UCLA conference probes far-reaching impacts of the AIDS pandemic. Looking further than the millions of deaths and orphans, specialists weigh disastrous impacts on infrastructure of African states.
Four panels of experts reported on many of the often ignored side effects of the HIV/AIDS disaster in Africa at an all-day conference at UCLA's Faculty Center May 30. The sessions were sponsored by the UCLA Globalization Research Center-Africa, a project of the James S. Coleman African Studies Center. The conference was chaired by political scientist Edmond Keller, director of the Globalization Research Center-Africa.
Following are summaries of the highlights of each of the four panels.
Price-Smith painted a grim picture of the many repercussions of the AIDS pandemic, spreading out to undermine all aspects of society. "Southern Africa is the global center of the pandemic," Price-Smith said, "with Botswana leading with 36% of the adults HIV positive; South Africa is at 26%." He said studies have shown that there is a strong correlation between a population's health and the capacity of its government to function effectively. It had previously been thought that health was a more or less passive factor, that it would improve as development progressed. Not so, Price-Smith said, "Public health drives state capacity more than the inverse. As a population's health declines it will have a significant negative effect on the functioning of the state." This is already happening in several of the states of Southern Africa.
There is "a huge cohort of orphans," he said. There are 700,000 in Zimbabwe and 600,000 in South Africa. These numbers are expected to grow geometrically in the next 8-10 years. "10-11 million orphans in the continent will be uncared for," Price-Smith told the audience, "they will be undernourished and lack significant education." He said that it is likely that many will turn to crime to survive, destabilizing the society. They are also likely to turn to political radicalism. "Orphan populations provide fertile ground for the recruitment of disaffected youth to radical causes and political organizations." In Swaziland he reported two Al Qaeda operatives were recently arrested who were moving "millions of dollars" into the region.
Long-term effects of the plague spell the destruction of a large portion of the region's human capital. This will diminish production. "We have already seen significant GDP declines and lowering of per capita income in Zimbabwe and South Africa," Price-Smith said. "AIDS is not the sole factor, but it is a major feature of that downward spiral."
National Savings Are Being Depleted, Debt Is Rising
Economic consequences that are frequently ignored, he said, are "depletion of national savings, increased deficit spending, and increased aggregate debt." Foreign investors are pulling back from the region, and where they will invest they are demanding that local governments or entrepreneurs put up a significantly larger share of the operation than in the past: "Now foreign investors ask for 25% local investment compared to 10% a decade ago."
Security and social services will also decline as a consequence of AIDS. "Military and police forces are weakened. Declining revenues from a shrinking tax base lowers the ability to provide education and health care. People will increasingly see the government as illegitimate."
Further, because the burden of disease falls primarily on the poor and lower middle classes, the epidemic "will increase class inequalities and deepen the deprivation of the lower middle class and the very poor."
Andrew Price-Smith predicted increased violence as yet another side effect of the AIDS deaths. "Declining income does not by itself generate social conflict," he said, "but when combined with declining state capacity it leads to rising violence. The increasing violence may compel governments to shift to more authoritarian modes of governance, as with Mugabe in Zimbabwe. More draconian policies are likely to be seen."
The military is being destabilized by AIDS in many African states, which can increase the likelihood of clashes between army and government. And the military becomes a primary source of the spread of the disease. "40% of the SANDF (South Africa National Defense Force) is HIV positive," he said. "This limits the ability to engage in peacekeeping missions. Under UN mandate you are not supposed to send infected troops on peacekeeping missions, but this is violated and is a vector for spreading HIV."
At the end of the road, he said, governments may simply collapse. "The greatest concern is the collapse of effective governments and of prosperity in the region and the rise of terrorism. Zimbabwe is the obvious candidate for the most serious effects, including possible collapse. If the state collapses there will be refugee flows into other countries. This will also be a vector of transmission."
