Governance Contribution To Spread Of Hiv Aids Health And Social Care Essay

CHAPTER 2

The causes of HIV/AIDS amongst children in Zimbabwe can be viewed from a socio-cultural, psychological, political, economic and demographic point of view in elaborating the determinants for the increase in vulnerability to HIV/AIDS infection. HIV/AIDS infection damages the immune-system making the body less able to defend itself against opportunistic infections. Severe damage may translate to severe conditions such as tuberculosis, malaria pneumonia or Kaposi’s sarcoma. Kaposi’s sarcoma is a slow progressing skin cancer, which spreads rapidly. According to Bury et al (1992), highlights some of the physical effects of HIV/AIDS infection which also translate to effects of adolescents in Zimbabwe.

2.1 Governance contribution to spread of HIV/AIDS

Whilst global attention has focused upon the political and humanitarian catastrophe of HIV/AIDS in Southern Africa, Zimbabwe remains economically and politically divided, making it difficult for government to effectively reduce the spreading of HIV/AIDS amongst children. In the wake of growing political instability, violence mainly directed at poor farm dwellers has been repeatedly shown to drive HIV/AIDS at it leads to sexual exploitation, increased social mobility and migration, destruction of vital health infrastructure and rapid decline in the ability for health monitoring as government fails to record the pattern and scale of the epidemic. In Zimbabwe social welfare system started to weaken even prior the impact of HIV/AIDS as a result of economic mismanagement, corruption and the imposition of structural adjustment programs Foster (2002). HIV/AIDS increases the burden on weak health systems, reduces public revenues and increases competition for resources, all of which can increase social hostility, political unrest and other government structures to lose public faith in developing countries like Zimbabwe, increasing the opportunity for conflict and violence.

Political conflict offer a platform for rapid growth of HIV/AIDS infections in vulnerable societies by creating an increase in both forced and voluntary population movements. With public resources being redirected to military expenditure and declining public revenues leading to a de-prioritisation of HIV/AIDS prevention programmes. There has been an erosion of public health infrastructure. Sadly the GoZ refuses to acknowledge that its people are suffering to the international community and stands in the way of thereby declining the assistance of vital aid from NGOs such as Back to School feeding programme offered by the United Nations Children’s Fund (UNICEF). Zimbabwe’s failure to retain highly skilled medical personnel due to poor salaries and deteriorating working conditions have undermines its effort to scale down levels of HIV/AIDS infection. Government failure to consistently record the strength and character of the epidemic undermines the political response to HIV/AIDS, which will have long-term effects upon good governance and the maintenance of democracy.

2.2 Poverty contributes immensely to the spread of HIV/AIDS.

Poverty in all its various forms has contributed immensely to the growth and prevalence of this epidemic thereby increasing risk of HIV infections, and its impacts are exacerbating impoverishment and suffering of affected children. Hunter (2003) argues that poverty makes the life of a sufferer a living hell as it becomes a constant struggle to survive.

According to Hunter (2003);

"poverty means loss of freedom, loss of dignity, loss of control over fundamental course of one’s life it makes you so hungry that you scavenge, so thirsty you foam on the mouth, so needy you will do anything to make a buck, even sell your body in prostitution" (p28).

This is the sad story of most destitute children affected by HIV/AIDS in Zimbabwe. Sadly for Zimbabwe families are also suffering from impoverishment, because most productive members of families and communities have fallen to this disease. All areas of society, such as the educational system and the food production sector, are affected. With Zimbabwe’s inflation soaring at 100% during 2006-08 prices of commodities continued to increase daily, leaving many people in Zimbabwe living in poverty. Hunter (2003) argues that families were forced into poverty by the illness and the resultant death from HIV/AIDS of member. Hunter states that, sickness of a family member pushed them to part with personal fortunes such as capacity goods, land, livestock, and small belongings leaving them vulnerable when more complex problem arose. Loss of work and demand for treatment and basic life survival pushed families to sell their price possessions. In Zimbabwe, children affected suffer most as they are left with nothing to live on when their parents finally succumb to the disease. The situation has been worsened by the ever rising inflation and corrupt preferential treatment of ruling party officials and their families who easily access medication meant for the majority people living with HIV/AIDS.

