The orphan crisis due to AIDS and the transformation of support systems in the context of HIV/AIDS

The extended family represents a system that provides social and economic security as well as support, particularly during periods of crisis Foster, Makufa et al., 1997. However, since “family structures are the true infrastructure of African societies“, they are also the first that must face upheaval and suffer its effects. Therefore, HIV/AIDS has devastated family structures and has caused profound “family breakdown and reconstruction” Pilon and Vignikin, 1996. 
The intergenerational solidarity network within the extended family allows it to survive numerous tensions caused by social upheaval or crises and armed conflicts affecting many sub-Saharan African countries for several decades. However, tensions provoked by the AIDS epidemic seem to be too difficult for the extended family to overcome Mukiza-Gapere and Ntozi, 1995.

Nonetheless, the extended family appears to adapt between the breakdown and continuity of  traditional structures and between the individualisation and diversification of family organisation and support in response to the HIV/AIDS scourge.. Marc Pilon and Kokou Vignikin speak of “survival strategies” Pilon and Vignikin, 1996. For Thérèse Locoh “where  traditional values of solidarity are expected to explode, they are seen taking on primordial importance in the current crisis situation“ Locoh, 1993.

How does current family solidarity specifically address HIV/AIDS?

• “Family breakdown and reconstruction” in the context of HIV/AIDS

The HIV/AIDS epidemic is related to the “disease of development” Dozon and Guillaume, 1994due to its existence in a fragile socio-economic context., The HIV/AIDS epidemic, in a context of economic crisis, mainly hits young adults, who are both parents and economic actors. This will deeply affect the family structure Dozon and Guillaume, 1994 even before the death of a family member infected with HIV/AIDS.

The specifics of AIDS and the current economic context have created new situations. On the one hand, profound transformations have occurred in the division of household tasks creating a double inversion of intergenerational flows. Children often care for their sick parents and those who are much older find themselves responsible for supporting sick adults and their children due to a lack of human resources.

“Elderly people are the first whose functions within the family group are affected (…) when the epidemic afflicts several members of the same family, the elders must take on the care of ill family members as a last recourse, and even resume lucrative activity to provide for the family’s needs or cover the children’ education costs Centre International pour l'Enfance, 1991” Pilon and Vignikin, 1996.

On the other hand, HIV/AIDS brings about changes in the size and composition of the household because the epidemic causes circulation within the extended family. The numerous deaths due to AIDS lead to a growing number of orphans who are cared for by other family members, which considerably increases the size of the household Mukiza-Gapere and Ntozi, 1995.

Finally, HIV can affect fertility, leading to behaviour changes especially concerning the number of expected children but relationships between HIV and fertility behaviours are complex. A study carried out in Zambia in 1995 by C. Baylies showed that fear of contracting the virus and the rising number of AIDS orphans needing care can cause families to decide to have fewer children in an effort to improve their support Baylies, 2000. Conversely, in Rwanda Allen, Serufilira et al., 1993 and Cote d’Ivoire Desgrées du Lou, Msellati et al., 2002 studies showed an increase in the incidence of pregnancies among women who know they were infected with HIV.

• HIV/AIDS and questioning traditional practices of remarriage

The HIV/AIDS epidemic has disrupted the norms in matrimonial systems based on patrilineal lineage. According to matrimonial customs based on in patrilineal lineage, marriage represents an alliance between two families. Through the dowry system (the payment in money or goods that the groom and his family owe the bride’s father), the wife and her children belong to the husband’s family (unlike the matrilineal system where kinship is passed down through the mother).

• In the levirate system, when a woman becomes a widow she must marry her husband’s brother. The new husband is obligated to continue his brother’s lineage. This custom assures that a widow and her children will not be left without male support in the household. 

Families are better at withstanding the disappearance of the father, primarily from a financial standpoint since the widow is supposed to retain her husband’s inheritance through remarriage with the inheritance generally returning to the deceased’s successor.

Then in terms of family life, the new husband must support his brother’s wife or wives and children as if they were his own. Thus, he is responsible for these children’s food, education, and health. This tradition allows the husband’s family to avoid “losing” either the couple’s children or the paid dowry.

