What Works for Women and Girls

maternal orphans were found to have more than five times the odds of engaging in sexualactivity with their current partner, more than fourteen times the odds of receiving basic needsfrom their current sexual partner, and nearly five times the odds of acquiring HIV as comparedto study participants who had not lost their mothers. The study also found that maternalorphans were less likely to have been physically forced the first time they had sex. This couldbe because more maternal orphans were intentionally engaging in sexual activity for materialbenefits and may thus be less likely to have been forced to engage in sex for the first time (Kanget al., 2008).Data from Rwanda and Zambia show that orphanhood, especially if it occurs closer toadolescence, results in earlier sexual initiation (Murray et al., 2004). Early sexual debut placesgirls at risk of HIV, other STIs, and unwanted pregnancies. Further, loss of a parent increasesvulnerability to trafficking, child prostitution, and hazardous labor situations (Ayieko, 1998;Human Rights Watch, 2003), in addition to forced sex (Birdthistle et al., 2008). These vulnerabilitiesenhance orphans’ risk for acquiring HIV. A study in Zimbabwe found a greaternumber of female orphans ages 15 to 18 had higher incidence of HIV infections than their nonorphanpeers (Gregson et al., 2005). “…The majority of orphans and children whose parentsare HIV-positive or AIDS-unwell are in fact adolescents and have a great need for informationand skills on sexual and reproductive health and development. These topics are frequentlyomitted from OVC programmes…” (Hallman et al., 2008: 36).Many Families Caring for Orphans Are StrugglingEvidence compiled during the Joint Learning Initiative on Children suggests that policies,programs and funding should support family-centered services that address material needs,cognitive development and psychosocial support (Richter, 2008). A study in Botswana usingdata from a 2002 sample of 1,033 working adults found that 37% provided orphan care. Nearlyhalf of working households with orphan care responsibilities reported experiencing financialdifficulties, lacking resources to provide basic needs such as food, shelter or transport.Only 42 social workers were responsible for the care of more than 100,000 orphans (Milleret al., 2006; Heymann et al., 2007). A baseline study conducted in 2007 in Malawi with 785AIDS-affected households indicated that cash transfers were needed for social protection ofOVC. Forty percent of households had no working age adult even though 60% of householdscontained 2.6 children. Seventy-three percent of households went without enough to eat foreight or more days in the past month (Huijbregts et al., 2008). A case control study done in2007 in Uganda with 369 HIV-positive children (49% female) between ages 7 months to 15years found that children cared for by grandparents were less likely than those cared for bybiological parents to have their immunizations up to date and more likely to have poor nutritionalstatus (Kintu et al., 2008).More Effective Programming and Policies for OVC Are NeededDespite the recognition of the magnitude and negative consequences of this problem, theevidence on effective programming for children affected by HIV/AIDS remains scant356 CHAPTER 12 CARE AND SUPPORT