Private investment in Africa dwarfs foreign aid, Vivian Derryck said. Chevron, Texaco, Exxon, and Occidental have invested more than $8 billion in Angola compared to United States aid of only $75 million a year. Not only do they have much more money in the countries of Southern Africa, but "the private sector can bring a discipline to decision making which is needed for government to be more firm in Africa."
Everything You Ever Hear About AIDS Is True
"Everything you ever hear about AIDS is true," she said. "It is the worst pandemic in history. There are 42 million with HIV and 22 million with AIDS worldwide."
The epidemic should not be seen as largely an African problem, she added. "AIDS is global. Look at India and China and Ukraine and Russia." Seconding Price-Smith, Derryck said that AIDS "is not just a health issue. It affects every aspect of development."
In her view the lack of progress in slowing down the AIDS disaster is due in part to reliance on the wrong institutions. African governments are weak. NGOs are overstretched. Donors have been pressed beyond what they are willing to give. That leaves the strongest remaining institution as the private sector, "both multinational corporations and the indigenous private sector."
Businesses do not usually see it as their responsibility to become involved in the HIV/AIDS prevention and treatment programs. Vivian Derryck suggested some reasons why businesses should reconsider not leaving the AIDS battle to other agencies:
"It is the self interest of virtually every firm in South Africa to become involved. The indigenous private sector is in most cases underdeveloped. All firms want to be seen as global. More trade means more jobs. AIDS stifles globalization. It stifles the market by killing both workers and consumers. It adds to the cost of doing business. The UN Economic Commission for Africa has noted that Kenya is likely to see a one sixth decline in its economy due to AIDS. South Africa will have a decline of 17% by 2020 due to AIDS."
Derryck suggested four specific initiatives that the private sector could take. "First, the private sector needs to strengthen its relation to the state. Most African states are too weak. Too much stress falls on fragile institutions. There are reduced revenues. There are agricultural shortfalls: 7 million agricultural workers will be lost by 2010. These states need increased money for health expenditures. The private sectors needs to partner with the state in new and unfamiliar ways. They are used to just getting a license to do business and leave. This is asking for a sea change in the mentality of the private sector."
Second, Derryck suggested that businesses become directly involved in prevention and treatment programs. They could underwrite treatment of their employees and their families, "especially the families. This will get the private sector out into the community." The private sector should see that it is cheaper to treat and retain workers than let them pass away and do the training all over again, she added.
Part of the treatment program could be enforcement of compliance with ARV (anti-retroviral therapy) regimens on the job. "In many cases the patients take the medication, then feel better and stop. Others feel worse and distrust the drugs. Others sell the drugs they are given to make money for their family. Here is an opportunity to have a good public-private cooperation to encourage compliance with the ARV treatment."
Her third proposal was that the firms "work aggressively to empower women." No program that does not empower women will succeed, she said. "It has been said that the face of HIV in Africa is the face of a woman."
Women provide about 80% of farm labor. "7 million agricultural workers have already died. Women are the backbone of the informal economy, which is key to the economic life of the continent. It is the women that have kept the society together."
Private Business Has a Stake in Helping the Orphans
Derryck's fourth proposal was that private business intervene on behalf of the orphans. "The numbers are absolutely astounding. In UN parlance an orphan is someone with one parent deceased. A double orphan has both parents deceased. Now 12% of African children are orphans.
"These children often live in poverty. They are more vulnerable to abuse. Girls often drop out of school and often become prostitutes. The boys drop out of school and often join gangs. They are a potential menace to society. The skill set is eroded. Intergenerational knowledge is lost, with dire consequences long term for the country."
The orphans, she said, "will not become good employees later. It is in the interests of the private sector to work to rescue this social group to ensure their own future supply of capable workers."
More generally, she added, the private sector should be concerned about the rapid declines in life expectancy, "which will affect its potential future labor force."
Derryck conceded there will be large difficulties in implementing her vision. "The firms don't trust the governments, while the governments think the firms are going to exploit them."