However, AIDS has caused this practice to gradually disappear as it becomes increasingly rare in sub-Saharan Africa. If the husband dies of AIDS, there is a high probability that his widow is HIV-infected, and the husband’s brother may refuse remarriage out of fear of HIVAIDS contamination. Without remarriage within the lineage, no family member is obligated to care for the orphans Ntozi and Mukiza-Gapere, 1995.

A study in Zimbabwe demonstrated that the custom of levirate is now rarely practiced; this is explained as much by refusals from women who fear contagion and spread of HIV/AIDS as from men who fear HIV infection Foster, Drew et al., 1995.

• Sororate is a parallel practice in remarriage customs where the widower marries the sister of his deceased wife who is expected to ensure continuity of the lineage and to raise her sister’s children as her own.

However, since the appearance of AIDS, few women want to marry widowers who they fear have HIV. Moreover, widowers often find themselves impoverished from the death of their wives because treatment and funeral costs are high, and they have difficulties taking care of their orphaned children. Therefore, they face more and more difficulties in remarrying due to AIDS. Mukiza-Gapere and Ntozi, 1995.

The practices of sororate and levirate, which have played a determining role in caring for orphans, are becoming rare because they represent a high risk of AIDS contamination and spread.

• The decline of these customs has led to an inversion of support mechanisms for children. According to Foster et al. (1995), children are cared for more and more by the mother’s family, contrary to the norms of patrilineal societies. These authors have concluded that a new model caused by the AIDS epidemic has emerged Foster, Drew et al., 1995, Caldwell, 1997, and the inversion between patrilineal and matrilineal lineages for orphan care, particularly in urban areas, reflects a decline in traditional practices in the extended family Foster, Makufa et al., 1997. 

For example, in Zimbabwe, the obligation to take in AIDS orphans now falls on the mother’s family, contrary to the past when this responsibility fell on the father’s family Foster, 1996.

Another study carried out in Tanzania drew the same conclusions: children are cared for more and more by the maternal family among the Sukuma. However, this Tanzanian ethnic group traditionally functions according to patrilineal lineage, with children belonging to the father’s family upon complete payment of the dowry Urassa, Ng'weshemi et al., 1997. Two other studies conducted in Uganda show similar results Kamali, Seeley et al., 1996, Oleke, Blystad et al., 2005.

• Limitations in caring for orphans within the extended family in an HIV/AIDS context

 “In the past, people used to care for the orphans and loved them, but these days there are so many, and many people have died who could have assisted them, and therefore orphanhood is a common phenomenon, not strange. The few who are alive cannot support them.”  A widow in her early fifties – Kenya Nyambedha, Wandibba et al., 2003.

The extended family has difficulties coping with this rising number of orphans Mashumba, 1994. These families comprise fewer and fewer surviving adults, impeding their capacity to care for orphans because the surviving individuals who make up these families are too old, too young, or too weak due to the disease’s progression. The epidemic has caused a transformation in the support system Foster, Drew et al., 1995; a growing proportion of orphans is now cared for by either the oldest or the youngest family members Foster, Makufa et al., 1996, Saoke, Mutemi et al., 1996.

Traditional family solidarity is confronted by its own limitations: “the breakdown of the extended family systems, stretched to their limits by the burden of caretaking” Hunter, 1990.

However, the traditional support system, although weakened, has not disappeared; it changes and adapts to societal transformations Foster, Drew et al., 1995, as will be demonstrated below. These changes show the strength, flexibility, and adaptability of the support mechanisms in the extended family Foster, Drew et al., 1995.

Family support for orphans today: mechanisms for adaptation

The “extended family continues to be the predominant orphan caring unit” in sub-Saharan Africa. However, the HIV/AIDS epidemic has led to the emergence of new situations for orphan care, especially concerning the choice of guardian Foster, Drew et al., 1995.

Although contexts vary between sub regions and even within them, similar new support practices exist.

• A large percentage of these vulnerable children are paternal orphans who are increasingly cared for by mothers

In most cases, when one parent dies, the orphans stay with the surviving parent.

