The rapid spread of the HIV infection in China is having a devastating impact on the country's children, and threatens to become an epidemic with significant social and public health repercussions due to the rapid rise in AIDS orphan population. The increased number of AIDS orphans in China parallels the increasing number of AIDS orphans worldwide, and is one of the most serious consequences of the AIDS epidemic today.
In rural China, many villages that up to now have had very few orphans have seen their rates soar following AIDS' deaths of their parents as a result of blood transfusions with contaminated needles. Until recently the remaining relatives used to take care of the children. Because in many cases those relatives are now affected by HIV/AIDS, they have become unable to provide basic support to children in their families. The toll on children has become so serious that UNICEF has included new indicator related to the prevalence of HIV/AIDS in its "child risk measure."
In 2003 it was estimated that worldwide more than 13 million children under 15 had lost one or both parents to AIDS. Although Thailand has the largest number of AIDS orphans —usually defined as children under 15 who have lost their mother or both parents to AIDS—their number is increasing fast in other Asian countries.
In Cambodia, Malaysia and India, the number of AIDS orphans has increased by 400 percent from 1994 to 1997. This rate of increase is similar to that of countries such as Namibia, South Africa and Botswana. Although proportionally the number of AIDS' orphans in Asia is much lower than in Sub-Saharan Africa, in absolute numbers there are more orphans due to AIDS in Asia than in Africa.
Orphaning is a worldwide problem. It is estimated that by 2010 106 million children will lose one or both parents, and 25 million of them will be orphaned because of AIDS. According to estimates of China's Ministry of Health there are at least 100,000 AIDS orphans in China. UNICEF's China Office estimates that over the next five years 150,000 to 250,000 additional children will be orphaned by AIDS.
Since 2003, UNICEF has worked with local health authorities and workers, the Women's Federation and communities to provide both psychological and social support to children affected by AIDS. It has also provided support to Summer Camps for Children Affected by AIDS, helping raise awareness about their needs.
Children orphaned because of their parents' death by AIDS are likely to be malnourished and unschooled, and are at greater risk of becoming HIV-infected themselves. At the same time, because they are emotionally vulnerable, when they grow up they may tend to engage in risky sexual behavior that may lead to a vicious cycle of abuse and exploitation.
What makes this situation particularly worrisome is that the number of orphans will continue to rise for at least the next decade. That is why, even in a country where HIV prevalence has declined, the number of orphans will continue to be high. According to Dr. Peter Piot, executive director of UNAIDS, "The orphan crisis is a major reason for introducing treatment for adults on a wider scale."
Orphans due to HIV/AIDS are part of a much larger problem, since countries that have high rates of AIDS' orphans also have high number of children directly affected by the epidemic, and who are often just as vulnerable. Although their total number is difficult to assess, it has been estimated that over 3 million children worldwide are living with HIV/AIDS.
It is necessary to develop a major educational campaign to make people aware of the dangers of the infection not only to them but also the risks it poses to their children. The majority of people in China still don't know how HIV is transmitted. According to a survey carried out in 2004 by the Futures Group Europe and the Beijing-based Horizon Research Group, only 8.7 of Chinese knew how HIV is transmitted and 25 percent of rural residents hadn't even heard of the infection.
To help AIDS' orphans in a more immediate and practical way it is necessary to strengthen the capacity of extended families to protect and care for orphan children by providing them with financial aid by local councils or provincial governments. Orphan children's special needs should also be addressed through community-based responses and by increasing the capacity of local orphanages.
It is also important to support the work of Non Governmental Organizations (NGOs) such as the China AIDS Orphan Fund who have been working in collaboration with other NGOs to improve Chinese orphans' health, education, and quality of life.
It is important to diminish the stigma surrounding the HIV infection. Often times, children who have lost their parents to AIDS are assumed to be also infected with HIV, which further stigmatizes them. It is critical to develop new government policies including legal, education and labor frameworks, and to make sure that these policies will be followed.
Dr. César Chelala is an international public health consultant and the author of AIDS: A Modern Epidemic, a Pan American Health Organization publication.
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