The last speaker of the panel was Robert Ostergard of Binghamton University, Binghamton, New York.
"How do we begin to conceptualize AIDS as a security issue when we have been used to looking it as a human issue?" he asked. He went on to say that the media in the West tends to define security as short-term, as in the attacks of September 11. "Africa is confronted by a long-term security threat. It will not hit like an attack. It won't be as sudden, but the long-term damage will actually be worse if not more deadly."
In the developed countries of Asia and the West the military is usually an institution of stability. In Africa "the military has been the greatest threat to security." Partly this has been because under unstable governments the military is prone to trying to seize power. And in part it is because the military "has been disproportionately affected by the HIV virus." These problems have a tendency to spread as armies have been used more and more to cross borders as peace-keeping forces in nearby troubled states such as the Congo.
In South Africa Some Military Units Are Rumored to Be 90% HIV Positive
In Nigeria, Ostergard reported, 20% of the army is HIV positive. In South Africa, "some units are rumored to be as high as 90% HIV positive." He asked, "What do you do with such a compromised military?"
Because of outside peace-keeping forces stationed in the Democratic Republic of Congo and other states, "the incidence of civilian rape has skyrocketed, spreading the HIV epidemic." The response from civilian rulers "has been at best shaky." In discussion of military rape with a high level leader of the Ugandan government, Ostergard said, he was told that "war will be war and boys will be boys." In Ostergard's opinion, the weak governments of Southern Africa are afraid to try to discipline the military for fear their governments will be overthrown.
The armies themselves are not just infected with HIV but devastated by AIDS deaths. "Ugandan officers say that one quarter to one third of the officer corps in the Uganda military has been wiped out by AIDS."
Among the hotspots for potential problems from the military are Nigeria, Uganda, and Sierra Leone.
HIV/AIDS also weakens the bureaucratic structure of government. "When life expectancy falls from 65 to 33," Ostergard said, "the ability to maintain the bureaucratic structure decreases. This may encourage the military to step in when civilian government appears too weak to govern effectively. In Ethiopia, Angola, and South Africa, militaries have expressed concern about budget cuts."
Africa may also become a source and a target of terrorism. "In Sierra Leone diamonds are being smuggled out and sold to Israel where they are sold for arms." Some may also go to Al Qaeda and similar terrorist groups.
The second panel was a roundtable, although a few of the scheduled speakers were unable to attend. Two panelists took up the issues: Matthew Hodge of McGill University, Montreal, Canada, and Stephen Commins of the World Bank.
Matthew Hodge opened by seeking to compare the impact of HIV/AIDS to an equal number of deaths from war or automobile accidents. Death for death, he said, HIV/AIDS took a much larger toll and therefore had a bigger impact in damaging economic development.
The principal victims of armed conflict, he pointed out, are young male combatants. "HIV prevalence and mortality is highest among women. Women are infected at a younger age than soldiers, with older men seeking out safe sex partners. Conflict moves to resolution through military victory, negotiation, and fatigue. HIV transmission continues indefinitely from a core group of infected males. Women have to protect themselves from predatory males and from being compelled to exchange sex for needs. Males are the transmitters in almost all of the African continent. You don't need a large number of males."
Wars, he said, tend to funnel resources into improvements in medical care, while HIV "kills health workers and overwhelms available services."
In Motor Vehicle Deaths the Victims Die Quickly, in AIDS They Don't
In the case of motor vehicle deaths there is premature mortality but the victims die quickly. HIV victims die "after dwindling over a long time. Thus motor vehicle deaths use minimal services while HIV victims become recurrently sick with common illnesses, placing great stress on health services." The HIV patients are a major financial drain on their families as well.