Before the AIDS epidemic, according to customary law governing matrimonial rules, the following rules of support for orphans who lost one parent were in place: 

• Maternal orphans stay in the father’s family and are cared for by either the husband’s other wives through the system of polygamy or the husband’s new wife especially through the sororate custom explained above, or they can even be distributed within the paternal family. Solidarity between co-wives in the institution of polygamy plays an important role in caring for maternal or double orphans; this type of care is currently common except when wives disagree Nyambedha, Wandibba et al., 2001, Urassa, Ng'weshemi et al., 1997.

• Paternal orphans stay with their mother but within the paternal family due to the practice of levirate (remarriage between the mother and one of the brothers of the deceased). If she refuses to remarry, she is required to leave the family of her deceased husband. In some communities of West Africa, such as the Mossi in Burkina Faso, the mother can only leave with the child she is nursing, and her other children must stay in the father’s family, to whom they belong; nevertheless, she must return her nursing child as soon as he or she is weaned Taverne, 1997.

 However, these traditional support practices for orphans are disappearing, particularly in urban settings, where “more and more women refuse to submit to decisions under customary law that remove their children from them and request the application of modern law,” Taverne, 1997 stipulating that in most cases if one of the two parents dies, full custody will legally go to the other parent.

Currently, most widows increasingly refuse traditional remarriage and keep their children on their own despite pressure from in-laws. Nevertheless, they are then deprived of their belongings or compounds by their in-laws. Hence, many widows live alone with their children in increasing economic vulnerability following the father’s illness, funerals, and property grabbing.

However, “studies show that to be members of such households is not necessarily a bad thing, that concerning health and education, women heads of households invest more in their children in terms of resources, time, and emotional support than do men” Pilon and Vignikin, 1996. Bruce and Lloyd confirm these results Bruce and Lloyd, 1996, Bruce and al., 1995. Recent studies conducted in Zimbabwe and Guinea Bissau confirm women’s commitment and investment to ensure the best upbringing for their children and those under their charge Nyamukapa and Gregson, 2005, Masmas, Jensen et al., 2004.

By contrast, maternal orphans are not automatically cared for by their fathers. For example, “in Malawi, nearly three out of four paternal orphans continue to live with their mothers, while only a quarter of maternal orphans live with their surviving fathers. Fathers are also more likely to look after orphaned sons than orphaned daughters.” UNICEF, 2003.

Another study conducted in Tanzania in the rural community of Kisesa confirms that the mother more commonly assumes orphan care than the father Urassa, Ng'weshemi et al., 1997. Table 7 indicates the percentage of orphans cared for by one or the other parent by African regions.  

Table 7 : Practices in providing care for paternal and maternal orphans.

Region	Percentage of paternal orphans living with their mother	Percentage of maternal orphans living with their father
West Africa	68	56
Central Africa	73	52
East Africa	86	59
Southern Africa	70	39
Sub-Saharan Africa	73	55

 UNICEF, UNAIDS et al., 2004

This new support practice follows the general trend of an increased number of female-headed households observed in sub-Saharan Africa since the 60s.

Factors explaining the emergence of this type of household continue to be vague, despite the hypothesis suggesting that they result from labour migration, marital instability, the rise in the number of single women, economic crises, armed conflicts and as a rule, from widespread emancipation among African women. Pilon, Seidou Mama et al., 1997.

A study conducted in Benin demonstrated that this type of household develops foster-care strategies that strengthen family solidarity Pilon, Seidou Mama et al., 1997, and therefore plays a determining role concerning orphan care in a context of HIV/AIDS.

Therefore, numerous studies highlight that in a context of HIV/AIDS, mothers and women in general assume most of the responsibility concerning orphan care.

Female-headed households generally care for a greater number of orphans than households where the head of the family is a man Monasch and Boerma, 2004, Urassa, Ng'weshemi et al., 1997, Nyambedha, Wandibba et al., 2003.

Figure 3 : Percentage of maternal orphans living in female-headed households.

• Grandparents are heavily called upon

“Grandparents who previously received support from their children now see a change in their situation due to the mortality of young adults, and therefore, they find themselves much more involved in caring for their grandchildren and the family’s economic activity” Locoh, 1997.

The specificity of HIV/AIDS implies a high probability that both parents are infected and die leaving behind a rising number of double orphans.

