ein are those of the authors and do not
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Cover photos (top) courtesy of PAHO/Gaggero and Waak.
Cover photo (bottom) courtesy of UNICEF/Pirozzi. More than 44 million
children in 34
developing nations will
likely have lost one or
both parents by 2010.
Most of these deaths will
result from HIV/AIDS
and complicating
illnesses.
2000
C
hildren on the Brink 2000tells a compelling
story about millions of children who have
fallen victim to the global HIV/AIDS pandemic.
More than 44 million children in 34 developing
nations will likely have lost one or both parents
by 2010. Most of these deaths will result from
HIV/AIDS and complicating illnesses. The
human and social dimensions of these losses are
staggering.
In countries across Africa, Asia, and Latin
America, HIV/AIDS is unraveling years of
progress in economic and social development. Life expectancy which has
been rising for three decades will drop to 40 years or less in 10 sub-Saharan
African countries by 2010. In all 34 countries included in this study, AIDS-
related mortality will eliminate the gains made in child survival over the past 20
years. In at least seven sub-Saharan African nations, infection levels in the
general population are 20 percent or higher. In Asia, Latin America, and the
Caribbean, epidemics are escalating rapidly.
The scope and complexity of the challenges facing children affected by
HIV/AIDS cannot be overstated; they are more likely to drop out of school,
contract HIV, or be forced to work in order to survive. USAID is working
diligently to improve the safety, health, and survival of these children. A
commitment of more than $1.2 billion to HIV/AIDS programs over the last
decade has enabled the USAID to establish effective partnerships with
international organizations, donors, national governments and non-
governmental organizations; develop innovative approaches to HIV/AIDS
prevention; and build community capacity to slow the spread of the epidemic.
The first Children on the Brink
report published by USAID in 1997
elicited a remarkable response and helped to break the silence about HIV/AIDS
worldwide. Children on the Brink 2000builds on that legacy. This report should
serve as a call to action for developed and developing nations alike. The ultimate
benefactors will be the children whose futures are very much at risk as a
consequence of this unrelenting pandemic.
J. Brady Anderson
Administrator
U.S. Agency for International Development
CHILDREN ON THE BRINK
A
ccording to revised 2000 estimates from the U.S.
Census Bureau, 15.6 million children under 15 have
already lost their mother or both parents to AIDS or other
causes. By 2010, there will be 24.3 million maternal and
double orphans. If children who have lost their father are
also included, the global total will be 44 million by 2010.
The human and social costs these estimates represent
are staggering. The challenges faced by children, families,
communities, and their governments in managing the
impact of HIV/AIDS will be enormous. And their message
is unmistakable: The world community must unite in
compassionate response and support.
Children on the Brink 2000updates the 1997
publication, Children on the Brink: Strategies to Suppor
t
HIV/AIDS. The 1997 version, the first comprehensive
global estimates of orphans of HIV and other causes,
helped raise world awareness of the impending calamity of
the HIV/AIDS pandemic in developing countries.
In the two-and-a-half years since Children on the Brink
was published, over 5 million adults have died from
HIV/AIDS (98 percent in developing countries), leaving at
least that many new orphans.
This executive summary of Children on the Brink 2000
includes:
1. New orphan estimates for 34 countries (See Appendix I
for statistical tables and figures.)
2. A description of what children, families and communities
are doing to address their growing orphan problems.
3. Strategies for intervention that have been adopted.
4. A new strategic agenda to guide coherent action by the
world community,
While Children on the Brink 2000updates the 1997
publication, the fundamental messages of that first
document are still valid:
The scale of the problem is enormous: The number of
children and young people orphaned by AIDS around
the world is staggering.
Childrens safety, health and survival are increasingly at
risk. In some countries more than 20 percent of all
children under age 15 are already orphaned by AIDS or
other causes of death.
We are still on the upward side of the curve: With few
exceptions, the number of children being orphaned in the
study countries will accelerate through at least 2010.
The problem is long-term: Projection estimates based on
current trends show that in many countries, the
proportion of orphaned children will remain tragically
high until 2020 or 2030.
The HIV/AIDS pandemic is producing orphans on a
scale unrivaled in world history. Our experience with
orphaning as a social problem is limited. Historically, large-
scale orphaning has been a sporadic, short-term problem
caused by war, famine or disease. AIDS has transformed it
into a long-term chronic problem that will extend at least
through the first third of this century.
1
2000
O v e rv i e w
CHILDREN ON THE BRINK
Photo courtesy of UNICEF/Jeremy Hartley 2000
2
Executive Summary
CHILDREN ON THE BRINK
T
he challenges faced by children affected by
HIV/AIDS cannot be overstated. Families, com-
munities and governments responsible for these chil-
dren must improve the effectiveness and coordination
of programs to help them. Eight fundamental consider-
ations must be taken into account in developing a new
strategic agenda to address the issue.
Urgency:
Some 34.6 million children in the countries
included in this report have lost one or both parents
to all causes, including AIDS. The number of
orphans will grow as the epidemic grows in Africa,
Asia, Eastern Europe, Latin America and the
Caribbean. These estimates, large as they are,
represent only a portion of the total number of
children affected by HIV/AIDS worldwide.
Scale:
Programs so far have reached only a tiny fraction
of the most vulnerable children in countries hardest
hit by AIDS. Intervention programs must quickly be
brought to a national scale, which will require that
national leaders develop alternative funding
resources, including community and voluntary
resources and donor financing. Increased scale will
also require a broadened base of effort a network of
interrelated programs rather than a few massive ones.
Duration:
Intervention programs must be sustainable
for at least two decades. This means that the
programs must rely on family and community-based
initiatives. This, in turn, requires that poor families
and communities be able to support themselves
economically.
Hitting Moving Targets:
We do not yet have the data
to cope with ongoing national strategy development.
Regular national estimates of vulnerable children and
inventories of their status and needs are required so
that policies can be adjusted to keep pace with the
epidemics growing and changing impacts.
Integration:
Assistance programs must be integrated
with basic health and education services to succeed
over the long term. Infrastructure, especially safe
water and sanitation, is needed by families caring for
vulnerable children. Common to effective
HIV/AIDS programs has been the use of a set of
mutually reinforcing strategies that address risk and
vulnerability to HIV and the care of those infected.
Complexity:
HIV/AIDS affects every sphere of life,
especially when coupled with pre-existing conditions
such as severe poverty. There are no simple
solutions. Collaborative, complex interventions are
needed to respond to the broad range of needs of
children, families and communities.
Collaboration:
No single group or individual has the
capacity to make a definitive difference. Openhearted
sharing and cooperation must be institutionalized at
local, regional and national levels to ensure the wisest
use of scarce resources.
Strategy Building:
All of these issues are best addressed
by developing a national strategic plan for orphans
and other vulnerable children, families and
communities.
Photo courtesy of PAHO.
A New Strategic Agenda New Orphan Estimates
Children on the Brink 2000includes orphan estimates for 34
countries, 11 more than the original version. Most of the
increase in coverage has been in sub-Saharan Africa, where
estimates are now available for more than half of the
countries. HIV infection levels in at least seven sub-Saharan
African countries are now 20 percent or greater. In Asia,
Latin America and the Caribbean, epidemics are also
escalating, but from much lower levels. The increased
numbers of orphans and the social and economic
dislocation now being experienced in sub-Saharan Africa
may be replicated in several countries in Asia, Latin
America and the Caribbean.
Children on the Brink 2000estimates include orphans
for all causes of death. AIDS currently accounts for only
about half of all orphans in many of the countries included
in this study. Including orphans from any cause in the
estimates is consistent with policy decisions in many