The effects of high HIV prevalence on orphanhood and living arrangements of children in Malawi, Tanzania, and South Africa

Abstract

Using longitudinal data from three demographic surveillance systems (DSS) and a retrospective cohort study, we estimate levels and trends in the prevalence and incidence of orphanhood in South Africa, Tanzania, and Malawi in the period 1988Á2004. The prevalence of maternal, paternal, and double orphans rose in all three populations. In South Africa*where the HIV epidemic started later, has been very severe, and has not yet stabilized*the incidence of orphanhood among children is double that of the other populations. The living arrangements of children vary considerably between the populations, particularly in relation to fathers. Patterns of marriage, migration, and adult mortality influence the living and care arrangements of orphans and non-orphans. DSS data provide new insights into the impact of adult mortality on children, challenging several widely held assumptions. For example, we find no evidence that the prevalence of child-headed households is significant or has increased in the three study areas.

Growing Up in the Era of AIDS: The Well-Being of Children Affected and Infected by HIV/AIDS in Sub-Saharan Africa

“…Child-headed households (CHHs) may be defined as households headed by a person who is under 18 years of age (Hosegood et al, 2007, p. 331) and Luzze & Ssedyabule (2004) add that it should be recognised by the community as an independent household. Whether or not the AIDS epidemic is contributing to the phenomenon is contested in the literature with some contending that there is an increase in CHHs as a result of parental death and parallel impact on extended family (Evans, 2010;Kipp, Satzinger, Alibhai, & Rubaale, 2010;Luzze, 2002;Luzze & Ssedyabule, 2004) while other authors assert that there is no evidence of an increase in the incidence of CHHs (Hosegood, 2008;Hosegood, et al, 2007;Meintjes, Hall, Marera, & Boulle, 2010;Monasch & Boerma, 2004). Hosegood et al (2008) point out that it is quantitative studies based on demographic surveys and census material that show low and unchanging incidence while qualitative studies focussed on CHHs find plenty of evidence of their existence.…”

Urban–rural disparities in adult mortality in sub-Saharan Africa

“…Of course, it is possible that child residence is not a good proxy for parental residence (Lankoande 2016), as children are fostered or parental mortality may lead to orphan migration -concerns we consider below. Yet despite widespread fostering, evidence shows that in many SSA countries the majority of children under 15 live with both parents or with either mother or father if orphaned (Beegle et al 2010;Hosegood et al 2007;Lloyd and Desai 1992). The necessary assumption of shared urban-rural status for adult siblings is more difficult to make, reducing the value of the sibling approach for estimating separate urban-rural adult mortality levels.…”

Child and young adult-headed households in the context of the AIDS epidemic in Zimbabwe, 1988–2006

“…The specific targeting of CHH by social programs has been questioned before, both on the grounds of low prevalence (Hosegood, 2007;Meintjes et al, 2010) and of a relatively low vulnerability (Ritcher and Desmond, 2008). Although these accounts underestimate the role of external support in explaining the relatively low prevalence and vulnerability of CHH, they make an important point by underscoring the risks of leaving other similarly vulnerable (though apparently less dramatic) situations unattended.…”