HIV/AIDS In Africa: Children Infected And Affected By The Pandemic

Remarks by Dr. Chinua Akukwe at the US Congressional Human Rights Caucus (CHRC) Seminar on the Global Challenges of HIV/AIDS: Drawing the line in Africa, April 2, 2003, Capitol Hill, Washington, DC.

The Perspective
Atlanta, Georgia

April 4, 2003


Africa is at the crossroads of multiple issues such as poor governance, underdevelopment, conflicts, environmental disasters, economic exploitation, and grinding poverty. However, the HIV/AIDS epidemic is by far the biggest challenge of modern day Africa. With more than 30 million individuals, mostly men and women at the prime of their lives, living with HIV/AIDS in Africa, and less than 5% of these individuals having access to lifesaving medicines, the future is not very promising.

African children infected and affected by HIV/AIDS are the ultimate development nightmare for a continent grappling with major socioeconomic problems. According to the UNAIDS, every day, two thousand infants contract HIV through their mothers throughout the world. At least 95% of these infants are born in Africa. Every day, in the entire world, six thousand children lose one or both parents to AIDS. More than 90% of these children are Africans. Every day, sixteen hundred children die of AIDS worldwide. At least 90% of these dead children are Africans. Today, every child in Southern Africa is 50% most likely to die of AIDS in his/her lifetime. Today in Africa, 95% of pregnant mothers do not have access to health programs that can significantly reduce the incidence of mother-to-child transmission of HIV.

The worse is yet to come. According to the UNAIDS, UNICEF and USAID, by 2010, at least 20 million AIDS orphans will live in Africa. This is in a continent where children face the deadly combination of high rates of infant deaths, vaccine preventable deaths, under-five mortality, diarrhea-related deaths, and death from malaria. It is also a continent where children face major challenges of going to school, staying in school, eating nutritious meals, and having access to adequate sanitation.

African children infected and affected by HIV/AIDS face current and future dangers. These children, as extended family systems become stretched, face the daunting prospects of life on the streets. The also face the ever present dangers of conscription into the sex trade industry and forcible enrolment into private militias and criminal gangs. The education and health needs of these children are unlikely to be met, as shown by the current predicament of Southern Africa street children. In simple terms, the scenario of 20 million uneducated, street hardened, weather-beaten, and ultimately bitter African children will present formidable challenges to constituted governments in the continent by 2010.

Current Remedial Efforts

What are the current policies and programs for children infected and affected by the HIV/AIDS crisis in Africa? Today in Africa, I am not aware of any serious continent-wide, comprehensive, multisectoral policy or program directed at the more than 12 million AIDS orphans in Africa. I am also not aware of any comprehensive, multisectoral program directed at children infected and affected by HIV/AIDS in any African country. I am also unaware of any serious, integrated and comprehensive corporate or civil society effort to address the issue of children infected and affected by HIV/AIDS in Africa.

Obviously something is going on in Africa about children infected and affected by HIV/AIDS. I am aware of heroic efforts by small-scale community-based organizations to provide basic support for AIDS orphans in various countries in Africa. I am also aware of the role of faith-based organizations, international agencies, and foundations in addressing pockets of the AIDS orphan problem in Africa. The Gates foundation initiative on AIDS orphans in selected African countries readily comes to mind. The role of communities and families, most often poor, is also critical in current palliative efforts to address the problems of children infected and affected by HIV/AIDS. Grand parents, especially grandmothers are now major breadwinners for AIDS orphans in many parts of Africa.

It is instructive that as the AIDS orphan crisis grows in Africa, and more children become infected and affected by the epidemic, very little action is underway to meet the needs of these children. Most initiatives in Africa are limited in scope and coverage, and rarely focused on an index AIDS orphan or a child either infected or affected by the epidemic.

Way Forward

What can be done to remedy the situation? I suggest three basic principles for dealing with children infected and affected by HIV/AIDS in Africa.

Three Principles for Dealing Children Infected and Affected by HIV/AIDS in Africa

1. Say no to token or palliative programs. Initiatives in Africa should be comprehensive and multisectoral in dealing with the needs of infected and affected children.

2. Recognize the unique needs of children LIVING with HIV/AIDS and those children AFFECTED by HIV/AIDS.

3. Aggressively prevent transmission of HIV and/or provide antiretroviral therapy to those in need.

To move forward, we must step away from the present comfort zone of providing token, palliative remedies for African children infected and affected by HIV/AIDS. To provide comprehensive multisectoral programs, the African Union, the Economic Commission for Africa and the African Development Bank in conjunction with other international partners should develop a continent-wide blueprint for dealing with children infected and affected by HIV/AIDS. This blueprint, while recognizing distinct local and national issues, will set guidelines and parameters for scaled up continent and international remedial efforts. This blueprint should also set guidelines for regional initiatives, for sharing expertise across national boundaries, and, for creating opportunities for communities to share lessons learned.

To recognize the unique needs of children infected and/or affected by HIV/AIDS, local, national, continent and international remedial efforts should focus on outcome indicators for an index child. Did this infected child receive his/her lifesaving medicines? Did this affected child complete age-appropriate grade school? Did this infected child meet his/her nutritional needs (for example, through age-appropriate weight gain)? Did this affected child leave the streets and move into decent housing? To meet the challenges of these children, each unique need must be met or considered.

To stop HIV transmission, aggressive information, education and communication campaigns must continue in Africa. Pregnant women in Africa should have access to antiretroviral therapy that can cut maternal transmission in half. Children and adults living with HIV/AIDS should have access to antiretroviral drugs.

Seven years from now, 2010, Africa will face the prospects of 20 million AIDS orphans and millions of other children infected with HIV. Before 2010, every year, successive cohorts of AIDS orphans will become young adults, the economic and social fulcrum of their societies. No matter our actions or inaction, these children will assume their natural role as the engine room of their societies. Whether these children are socialized, educated, clothed or fed, they will assume their role in the society. The question is what kind of role do we expect these children to play in the future. The choice is entirely ours.

Dr. Akukwe ( is a Member, Board of Directors of the Constituency for Africa (CFA), Washington, DC, a Former Vice Chairman of the National Council for International Health (NCIH), Washington, DC, and Adjunct Professor of Public Health, George Washington University School of Public Health, Washington, DC. His work on AIDS includes:
1. Chinua Akukwe (2002). HIV/AIDS in Africa: An Integrated Regional Approach. AFRICA NOTES, July/August, pages 7-11. Cornell University, Ithaca, New York State.
2. Peter Piot (2002). Speech to the United Nations General Assembly Special Session on Children, United Nations, New York. Geneva: UNAIDS.
3. UNAIDS (2002). Report on the Global HIV/AIDS Epidemic. Geneva: Author.
4. USAID, UNICEF, UNAIDS (2002). Children on the Brink 2002. Washington, DC: USAID.
5. UNDP (2002). Millennium Development Goals and the UNDP Role. New York: Author.