At Risk Groups
Over 40 million people in the world are currently infected with the HIV virus and 90% of them live in developing countries. Sub-Saharan Africa remains by far the worst-affected region, with 25.4 million people living with HIV at the end of 2004, compared to 24.4 million in 2002. Our models and programs currently focus on children and women as these groups are particularly at risk for infection and have special needs that often go unaddressed. Because the emphasis of AIDS work is typically on adults, children fall between the cracks and go unnoticed. Additionally, women, the primary caregivers for people living with HIV, need support in this role.
Children
At the end of 2005, 2.3 million children (less than 15 years of age) were living with AIDS (UNAIDS, December 2005).
The most direct effect of HIV is when a child has been infected and becomes vulnerable to opportunistic infections because of the virus. Without proper medical intervention, these opportunistic infections ultimately lead to the death of the child. Of the three million people who died in 2005 because of AIDS, 570,000 were children.
In families where the parents have HIV, children often end up caring for sick parents and, if parents are unable to work, become the principal wage earners for the family. If there is HIV in the family, the children experience stigma and fight discrimination by the community.
Often children lose one or more parents to AIDS; in 2005 it was estimated that there are 12 million orphans due to AIDS in sub-Saharan Africa. In countries such as Swaziland, Botswana, and Zambia, orphans now constitute close to 20 percent of all children under 18 years. A World Bank report estimates that by 2010, this number will grow to 20 million orphans.
Children who have been orphaned by HIV/AIDS face multiple risks. In all likelihood, they have contracted the disease from their mother (90% of 700,000 children were infected by mother-to-child transmission in 2005). They often face isolation because extended families may be unwilling or unable to care for them. If children have younger siblings, the eldest child becomes responsible resulting in a growing number of child-headed households. These children face exploitation or abuse in their attempt to survive or care for siblings, putting them again at risk for infection.
Children with HIV can lead longer, healthier lives with proper treatment and care. Anti-retroviral treatment is still a complicated process where children are concerned and caregivers need support in administering these drugs. “Developing countries need not only drugs to treat children, but specialist training for staff and funding to enable treatment and ongoing care to take place.” (AVERT)
Women
In sub-Saharan Africa, women make up 57% of all people infected with HIV, but represent 67% of new infections. A striking 3 out of 4 young people (aged 15–24 years) living with HIV is female; additionally women in this age group are three times as likely to become infected.
The reason for the higher rates of infection in women is because physiologically, women are much more vulnerable to contracting HIV. They are twice as likely to become infected than men through heterosexual sex, the primary mode of infection for women.
Societal norms often limit women’s decision-making in sexual relationships. Some patriarchal societies do not allow women to choose their sexual or marriage partners; these decisions are reserved to the male members of the family. Within committed relationships, such as marriage, women are frowned upon if they know too much or wish to discuss sex.
If societal norms don’t limit women, economics does. Because women usually have little or no independent income and fear abandonment, they are vulnerable to the decisions and actions of their male providers.
Poverty often drives women to sex work where discussions around condom use usually involve negotiating a higher price to not use one. Because of her economic situation, if the woman would prefer to use a condom, sheer necessity prevents her from enforcing this preference.
Physical and sexual violence, especially in lower economic classes, is a factor. Fear of physical violence prevents women from negotiating safe sex. Additionally, myths prevalent in large parts of Africa, such as having sex with a virgin can cure AIDS, leads to HIV positive men preying on and raping girls.
Women have multiple roles in the social structure of communities and the pandemic has a direct impact on these roles. Nurses and teachers are typically women; their absence breaks down the medical and educational structures that are vital to stable, growing communities. In homes, women are irreplaceable as caregivers. Their responsibilities go beyond the home as they also work to support their families. The absence of a woman in the family is the loss of a nuturer, protector, role model, and breadwinner.