HIV/AIDS and Children’s Rights
The HIV/AIDS epidemic is a disaster for children, violating their rights and preventing them from having their needs met. HIV/AIDS touches on nearly every aspect of a child's life. The poorest and the least empowered are the most affected - the children living in poverty, those living with violence and abuse, those living with a disability, and girl children generally.In South Africa, AIDS will kill more people this year than from all other causes put together.
HIV/AIDS is hurting children, violating their rights and preventing them from having their needs met. Below we highlight the rights most dramatically challenged, and some of the ways these will hurt children.
The right to family life and alternative care (UN CRC Articles 5,9,10, 18, 20, 21 and 25)
Children need warm, supportive families. The right to family life and alternative care will be affected by:
- Increased rates of children being orphaned
- Stressed families with decreased ability to cope with increasing demands
- Fewer doing more - with increased time, effort and resources going to care for the sick and the sick unable to contribution normally
- Increased psychological problems including depression & anxiety
- Increase in disruptive and destructive behaviours
- Poor quality family Life
- Inability of government or communities to meet the scale of need for Alternative Family Care
- Decreased monitoring of children who are informally placed within extended family systems.
It is projected that there will be between 3.6 million to 4.8 million orphans in South Africa and in the Province of KwaZulu-Natal alone this will mean three quarter of a million orphans. Orphans will constitute between 9-12% of the population.
The right to an adequate standard of living (Articles 20, 25, 33, 34, 75)
Children have the right to a standard of living that allows them to grow and develop.
This is being eroded by:
- Increased levels of and exposure to already high levels of poverty
- Increased numbers of children living and working on the street, as well as children living on the streets at earlier ages.
The right to social security (Articles 7, 8, 27, 40)
The government is obligated to provide social security for children who require it. This right is being violated on a wide scale due to:
- Inadequate legal provisions to address the changing nature of need
- The inability of children to directly obtain access to social services
- The increased dispossession of inheritance of property, savings and insurance
Children have the human rights of life and health care. Children's lives are increasingly at risk through decreased health care provision and inadequate nutrition as well as HIV infections either from their own mothers, from abuse or early sexual activity.
- Survival: From birth children can expect to live a shorter life as overall life expectancy is predicted to drop. More over, 1 in 3 children born to a mother who is HIV positive will be HIV positive. Of these HIV positive babies, 1 in 3 will die within the first 2 years of life. Unless the South African government implements a national programme to reduce Mother-to-child HIV transmission, a large number of babies and children will die from a predictable, preventable and painful cause at young ages.
- To this number must be added the number of young uninfected children who are more likely to die because they are orphaned - death rates are higher in children without parents than those with parents.
- Free medical care is theoretically provided by statute for pregnant mothers and children up to the age of 5 years. In reality, provincial hospitals are only treating emergency cases, stabilising the child and sending them home before they are well. Children whose parents and caregivers are sick and those who are orphaned are less likely to have preventive and curative health care provided.
- Abandoned babies in hospital: an increasing number of newborn babies are being abandoned in the hospitals at birth because of their HIV/AIDS condition. There is little infrastructure to give these woman support they need to parent their children as long as possible.
- Drug Therapies the drug AZT or Nevirapine when given to pregnant women reduces the chances of the virus being passed onto the baby by about one half. But at present AZT or any other retro-viral therapy is not freely available to all pregnant mothers who might choose to request it through the public health department.
- Immunisation is still necessary for all children. The clinics provide advice about this.
- Care of sick children: It is important that a child who is sick is taken to the clinic as soon as possible and given the necessary treatment. HIV/AIDS children are more susceptible to diseases such as TB, diarrhoea, and pneumonia, and these can cause severe illness and death. Children who are HIV positive need immediate medical attention even for small complaints, to help keep them well as long as possible.
- Sexual abuse as a medical issue: children who have been sexually abused run a high risk of catching the virus that causes HIV. This applies to both girls and boys. This risk can be reduced by about a third if the victim gets immediate treatment with a retro-viral drug such as AZT, and completes the full course. It is however difficult to obtain this
retro-viral treatment, and there is lack of support for victims who need to persevere with the drug in spite of the unpleasant side effects.
- There are few accessible resources for trauma counselling and ongoing support for children and families who have been affected by rape and abuse.
There is a dramatic increase in children being raped and becoming infected with AIDS. This is largely preventable if anti-retroviral drugs are used as "post-exposure prophylaxis" as is done as a matter of policy for needle stick injuries for staff in the public health sector. Tragically this policy has not been extended to victims of sexual assault. Thus compounding the first set of traumas, including children losing their mothers when women are sexually assaulted.
The right to education (UN CRC Articles 6, 20, 26, 28, 29, 31)
Children have the right to education and development.
- School drop-outs: children affected by HIV/AIDS are more likely to drop out of school as there is not enough money to pay for school fees, uniforms and books. Also the demands to help at home and care for sick parents will compete with educational needs. The levels of literacy, the strength of democracy and human development will face dramatic setbacks. A 24% drop in school enrolment in 2001 was reported.
- The role of the school: Schools have direct contact with the child and family on a daily basis and they could take a leading role in the crisis. The role of educators and the education institution may have to change in order for them to help with the custody and the care of children infected and affected by HIV.
- Awareness and prevention: up until now, the education department's main emphasis has been the development of AIDS awareness and prevention campaigns.
"We need also to challenge the quite misguided view that if children receive HIV life-skills, sexuality education and condoms they will become sexually promiscuous. This attitude is insulting to children and educators, and again pushes the interest of one particular group."
