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South Africa
Raphael Centre
When I first met Pamela she was five years old and too weak to walk. She was carried everywhere on her mother Nonkhundla’s back. Nonkhundla found out that both she and Pamela were HIV infected, after months of suffering and recurrent illness. She spent all of the family’s meagre income at the Sangoma (witch doctor) undergoing agonising rituals for the banishment of evil spirits. Eventually, almost as a last resort, she visited the Raphael Centre for people living with HIV/AIDS in Grahamstown. Nonkhundla’s greatest fear was that she would die before her child and she had heard that we sometimes look after sick children.
At that time, no anti-retro viral (ARV) treatment was available to poor people in South Africa. Our support of Pamela and Nonkhundla involved ensuring that they obtained life-skills and good nutrition. This was beneficial because their health improved and they suffered from fewer opportunistic infections. However, after the Government had been compelled by court cases to make treatment available to the poor, we were able to ensure that Nonkhundla became one of the first in our region to be treated with ARVs. This was immediately successful and she now has an undetectable viral load. We were then able to argue that Pamela also needed treatment. Subsequently, Pamela became one of the first children in our community to receive paediatric ARVs. We also have a programme geared toward preventing children like Pamela from ever becoming infected.
Our prevention of mother-to-child transmission targets pregnant women and encourages voluntary counselling and testing. If pregnant women are aware of their HIV status, treatment can be provided. We also educate women about ways of minimising transmission of the virus to their baby.
The Raphael Centre supports 160 AIDS-affected children like Pamela. There is no orphanage in our community and we support children in the homes of caregivers. Children living in AIDS-affected homes have a higher rate of absenteeism than their peers, and are more likely to leave school altogether. This can be attributed to the stigma still surrounding AIDS and those associated with it, and the financial burden placed on children with parents unable to work. At the Centre we try to counter this by paying school fees and providing school uniforms and emergency food parcels. We believe that encouraging orphans and vulnerable children to stay in school for as long as possible increases their life chances. We have had remarkable success. In the past six years, only two out of several hundred children supported by us have dropped out of school.
Pamela, the child who was too weak to walk, is now thriving in school. She is bright, agile and, according to her teacher, capable of whatever she sets her heart on. The last time I spoke with the nine-year-old, she was not quite sure of her future career plans but was dreaming of becoming either a rock star or a famous fashion model.
St Anne’s Homes
The impact of HIV/AIDS on the South African child is enormous. Of the 1.5 million orphans in South Africa (maternal orphans under the age of 18) about two thirds were orphaned due to AIDS, with 300,000 becoming orphans in 2006 alone, according to the Actuarial Society of South Africa report in 2006.
Orphaned children experience enormous pressure as they often have to assume adult roles in treatment, care and support. Surviving siblings suffer stigma and discrimination in their communities. They are also much more exposed to violence, abuse and exploitation and drop out of school for a variety of reasons. In addition, orphaned children experience the loss of caregivers and lack of access to essential services such as education and health care.
While residential care is widely perceived as the last resort for addressing children’s care needs, orphanages are mushrooming across sub-Saharan Africa. Major international agencies concerned with the needs and rights of children, such as UNICEF, advocate that residential care must only be a temporary “last resort” for children without parental care.
These agencies and literature repeatedly reiterate negative impacts on children resulting from residential care: e.g. it marginalises children from society and results in stigma; it fails to transfer critical life skills to children resulting in their being inadequately prepared to cope with life when they leave care; it frequently fails to respond to children’s individual needs – characteristically prioritising the needs of the institution.[1]
St Anne’s Homes, a shelter in Cape Town which cares for and empowers pregnant, abused and homeless women and their children, has been overwhelmed by the scourge of HIV/AIDS. We believe that the sacred bond between mother and child must be preserved at all costs. In the past few years, we have received a number of referrals suggesting the mother and child be separated because of their HIV status. We constantly have to stress that HIV is not a good enough reason to separate a child from its mother, especially when there is sickness. At the same time, we have been struggling, due to a lack of capacity, to meet the needs of temporarily ill HIV-infected mothers and children. In one such case, where the mother became so sick that we could not keep her in our care, we were forced to refer her to an organisation that runs an adult hospice and orphanage. Although the child was not with the mother, at least they were in the same organisation. St Anne’s Homes have since had to expand their own HIV/AIDS programme.
South Africa has developed various policies addressing the impact of the epidemic on children. Interventions targeting vulnerable children focus on the provision of Home– and Community-based Care Services and the establishment of community Child-Care Forums to identify and support children. The Orphans and Vulnerable Children’s Policy Framework, in addition, recommends the provision of formal foster-care placements for orphans in an attempt to reintegrate orphaned children back into families.
It was due to the strength of civil society and HIV/AIDS activists that the South African Government was not able to downplay the enormity of the epidemic. Instead, under the leadership of the Deputy President, the Government’s response improved and the Government, through the President’s office, has called on religious communities to help in addressing key social problems, including HIV/AIDS.
The Anglican Church in South Africa, under the leadership of Archbishop Njongonkulu Ndungane, is playing a central role in addressing the issue both within the Communion and on an interfaith level. For more information on the church’s programmes visit www.fikelela.org.za and for more information on shelters for mothers and children visit www.stanneshomes.org.za
1. Home Truths: The phenomenon of residential care for children in a time of AIDS, 2007:9
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