Hodge discussed the positive effect of the "demographic dividend" on development in Southeast Asia. In what is known as the demographic transition occurring in most of the world, health care improvements lead to longer lives, and improved living standards lead to a drop in the birth rate. In Southeast Asia, Hodge pointed out, health was improved a little before women began to have fewer babies, so there was "a pool of young labor to shift from agrarian to industrial economy." If that group dies, as is happening in Southern Africa, "there is no demographic dividend."
Another factor is death in childbirth. How many children a woman has is closely correlated in most societies to how likely it is that they will survive. Where survival is chancy women have more children, and more women die in childbirth. Hodge gave some comparative figures on current infant mortality rates in developing countries.
"Under 5 mortality in Egypt is now less than 50 per live births for under 5s per 100,000. Bangladesh has accomplished a significant reduction, from 250 per 100,000 to 75 live births. In Botswana there were declines from 1970 to 1990, then the death rate doubled. In 1970 the rate was 180 per 100,000. It dropped to 57, but has now climbed back to about 100. Some of these children die because they have HIV and others because their parents are dead from AIDS."
Hodge pointed to growing famines and food shortages in many of African countries. These, he said, are exacerbated by drought and bad policy, "but also the productivity of people with HIV/AIDS is greatly reduced. African agriculture is highly labor intensive. Shortages then raise food prices and malnutrition grows. This is especially deadly for HIV positive people." These effects are cumulative, as the deaths of skilled farmers mean that "agricultural knowledge is not being passed on sufficiently."
Hodge took South Africa and Zimbabwe as examples for other effects of the HIV/AIDS toll. Household savings, he said, have fallen drastically since the epidemic began. "In Africa foreign investment is small. Household savings are crucial. We call this micro enterprise, where people save up to buy a bicycle or a sewing machine which can then help to generate further income. If you have a family member who dies quickly you don't spend much money. If you have a family member with AIDS people spend all of their savings for services and treatments. This is an asset stripping process. Capital for micro enterprise is diverted into counterfeit drugs and panaceas. The drug sellers market is affecting capital formation."
Stephen Commins is a senior human development specialist at the World Bank. His comments took up the health care infrastructure. "In most countries," he said, "the epidemic has not peaked yet. Response to date is heroic but inadequate."
International agencies and governments, he said, are still wrestling with what constitutes an effective use of the limited resources. Money alone often has little impact. In 2002, he said, $1.2 billion was spent on AIDS in Africa, "but the whole is much less than the parts."
He made several points about the situation: Governments and not donors need to direct the process. There needs to be a focus on building health care capacity as national health systems are collapsing. "It is immoral to deny treatment because it cannot be paid for." Community action is needed as well as government action. And prevention as well as care should be a single package.
Elites Tend to Capture the AIDS Relief Resources
One of the problems with the present system of public services is that elites have more influence on where the resources go than the poor. "The expenses are captured by the elites, they do not go to the poorest 20 or 30%. People dying of AIDS and orphans have the weakest voice."
Commins described the work of the World Bank in this area. The Bank runs a multicountry AIDS program that funnels money directly to communities. It tries to reward real results in its allocations. These monies are given as grants and the Bank solicits private contributions to pay the interest from agencies such as the Bill Gates Foundation. To date, Commins said, the Bank has given out $55.2 million in such grants.
"We need to bring down the cost of drugs," he said. Also, "Don't build orphanages, they take children out of their societies."
In the discussion Matthew Hodge told the audience that his university had trained 10 African agricultural specialists and sent them back to bolster the sagging food production sector, but that within two years they had received word in Canada that 4 of the 10 had died of AIDS.
The first panel of the afternoon heard reports from Professor Paula Tavrow of UCLA's School of Public Health, from Scott Chaplow, a consultant for the UN Special Conference on Africa's Least Developed Countries (UNOSCAL), and from Jim Vellequette, a staff member for the Amy Biehl Foundation in Capetown.
