When HIV/AIDS affects a family, women - particularly elderly women, as well as girls and young women - take on by far the greater burden of care. The strain is beginning to show. Two thirds of caregivers in households surveyed in a recent study in South Africa were female, with almost a quarter of them over the age of 60. Female-headed households generally assume the care of more orphans than those headed by males, often compounding their own poverty.

Children or adolescents are often forced to assume the burden of caring for sick parents or for their younger siblings. The proportion of households officially headed by children is still small - less than 1 per cent in most countries - but this vastly underestimates the scale of the problem. Though a household in which the lone parent is sick and needs the care of older children may still formally be headed by the parent, in practice the burden of responsibility may have already passed to the children. Similarly, even where children have been taken in by grandparents or other relatives, they may be required to work and help sustain the family.

Figure 4.5: Challenges facing children and families affected by HIV and AIDS. Click here to view this figure.

In many cases assuming this burden of care results in children dropping out of school. Foregoing their education does not just limit the chances that they will be able to create a better future for themselves and their families, it also means they will not receive important, often life-saving information on how to avoid HIV infection or access treatment for AIDS.