It is a very tough situation for children born with HIV/AIDS in poor countries. In most cases the parents of such children or at least one of them has passed on due to AIDS. Since the parents are the family's bread winners it implies that the poverty situation of the affected family gets worse with the death (s), as income reduces drastically. Unfortunately, the affected household needs more financial resources to cater for the burials of the dead, and the sickness of the children. Even if medication is free, which is the usual case thanks to global health donors, there's need for transportation, lunch, medication for secondary ailments (like fevers and colds). Since children also traditionally provide supplementary labor to their parents, such labor is now lost since they are sickly most of the time. The burden of bringing up these poor, sick, and highly demanding orphans falls upon extended family members, who most times divide up the affected children with each relative taking one or two in accordance to their own economic situations. It is at this early stage that the social world of these orphans falls apart. The orphans will live thanks to availability of free medicine but they are traumatized because their parents are dead, they are separated with their off springs, and are now living with relatives they never knew or knew very little about, who in turn will treat them as second class individuals because they are sick this is where stigma starts. In a slightly better situation the orphans will live by themselves and take charge of their affairs under patronage of relatives living not so far away from the children's home.
"The support system for AIDS orphans in most parts of rural Africa the extended family has always been important in providing care for children whose parents are dead or not able to take care of their children. Children may be sent away to live with relatives when the family does not have sufficient funds. Caring for orphans is a characteristic feature of the rural African extended family. Preble argues that "orphans usually have been willingly and relatively easily adopted by other family members" (Preble 1990:678). However, if the adopting family have restricted resources, the children's education and nutritional status is likely to deteriorate. Today, a large proportion of households has to care for an orphan. Although many orphans are taken care of by the relatives and incorporated into existing households, the stress on the resources of these households may be substantial (Barnett and Blaikie 1992). A study from Zimbabwe reports that almost half of the caregivers were grandparents of the orphans and a third of the caregivers were over 60 years (Foster et al. 1996:389). The study from Tanzania referred to above shows that many orphans were taken care of by grandmothers. The epidemic has further increased the dependency burden and jeopardised the future welfare of the surviving older generation (Tibaijuka 1997:972). In Tanzania the traditional system that used to take care of vulnerable groups is reported to be breaking down, which will mean an increased need for safety-net programmes (The United Republic of Tanzania 2001b:10)." (1)
"Children in sub-Saharan Africa are probably the most vulnerable group and suffer hard from the HIV/AIDS epidemic. Children may grow up in circumstances less than optimal for their development as limited resources may restrict the family's ability to provide sufficient care. Possible consequences are deterioration of the children's situation in terms of education and nutrition. From Zambia it is reported that more than 50 per cent of children are chronically malnourished (UNAIDS and UNICEF 1999:15)
Girls are the first to suffer as they are the most likely to be taken out of school to support the household (UNAIDS 1999b:21). It is reported that children are increasingly seen as a part of the labour force and expected to assist the parents from the age of 8-9 years (Barrett and Browne 2001, see also Danziger 1994:907-908). Extensive involvement in the farming tasks of the household is not compatible with maintaining an adequate focus on education. The primary school enrolment rate in communities that are hard hit by HIV/AIDS is decreasing. A recent report from South Africa states that since 1998, enrolment in first grade has dropped 60 %, and the decline is even more dramatic for girls, suggesting a growing gender imbalance (USA Today 2002). Furthermore, schooling facilities may be severely affected by the increasing deaths from AIDS. A recent report from South Africa also points to the grim fact that 85 % of schools in the province studied have reported the death of teachers "presumably" from AIDS-related illnesses (USA Today 2002). The loss of qualified teachers will severely undermine the education system in countries hard hit by HIV/AIDS." (2)
(1), (2) are extracts from a study by Jan Isaksen Nils Gunnar Songstad Arild Spiss°y titled the ???Socio-economic effects of HIV/AIDS in African countries??? ; A study commissioned by NORAD (2002).