Paula Tavrow spoke of her work in Malawi where she witnessed the severe impacts of the epidemic on the health and education infrastructure. "There has been significant decrease in adult longevity," she said. "For most countries life expectancy on attaining adulthood has dropped to 40-50 years. There is a growing structural imbalance of the gender ratio: younger women are dying, there is increased infant and child mortality."
One effect has been to reduce the number of families able or willing to make the very large sacrifices needed to send their children to college or medical school. Not only are resources lower in the families, but the expected payoff is lower also: "Careers are now 20-30 years instead of 40-50 years."
Some of the implications of decreased adult longevity, Tavrow pointed out, are "an increased dependency ratio (elderly and children), a decrease in savings, an increase in consumption, especially of health care, a reduction in voluntary labor, lower returns to higher education, a reduction in development of expertise, capital and human flight, and fewer health and education professionals." Before, she said, if you funded a PhD you would get a long productive life. Now you get a much shorter return.
"People are reluctant to invest in higher education, they are sending their children abroad. In Botswana 50% of girls age 15-29 are HIV positive. Parents send their children abroad and don't want them to come back."
There has been an increase in commercial sex because of loss of women, as well as earlier sex for girls.
AIDS deaths, Tavrow said, are impairing the functioning of many units in the tertiary sector and raising the costs of training. "There are fewer secretaries and researchers. There is a loss of specialized people. There are direct costs such as an increase in recruitment and training costs, as well as HIV/AIDS education and treatment for sick employees. But there are also indirect costs: absenteeism, ill people working slower, staff out to attend funerals. There are systemic costs: loss of workplace cohesion and morale, loss of productivity, loss of skills and experience."
HIV in African Universities
Turning to the effect of AIDS on African universities, Tavrow began by pointing out that rates of university education in Africa were already extremely low: "Only about 3% in Africa in 1995 got a university education. In South Asia this was 7 %, and in Latin America 18%. Almost no women get a university education; there is about a 4-1 ratio male to female. In Latin America there is about an equal male and female ratio."
There are no good statistics on HIV/AIDS in African universities. "There is no HIV surveillance of faculty, staff or students. Most who fall ill use off-campus health facilities. The cause of death is commonly not determined or revealed, because of stigma. But I have some information about the University of Nairobi, Kenya. There has been a big increase in emergency loans, and a big increase in funeral transport and funeral expenses. In 1991 deaths among faculty and staff were running at about 0-3 per month. In 2000 this had grown to 8-12 per month."
Most African universities contribute to the problem by failing to provide HIV/AIDS and sexuality education and by limiting access to condoms, contraceptives, and treatment for sexually transmitted diseases.
"They also fail to curtail sexual harassment and rape," Tavrow said. "There is no punishment of rapists. Rape is rampant in African universities. There is no counseling for female students. Overcrowding is very common for female students. Women students often sleep in empty classrooms, and are raped there. There is a lot of consensual rape from pressure to get better grades, etc."
At the University of Malawi, she reported, 19% of students are female. 12% have reported being raped on campus, and 61% reported severe sexual harassment. "Contraception is distributed only on Friday afternoons between 1:00 pm and 4:00 pm. Women have to sign their name and the number of condoms taken, with aggressive male students watching."
The Situation in African Hospitals
In high prevalence countries, Tavrow reported, infection rates among inpatients in hospitals run to 30-70%. "The costs of treating HIV positive patients can be double that for HIV negative patients. There is a sharply increased nurse workload. Occupancy was at 108% of rated capacity in 1988. This rose to 190% occupancy in 1997. Patients are sicker. HIV positives rose from 19% in 1988 to 40% in 1997. Some are demented. There are fewer health personnel due to absenteeism, illness, death, and flight. Families often abandon patients in the hospital. Nurses and staff are leaving the profession."
In Kenya, she said, there are 12 doctors per 100,000 people compared to 279 doctors per 100,000 in the United States. In KwaZulu Natal, South Africa, for 10 hospitals surveyed, 21% of the nurse posts were vacant while admissions were running at 49 per nurse per day.
