Research has pointed out that AIDS orphans are vulnerable to exploitation as cheap labour, through sexual abuse, and financial deprivation through property grabbing, or the siphoning off of childcare grants in countries that provide them. This provides a powerful motivation for increased funding for NGOs that work with, or do research about, children, but falls short of advocating deep changes to the state welfare system, said the review.
Few authors draw attention to the failure of the state to care for South African orphans, the report said. Elsewhere in Africa, relief agencies and the media highlight the plight of orphans and the funding needs of NGOs, but the failure of governments to adequately address the issue is seldom discussed in the media or academic literature.
Most studies deal with the numbers and ages of orphans and their material needs. There is little research proper, only anecdotal evidence, on quality of life, child care arrangements and psychosocial support, the review found.
Financial and material needs are usually presented as the most pressing, neglecting the emotional needs, as poignantly expressed by Apiwe, aged 13, at the National Children's Forum on HIV/AIDS in South Africa in 2001.
"My sister is six years old. There are no grown-ups living with us. I need a bathroom tap and clothes and shoes. And water also, inside the house. But especially, somebody to tuck me and my sister in at night-time," she said.
The result is a focus on material needs - distributing blankets, food and clothes - and little counselling, emotional and psychosocial support. In her Botswana study, Daniels said it was hard to find workable means of dealing with emotional trauma or what she called "hidden wounds".
"It is easier to give clothes than to confront the huge emotional needs," said Stein.
Notably, most literature looks at orphans after the death of parents. Yet the trauma starts way before, during illness: selling assets for medicine; role reversal when children nurse parents, and assume domestic and child care responsibilities beyond their years. In a study in South Africa in 2000, R. Smart found that the "parentification process" is associated with
growing isolation. Many children constantly worry about going to school and leaving their parents to die alone.
Bereavement and grief among African children deserve more research, as do issues of disclosure of HIV status. Studies find that, generally, children who know about their parents' HIV-positive status are less stressed than those who have not been told, but perceive anyway that the parents are not well.
The only African study concerning disclosure to children, conducted by T. Marcus in South Africa's KwaZulu Natal province in 1999, found that young children are excluded from discussion about the imminent or recent death of a parent because death is a topic for adults. If silence and exclusion are accepted cultural norms, this affects disclosure and communication among the family.
Other academic literature suggests that culture is frequently invoked as the reason for silence regarding death. Such taboos can be so strong that someone who openly talks about his or her impending death could be accused of witchcraft, one study found.
Professional psychological knowledge about bereaved children has largely been developed in a Western context, so there is a gap in information on HIV-specific grief among African children.
Among other researchers, S.A. Mallman and J. Altschuler have examined how children cope with death, burial and adversity. However, most research looks at children after parental death, although interventions before bereavement are also important.
One exception is memory work, conducted in Uganda, Kenya and South Africa, geared specifically to the needs of parents and children. [
AFRICA: Memory boxes to help say goodbye]
The study concludes with a clinical overview of children's conception of death and dying, and its implications for interventions. However, warns Stein, psychosocial support must be grounded within a broader net of social services for vulnerable children.
[ENDS]