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DATA BRIEFS:  PROGRESS AND DISPARITY

AIDS' impact on children's lives

In one of its most devastating and least visible consequences, HIV/ AIDS is eroding precious and hard-won infant and child survival gains in a number of countries in Africa.

In Botswana, for example, AIDS will be responsible for 64% of deaths of children under five by the year 2000, offsetting much of the country's impressive child health progress. In South Africa and Zimbabwe, AIDS is projected to account for a 100% increase in child mortality. Some experts predict even more dramatic increases are to come. The US Census Bureau projects that by the year 2010, the mortality rate among children under five in Zimbabwe will be three-and-a-half times as high as it would have been without AIDS, and infant mortality may double. In some African countries, hospitals report that three out of four paediatric beds are taken up by children with AIDS.

The impact on children extends beyond those infected, as millions in the hardest-hit countries suffer the loss of parents and caregivers, and thus incur much greater risks to their health, nutrition and education. Mounting effects are already being seen on the nutrition of children living in households affected by AIDS. A study in Kagera (Tanzania) found that food consumption in poorer families dropped by 15% at the time of an adult's death from AIDS. Such a decline can have a significant impact on a child's development. Furthermore, children orphaned by AIDS run a higher-than-average risk of stunting; according to the World Bank, stunting among orphans is around 50%.

A fall in literacy rates in many countries is expected since children in AIDS-stricken households are taken out of school when families can no longer afford fees or when children are needed to help out at home or to earn an income. Orphans living in extended families are also generally the first to be denied an education. A study in Zambia indicated that in urban areas, 32% of orphans were not enrolled in school, compared with 25% of non-orphans. In rural areas, 68% of orphans were not in school, compared with 48% of non-orphans.

Much of the disease's economic impact remains difficult to measure; but there is no question that increased health care expenditures and loss of family income are straining resources, burdening women in particular and putting surviving children at greater risk of malnutrition, illiteracy and disease. AIDS is also decimating the ranks of the skilled and educated during their prime years, with potentially tragic implications for future development. A recent survey in Malawi, for example, found the rate of infection among schoolteachers to be higher than 30%.

In some African countries hit hard by AIDS, it is no longer unusual to see children under 15 heading households. This Ugandan girl, who lost her parents to AIDS, cares for a blind grandmother and younger siblings

The burden is also great on already inadequate health care systems. In Zimbabwe, government projections are that HIV/AIDS will consume 60% of the health budget by the year 2005. In most developing countries, the disease is increasing the price of health care and reducing its availability, which will have the greatest impact on the poor. In many communities, healthy children whose parents have died from AIDS are at greater risk of dying of preventable diseases, because their illnesses tend to be attributed to AIDS and thus to go untreated. Evidence also indicates that orphans are less likely than other children to be immunized and to have their health care needs adequately met.