"There has been an erosion in quality of care, basic services suffer. Patients don't get regular sugar measurements or blood pressure checks, records are lost, patients are not turned in bed. There is limited time to keep records. Many nurses have to work without gloves, and there is no AZT for needle sticks."
In his remarks Scott Chaplow urged the use of various groups and agencies of civil society to take up some of the slack of weakened government agencies. He pointed to informal grassroots organizations, burial societies, community based organizations, NGOs, faith based groups, and microfinance organizations as examples.
One of the most compelling and moving speakers of the day was Jim Vellequette, himself an AIDS survivor, who is regional manager for an HIV after school program in Capetown operated by the Amy Biehl Foundation. He is also an advisor to Being Alive in Los Angeles.
Amy Biehl, a white American Fulbright scholar, was stabbed to death in South Africa by radical members of the Pan Africanist National Congress in 1993 while working to register black voters in that country's first all-race elections. Her parents created the Amy Biehl Foundation in her memory, which works in South Africa on a variety of causes. Jim Vellequette told the audience that Amy's two murderers, after serving about two years in prison, were released in a general amnesty by the new black government, and were later hired by the Amy Biehl Foundation in an extraordinary show of reconciliation, if not forgiveness. Vellequette is a program manager for the foundation in Capetown where he teaches HIV prevention.
"There are breakdowns at all levels of society," Vellequette told the audience. "Capetown and Durban are competing with Johannesburg to be named murder capital of the world. People are living in fear. Twelve-year-old girls are giving blow jobs to get free beer. Men are not taught sex until they are circumcised at 20-24, usually too late. Women take cash for sex to pay school fees for their children. Unemployment is running at 70-80% for blacks."
The spread of HIV and AIDS is speeded by a general social denial of the existence of homosexuality and by a deep stigma for having the disease that leads many carriers to hide the face. "Black men are not gay," Vellequette said ironically, summarizing local beliefs. "Guys will say, I have sex with men but I am not gay. Anal sex is the most dangerous sex, but many who do it do not self-identify as gay." On man admitted to Vellequette that he has sex with other men only because Vellequette was about to get on a plane to Los Angeles. "I didn't tell him I'll be back next week," Jim Vellequette added with a sly grin.
Giving Out 250,000 Condoms Quietly
Despite facing a basic distrust of whites, Vellequette and his coworkers have given out some 250,000 condoms. "We put out condoms in places where no one can see you take them, to avoid embarrassment -- in bathrooms, in bars. Some people tell me, don't put them there, people will take them. Well, that's the idea! You constantly are offending people with everything you do, but you have to go on anyway."
The denial in South Africa is very deep: "All these people are dying but no one is dying of AIDS. It was a cold, it was a broken ankle, no one wants to admit to AIDS. People get stoned to death when they say they are HIV positive."
Jim Vellequette in not just an observer. "I've had AIDS twice. I take a lot of medication, very expensive medication. I've had AIDS for 12 years. In 1994-95 I lost 100 people I knew in Los Angeles."
He closed by repeating the mantra of AIDS prevention: "Always remember the 5 fluids that spread AIDS, seminal fluid, semen, blood, breast milk, and vaginal secretions."
The final panel of the day heard from medical doctor Eric Bing of the Charles R. Drew University of Medicine and Sciences in Watts; Joe Muwonge of World Vision, and Patricia Langan, regional director for Africa and the Middle East of the International Youth Foundation.
Dr Eric Bing has been involved in Angola in efforts to stem the spread of AIDS in the Angolan military. He reminded the audience that Angola has been torn by war and civil war for more than 40 years, from the opening of a war of independence against the Portuguese in the early 1960s to the civil war that began in 1975 when the Portuguese left and ended only last year. "America and South Africa supported Unita, while the Cubans and Russians supported the other side. The civil war continued until last year, with a short break in 1992."
