The effects of HIV infection and AIDS on children in Africa.

Two months ago, I was in rural Uganda with a team of local researchers. Mud houses with grass roofs were connected by a maze of footpaths, and roads were few and far between. We were there to interview people in homes where children were affected by AIDS. Some of the children were living with an HIV-positive parent. Others were already orphans and had been taken in by a relative. It struck me, as we advanced awkwardly by van, how frequently we stopped at eligible homes to dispatch an interviewer. You could throw a stone from one household confronted with AIDS, and it would land in the neat garden plot of the next. This disease closes in on children from all sides in the hard-hit regions of East and Southern Africa. Children nurse their parents during prolonged illness and watch them suffer and die. Some even watch their guardians succumb to AIDS. They lose sisters and brothers, uncles and aunts, teachers and leaders. At the very least, they grow up sharing their meals with orphaned cousins. The US Bureau of the Census estimates that, by the end of 2000, 15.6 million children around the world had lost a mother or both parents to AIDS. By 2010, at least 44 million children will have lost a mother, father, or both parents to AIDS. Even these daunting figures exclude older orphans aged 15 years and older, children orphaned by war and other causes, orphans on the streets and in institutions, and children whose parents are ill with opportunistic infections of AIDS. Perhaps the unluckiest children of all are those infected from birth or in infancy. True, we can take heart in our slowly improving ability to reduce the transmission of HIV from mother to child. But already 1.5 million children in Africa are living with AIDS. And until HIV-positive mothers are kept alive, their virus-free children are sentenced to orphanhood and its attendant vulnerabilities.