Double orphans are taken care of by the extended family, mainly by grandparents and more precisely by the maternal grandparents. These care practices break away from customary laws within the patrilineal lineage. Foster et al. stress the importance of this inversion of intergenerational flows in a study in Zimbabwe among the Shona ethnic group, traditionally based on a patrilineal system where the responsibility for care falls on the father’s family. In this ethnic group, they observe that the maternal family more commonly cares for orphans than the paternal. This inversion of support systems compared to the traditional model reflects a decline in traditional rules that govern the extended family in sub-Saharan Africa Foster, Makufa et al., 1997. Another study conducted in a rural community in western Kenya emphasises that 27.7% of double orphans are cared for by the maternal family, in spite of tradition Nyambedha, Wandibba et al., 2003.

Nevertheless, this change leads to economic problems within these households because the maternal family receives none of the inheritance nor support from the paternal family Foster, Drew et al., 1995.

Numerous studies mostly carried out in East and Southern Africa highlight this new phenomenon Ntozi, Ahimbisibwe et al., 1999, Urassa, Ng'weshemi et al., 1997, Foster, 1996, Ntozi and Mukiza-Gapere, 1995, Nampinga, 1995.

Given the growing number of orphans and the increasingly limited number of foster families and potential guardians, orphans live more and more in larger households that are headed by elder family members Monasch and Boerma, 2004.

Therefore, according to C. Obbo, there are many grandparents who have lost three or four children and are responsible for seven to twenty orphaned grandchildren Obbo, 1993.

In Namibia, the percentage of orphans who are cared for by their grandparents went from 44% to 61% between 1992 and 2000 probably because many other family members are themselves dying of HIV/AIDS or have already died Foster and Williamson, 2000.

The graph below drawn from the study in Namibia clearly illustrates the growing role of grandparents in care practices for children:

Figure 4 : The growing role of grandparents in Namibia.

In Zimbabwe, grandparent-headed households are increasing in number. In the Manicaland area, 125 orphan households of the 292 surveyed (43%) were headed by grandparents Foster, Makufa et al., 1997.

According to Olivier Appaix and Sandrine Dekens, 30% of orphans sponsored by the association “Orphelins du Sida International” at the Social Solidarity Action (Solidarité Action Sociale; SAS), centre of Bouake in Côte d’Ivoire, lived with their grandmothers Appaix and Dekens, 2005. In Zambia, a national survey carried out in 1996 showed that 38% of orphans were cared for by their grandparents Deininger, Garcia et al., 2003.

A study conducted in Tanzania indicated that on a national scale, 80% of the orphans are cared for by their grandparents Caldwell, 1997. All these examples show the grandmothers’ decisive role in caring for orphans.

As noted, women are more involved than men in taking in and protecting orphans,throughout their lives. Studies conducted in Uganda and Kenya highlight this phenomenon and the increasing number of grandmother-headed households Ntozi and Zirimenya, 1999, Nyambedha, Wandibba et al., 2001, Nalugoda, 1997, Madhavan, 2004. These households are severely affected by economic vulnerability because they bring together two age groups from the inactive population—children and the elderly—and increase the level of economic dependence.

These households that bring together grandmothers and grandchildren should receive priority support by communities and institutions. For example, this association of grandmothers in South Africa was formed for members to support each other and to handle the orphan crisis: “The Go-Go Grannies are a group of grandmothers in South Africa’s AlexandraTownship who help and encourage each other as they raise their orphaned grandchildren. They have lost their own children to AIDS and are now finding it difficult to cope, both emotionally and physically. The Grannies are part of the Alexandra AIDS Orphans Project, which runs support-group programmes for children and caregivers living with, and affected by, the epidemic. The project currently provides psychosocial, financial and material support to 30 grandmothers. This includes one-time building grants to ensure adequate shelter for their growing families, as well as seeds and fertilizers so the women can start their own gardens to bring in food and income for their families.” UNAIDS, 2002.

This synthesis aims to bring out the general trends in orphan care in the context of HIV/AIDS, though this is not an exhaustive review of all support mechanisms for these children. Intergenerational solidarity can also be represented by uncles, aunts, brothers and sisters, neighbours, friends, etc., and may constitute new research topics that have until now rarely been explored in literature on orphan support.

This section ends with the graph below which shows the various support/care practices that exist in sub-Saharan Africa.

Figure 5 : Extended families traditionally care for children.

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