The country was completely ruined. One legacy of the decades of war is the 20 million land mines buried throughout the nation, which has greatly limited mobility, but also limiting the spread of HIV/AIDS. Dr. Bing reported that HIV prevalence in Angola is only 6% compared to 10-35% in the Congo, 20% in Zambia, and 35% in Botswana.
"One of few institutions left after the civil war was and is the military. They are the only infrastructure in all parts of the country that really works. The U.S. has a special interest in Angola because it is rich in oil -- 10-15% of U.S. oil imports come from Angola. The U.S. military has formed a partnership with the Angolan army to work to slow the spread of HIV/AIDS." It is through that program that Dr. Bing, a civilian, went to Angola.
"Our experience," he said, "is that you have to have a treatment plan as well as a diagnosis plan. You have to offer hope or people won't want to get tested. You also have to do behavioral surveillance, not just surveillance of those already infected, looking for risky behaviors."
There was no testing done in the military until near the end of 2001. "Now testers go to key regions to do surveillance of soldiers. Everybody wanted to know their status, there are long lines of people. We do a rapid test, which gets results in 20 minutes."
They testing showed that troops around the borders have higher prevalence, 7-10%, while troops stationed in the center of the country are very low, only about 1% infection. In Luanda, the capital, the infection rate in the military is 6%.
The Soldier on the Poster Has a Gun in His Left Hand and a Condom in His Right
"Soldiers are trained in how to talk about HIV. They go out to the troops and encourage them to get tested, give them condoms. There have been 2-hour sessions with 20,000 Angolan troops. There is also a social marketing campaign to promote the use of condoms. It uses a poster to educate soldiers. During the war posters of soldiers had a gun in the right hand. In our poster the gun is in the left hand and a condom is in the right hand."
Joe Muwonge, an African-born leader of the Monrovia, California, World Vision, a global relief and development coalition, has spent a lot of time working with orphans in his native Uganda. The epidemic has struck very close to home for him. "I had an uncle with 8 children," he told the audience, "now there are 3; another uncle had 7 children, now there is 1. Another had 6 children, all are dead. In my own family there were 7 brothers and sisters, now there are 5 -- 2 are dead of AIDS."
Muwonge said that the carnage has changed an age-old custom on how you greet friends. "Now you do not ask how the family is."
Uganda was the country of notorious dictator Idi Amin, who ruled from 1971 to 1979. In 1989, Joe Muwonge said, there were already 500,000 to 700,000 orphans in Uganda, in part through armed conflict and in part from the early ravages of AIDS. The number of Uganda orphans is expected to reach 3.5 million by 2010.
"Initially we placed children with extended families," Muwonge said, "but this system has been becoming too stressed since 1990. Of all orphans, 25% have lost both parents and 30% are in the care of grandparents. 52% are living with families with 6-10 other children." The foster families are often unable to pay much attention to their charges. Muwonge said that 60% of the families did not know how the orphan children had performed in the last term at school. 5% of households are headed by other children, 30% are in households headed by the elderly, and many are in households headed by the ill. About one third of the total have been pulled out of school to take care of a surviving parent.
Muwonge said that the dropout rate is one-third of all children of school age in several areas. Schools, which are often self-supporting, are having to increase tuition because of falling enrollments. "This causes more students to drop out, and schools have begun to cut back on levels of instruction. Shopping centers are in decline."
Joe Muwonge's World Vision program has tried to interest the broader community in caring for the orphans. It has raised some funding for tuition and books, and encouraged artisans to take on orphans as apprentices in exchange for some tools but has had to monitor this program to prevent exploitation. In some places World Vision has convinced communities to repair or build houses for the orphan children living on their own.
"We help about 30,000 children a year to attend school. We helped to raise enrollment in Kakuuto county from 61% in 1990 to 87% in 1994."
The final speaker of the day discussed an effort to involve young people in taking a more active part in improving their communities.
Published: Tuesday, June 10, 2003
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