What Works for Women and Girls

12B. Care and Support: Orphans and Vulnerable ChildrenGirls who have been orphaned by HIV/AIDS face an intersection of vulnerabilities: As children,they lack the legal rights (e.g., inheritance and property), maturity, and skills to careand provide for themselves. As girl children, they most often do not have equal access tohousehold resources for schooling, nutrition, or health care. When a catastrophic event hitsthe family, girls are more often the ones who must leaveschool and take on a greater burden within the home. Astudy in Tanzania found a dramatic increase in labor forceparticipation by adolescents ages 10–14 and a decrease inschool attendance, especially for girls, which correlatedwith the increased HIV/AIDS prevalence and incidencebetween 1990 and 1991 (Wobst and Arndt, 2004). A studyin Rwanda found that “90 percent of the estimated 45,000child-headed households were headed by girls” (UNHCR,2001 cited in Lawday, 2002). Many receive little socialsupport because of the stigma associated with HIV/AIDS.OVC, and girls in particular, are more likely to have highrates of absenteeism from school, experience behavior orperformance problems in school, or leave school altogether (Cornia, 2002; Steinberg et al.,2002). In households that experience the death of a woman, girls have lower enrollment ratesand are more likely to assume activities typically done by women (Desmond et al., 2000).Further, a study based in Zambia with 228 OVC found female OVC had less decision-makingpower, lower self-confidence, negotiation and communication skills than males (Alvarez et al.,2008).Girls Who Have Lost Their Mothers Are at Particularly High RiskThe number of children receivingantiretroviral therapy increasedfrom 198,000 in 2007 to about275,700 in 2008, reaching 38% ofthe 730,000 children estimatedto be in need of antiretroviraltherapy in low- and middle-incomecountries (UNAIDS, 2009d: 87).Parental death is recognized as one of the most stressful life events a child or adolescent canendure… (Hallman et al., 2008: 38). Interviews conducted in 2005 with orphans and vulnerablechildren, their parents and caregivers, students and teachers in communities heavilyaffected by HIV/AIDS in South Africa and Swaziland found that parental death is one of themajor causes of disruption of children’s lives. Interviewees reported that illness and/or deathof parents leads to increased poverty, child’s engagement in risky behavior and more vulnerabilityto HIV infections, and a higher likelihood of dropping out of school. The interviewsreported that boys are more likely to get involved in multiple concurrent relationships anddrug-taking while girls are more likely to get pregnant or engage in sex work or sexual relationshipswith older men in exchange for money and food. Girls are also at higher risk of rape andabuse by teachers in their school (Poulsen, 2006).A study of 200 orphaned and non-orphaned girls ages 16 to 19 in Zimbabwe highlightedthat maternal care and support is important for HIV prevention. Seven percent of girls in thestudy had lost only their mother while 20 percent had lost both parents. Female adolescentWHAT WORKS FOR WOMEN AND GIRLS355