Afterward, the blood [was] pooled, the components needed for medical use [were] separated and the remaining blood [was] divided up and re-infused into the original donors. This unsafe procedure expose[d] people to the blood of six to 12 other donors every time they donate[d], facilitating the spread of not only HIV but hepatitis and other serious diseases” (Chan). The practice was banned in 1998, but official action came too late. In villages like Wenlou and Donghu, infection prevalence rates were measured at one time to be as high as 65% and 80% respectively. According to Xie Yan, a woman who tested positive for HIV and who was interviewed by The New York Times in 2002, “‘I try not to think about myself since I know I won’t be cured,’ she said. ‘But at night I can’t sleep—I have nightmares and wild thoughts—worrying about what will happen to the [children]” (Rosenthal).

Xie Yan’s question is one that has haunted leaders in HIV/AIDS response for over a generation. What happens when parents die, leaving behind millions of orphans?

According to The Orphan Foundation, there are more than 143 million orphans in the world today—a number that far surpasses the expectation announced a decade ago that there would be 100 million orphans in the world by 2010. When combined with 20 million children who have been “displaced” in the world, the number of orphaned and displaced children number more than the entire population of Russia. Fewer than 50% of these will live to see their twentieth birthday, and half of those that do will end up working in organized crime or sex work, or will become addicted to drugs. In many countries of the world, orphaned and homeless children are recruited as child soldiers to fight in wars and in militia movements.

It is not an overstatement therefore to say that the impact of HIV/AIDS on children has been profound. In 2004, the United Nations published a volume called The Impact of AIDS. The volume dedicates chapters to the impact of AIDS on demographics, households, firms, agriculture, education, the health sector and economic growth. Taken collectively, the report paints a sobering picture about the impact of a pandemic that has to date directly affected 58 million people, .008% of the world’s current population of 6.8 billion, with ripples that emanate outward, affecting a range of enterprises, from the world’s ability to conduct business to its production of the food supply.

Because the numbers are so large, it is difficult to process the staggering statistics that fill page after page of the booklet. Unlike most of the chapters, however, the article on the impact of AIDS on households is immediately jarring, so basic are its observations. The authors write, “The HIV/AIDS epidemic threatens the social fabric of the most affected countries. . . . The evidence shows that the AIDS epidemic is having severe effects on households” (39). The report goes on to outline “three kinds of economic impacts,” as well as four social implications (39). The economic impacts include loss of income, higher household medical expenditures, and indirect costs related to caregiving:

The first is the loss of the income of the family member, in particular if he or she is the breadwinner. The second impact is the increase in household expenditures to cover the medical costs. The third impact is the indirect cost resulting from the absenteeism of members of the family from work or school to care for the AIDS patient. . . . If a household member dies from the disease, the funeral, mourning and other costs may also add to the burden of the household (39).

There are also four social implications that the book outlines, including “change in household composition, with the gradual disappearance of the parental generation and children being cared for by grandparents and other relatives . . . [or] an increase in one-generation households headed by the older children” (39). In addition, the book outlines how many children withdraw from school as the result of an infection in the household, how many households enter into poverty, and how welfare is correlated to the willingness of the community toward helping households in need (39-40).

All of these implications of high HIV/AIDS prevalence rates are painfully evident today in South Africa, among other places. Grandparents—grandmothers, in particular—are caring for their grandchildren, even in the midst of mourning over the loss of their own children. Participants 19, 20, and 21 in “30 Years / 30 Lives” all share stories of children acquiring an infection, leaving grandchildren behind for them to look after. Others, like “Participant 04” in “30 Years / 30 Lives” who opened her shack to twelve children not biologically her own, are stepping up to care for children without family to look after them. She recognized an enormous need in her community, and she refused to turn away.

The UN document on The Impact of AIDS on households goes on to discuss this impact of AIDS on older persons. “Recent survey data . . . confirm that orphaned children are more likely to reside with grandparents than with other relatives or non-relatives” (45):

[O]ne effect of the disease is to change the structure and composition of households. In many affected regions in developing countries, more and more older persons are taking care of AIDS orphans. Older parents may also provide end-stage care to their adult children afflicted with AIDS. A study conducted in Zimbabwe showed that older caregivers were under serious financial, physical, and emotional stress owing to their care-giving responsibilities. . . . The AIDS epidemic not only puts more stress on older persons, but it also impoverishes them at the very same time they themselves may need to be taken care of. . . . [S]urvey data confirm that substantial proportions of the older population of many countries are living in skipped-generation households and that such households tend to score lower than average on an index measuring quality of housing and household amenities (45).

The three stories that participants in “30 Years / 30 Lives” shared with me upon meeting them at Ikamva Labantu, an organization providing integrated care for seniors and orphans, confirm these findings. On a tear-filled morning in Cape Town, I sat down with all three. One by one, they wrote their stories into the journal, reading their own entry aloud to us at the table when they were finished. We wept for the daughters they had lost and for whom they were providing care—and they spoke of caring for the little ones their daughters left behind.

But the stories grow more complex even still.

In 2006, I visited with a director of a senior center in one of the townships outside of Cape Town. When I asked her about the impact of AIDS in her community, she explained how senior citizens, in the post-apartheid situation, often live off of a governmental pension check equivalent to about $100/month. She spoke especially poignantly about how many young adults in their late teens and twenties, experiencing hopelessness from grinding poverty, inadequate education, and joblessness, are becoming addicted to drugs. And then she spoke about how these two disparate observations about seniors and their pension checks and young adults and their drug addictions are connected. One of her seniors, she told us, leaning in and speaking softly, had been locked into the public toilet facility in her community. After she stole her mother’s monthly pension check, the drug-addicted daughter used the money to buy drugs.

Jonny Steinberg, in his book Sizwe’s Test, recounts a similar story. Sizwe, the young man from the Eastern Cape Province in South Africa who Steinberg shadows for a period of eighteen months, approaches an elderly woman on a late Sunday afternoon. The woman is negotiating with a taxi driver to take her out of the village of Ithanga, and Sizwe bids her farewell, insisting she come back often.

‘Who is the old woman,’ [Steinberg] ask[s].

‘She is a customer of mine,’ [Sizwe answers]. ‘She has been coming to drink since the day I opened.’

‘Why is she leaving?’

‘Because of the gangsters. She has been robbed twice.’

He points to a hilltop on our right. It is among the highest in the village and is particularly steep. A solitary round hut sits incongruously near the summit. It appears as if its inhabitants might open their front door, step outside, and roll down the hill.

‘That is her home. It is very isolated at night. Twice, on the night after pension day, very late, maybe one in the morning, they have knocked on her door, and when she opened they pointed a gun at her. After the second time, she said enough is enough. She has gone to live with relatives. . . .’

To be sure, the HIV/AIDS pandemic has focused the spotlight on complexities of social safety nets. Monthly pension checks, intended to provide food and shelter for the elderly, do not necessarily secure the future, but endanger it. Access to antiretroviral therapy, intended to prolong lives so as to limit the number of vulnerable children left without parents, is threatened by constriction of the global economy, drying up the financial wells from which the treatments have been funded. When access to the drugs that enabled a Lazarus-effect that encouraged more and more to be tested and to be enrolled for treatment is reversed, more and more lives will be lost. Children will again be made vulnerable. Seniors will be expected to care for them. And not everyone throughout the world was able to afford access in the first place.

“Perplexity is the beginning of knowledge.” —Kahlil Gibran

“To know and not to do is not to know.” —Ancient Proverb

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