From Positive Outlook-Vol. 3(3)
- Life skills education: Firstly, the information and skills imparted in many of the life skills programmes have little value unless attitudes among the learners are addressed concerning sexual practice and the lack of power experienced by girls. It is also not easy to challenge the ignorance and myths about the transmission of the disease, and the discrimination that children and families experience within the school and community setting.
- Early childhood development: There are appallingly few resources and facilities to promote healthy children in an HIV/AIDS positive world. There is no official policy and no assistance to help pre-schools and places of care to provide resources in their communities for basic needs and care for young children. There is no adequate subsidy for food, water and shelter, and no adequate provision to ensure that adequate care is taken of children. Teachers are untrained, under-paid and are themselves affected by the HIV/AIDS crisis.
The right to play and recreation (UN CRC Article 31)
Every child has a right to play, be involved in recreational activities and to participate in cultural and artistic life. This vital component of their total development is being compromised by the HIV/AIDS crisis in two ways.
- Leisure-time reduced: the burden of care and responsibility born by children and young people will reduce the time and energy they have for recreation.
- Strained resources: as the economic burden of HIV/AIDS increases so the resources for non-essential items will be reduced, at all levels from the family budget to national finances.
Children have the right to be protected from abuse and neglect. This protection is largely absent. The more the HIV/AIDS virus spreads in adults, the more vulnerable children are to sexual exploitation. Rapists, abusers and users of prostitutes target younger persons and children as there is the less likelihood of them being already infected. There is also the deadly myth that if one has sexual intercourse with a virgin, it cures AIDS. Young children are vulnerable as they can be persuaded, bribed or coerced. Older victims are able occasionally to persuade the attacker to wear a condom, but young children are both ignorant and powerless.
The South African government has been very slow to respond to the implications of HIV/AIDS in children. They have also not done enough to prevent child abuse.
Children are receiving the care and support they require, as fewer adults are present in their lives. Increasingly, those adults who are present are under emotional, physical and financial stresses and less likely to consider meeting the needs of the children who depend on them.
Increase rates of sexual, physical and emotional abuse are being reported. As vulnerable individuals without social safety nets to protect them, children are bearing the brunt of adult anger, frustration and fear.
In addition the myth that sex with a virgin "cures AIDS" is contributing to increasing rate of atrocities being committed against children and babies.
Prevention of abuse is being lost as a message and as an approach.
- Trauma and neglect
Children experience trauma and neglect long before their parents die. As the primary caregiver becomes ill more frequently, children are too often becoming neglected. This is becoming a form of structural emotional abuse and neglect.
The right to be protected from exploitation (Articles 3, 32, 34, 35)
Children have the right to be protected from harm including sexual and commercial exploitation, prostitution, illegal drug use and any other forms of exploitation harmful to their well-being.
- Child Labour
Too often, they have to take on adult roles at a young age, including providing care for a sick parent and taking on extra household responsibilities. Other children may have to work outside the home to boost the family's income. These inappropriate responsibilities can create long-term emotional problems, and contribute to lost opportunities in education and development.
Child labour remains illegal, but law-enforcement will have little effect unless families are supported so that adequate alternatives are found. The state and the community have a responsibility to ensure that these children are not denied a childhood.
The rights of children with special needs (Article 22. 23)
- Children living with disabilities- children who are both disabled and affected by HIV/AIDS are doubly discriminated against. Resources to meet their needs are being further depleted and no other provisions are being made.
- Refugee children - refugee children whose parents have died from AIDS are in greater need of help than local children because of their isolation from their extended families and own communities. Agencies should cooperate with international agencies to reunite children separated from their families if they are orphaned.
Children living and working on the streets - the numbers of children living on the streets is expected to increase. These are children with an increased risk of abuse, exploitation and a very poor standard of living
In order for children to develop skills in decision-making, leadership and other important social skills they must practice these in a meaningful way. This practice can only come through their participation in important areas of their lives.
Only children and young people themselves can tell us what it means for them to live in a world with AIDS. Hearing what children and young people have to say often gives adults new insights into their wishes and needs and provides relevant information about activities and plans that can be undertaken to change policies to give them more protection, care and understanding.
There are ethical issues that must be considered when working with children and young people affected by AIDS, such as their right to privacy and confidentiality. Children's rights to confidentiality and freedom from discrimination must always be acknowledged. Breaking this code of ethics can lead to rejection, isolation and discrimination. Children must be allowed to feel safe with their own peers and the adults they are involved with and not feel threatened, frightened and used.
Children's right to participate in decisions that affect them should be respected at all times. Care must be taken to ensure that the child understands the implications of the decision, and is informed of all the alternatives. Communication must be appropriate for that individual child. The best interests of the child must always be taken into consideration especially so that the individual's ability, personality, age, gender, ability, culture and family background.
Children need to be listened to and their views taken seriously and their dignity must always be upheld.
The Right Not to Suffer Discrimination (Article 2, 20, 21, 22, 23)
Children, who are diagnosed HIV positive and/or live in an HIV positive household, are vulnerable to discrimination and rejection. Rejection may come from relatives, crèches and schools. Foster or adoptive parents may be particularly difficult to find for HIV positive orphans or those children who are in need special care.
The high levels of discrimination and human rights abuses against those who are HIV+ or who are from families with HIV+ member(s) may include teasing, name calling, ostracising, refusal of admittance or continuity of care in care and educational facilities, health and social services. In extreme cases, they are driven from the community or physically attacked.
The obligation of the State is to assist the child in establishing an identity and to ensure that the child receives all the rights that are his/her entitlement.
The question we need to ask is what are we doing about this catastrophe?