2.3 Exploitation and drug abuse are factors nurturing HIV/AIDS.

Cameron (1993) highlights the link between HIV/AIDS and substance abuse. The researcher blames the ethical problems such as unprotected sex prostitution and drug abuse which constitute risky behaviour which are usually enhanced through drug use. Street kids in Zimbabwe are known to use glue and marijuana as a way to cope with the harsh street life. Hunter (2003) argues that, the challenges of rent, food or money forces most young girls often engage in ‘unprotected vaginal and anal sex as a form of ignition play, or to establish dominance,’ putting them at risk of spreading the disease amongst themselves. There have been many reports of young boys being forcibly sodomised by their peer street kids and most street young girls end up in prostitutions putting them at risk of HIV/AIDS often live in situations of profound abuse with no parental protection and they suffer other loses. The loss of parents leaves young children vulnerable to sexual abuse and HIV infections. Sexual abuse of children is another major contribution to HIV/AIDS infection amongst children in Zimbabwe as demonstrated by the high number of cases of rape brought before the courts almost on a daily basis.

In a document submitted to the UN human rights committee, a pressure group, Equality Now (1998) indicate, "The majority of reported rape cases in Zimbabwe involved victims under the age of 14". Meursing, et al (1995) also highlights the extent of child sexual abuse in Zimbabwe. Child sexual abuse cases from between 40-60% of the rape cases brought to the attention of hospitals, police and courts and many remain unreported"

To showcase the link between child sexual abuse and HIV infection, Meursing et al (1995) gives the example of the case of two teenage girls who were admitted in hospital in Bulawayo in 1991 with HIV and STD as a result of sexual abuse. He reiterates that "the combined risk of HIV transmission via blood and sexual fluids during a violent sexual encounter with a sexually transmitted disease infected rapists might be extremely high". Meursing et al (1995) blames ‘male dominance in Zimbabwean society means of professed inability to control sexual desires based on magic beliefs’. Equality Now (1998) also highlighted the fact that "in cases of rape report, the accused can either pay comprehension to the girl’s father or pay lobola (bride price) and marry the girl, thereby evading prosecution" under common customary law. Meursing et al (1995), provides us with reason why some of the rape cases are often unreported. He argues that some offenders often use threats and bribe to prevent the child from reporting, and traditional cultures relating to family privacy and honour also stand in the way. Chidyausiku (2008) in an article for the Institute of War and Peace Reporting (IWRP) quoted by Betty Makoni, the executive director of the Girl Child Network (GCN), an NGO for homeless and abused girls who reiterated the fact that one reason why rape has increased in Zimbabwe to what she termed "dangerous belief", among HIV positive men promoted by many traditional healers, that sexual intercourse with a virgin is a cure for HIV/AIDS. Meursing et al (1995), blames ‘traditional healers for inciting child sexual abuse by advertising clients seeking luck in farming, business, gambling or other monetary affairs to have sex with young girls, often the clients own daughters.’ According to GCN, it has in its care some young girls raped by the fathers with ill advice from some self styles traditional healers and prophets.

Children orphaned by HIV/AIDS were particularly more vulnerable to abuse by the relatives and those in authority, even in schools and care institute leaving them more vulnerable to HIV/AIDS infections. Equality Now (1998), found that some of the sexual abuses perpetrated against children in Zimbabwe are embroiled within the customary laws which remain traditionally acceptable in Zimbabwean culture. Equality Now (1998), give some of these practises as "early marriages, usually arranged between parents without consent of the individuals concerned, circumcision practises, and the pledging of girls for economic gain. Government proclaims that it "protects children from sexual exploitation by prohibiting through legislation the solemnization of a marriage by a minor." Though the Zimbabwe government claims, under section 22(1) of the Marriages Act legislation which provides the minimum legal age of marriage as 18 years for boys and 16 years for girls, "to protect children from sexual exploitation by prohibiting the solemnization of a marriage by a minor", this remains contradictory accepted Zimbabweans ‘customary law which has no minimum age of marriage’

Zimbabwe’s harsh economic situation forces most girls to engage in prostitution putting them at risk of contradicting HIV virus. Sherr (1991)’ reiterates the fact that some children contact HIV virus through sexual encounters in teenage life amongst themselves or through child abuse. Manderson (cited in Catalan et al, 1997) look at the risk of HIV virus infection for students and young people are put at risk as a result of sex adolescence stage and sexual experimentation which is common among young Zimbabweans today. According to Meursing et al (1995), girls who become sexual active at a young age may end up being ‘sexually preoccupied and promiscuous and end up engaging in prostitution and other self destructive behaviours.

The background song on the Timesonline (2008), slideshow reflected the sad voices of former child sex workers in Zimbabwe. As the economy deteriorated more children turned to sex work as a means of survival. Child prostitution due to deepening poverty puts lots of young girls at risk of spreading the disease as some of them engage in unprotected sex and at times forced by their clients who think and believe that sex with a young girl is safe and cures HIV/AIDS. In agreement with Hunter (2003), the GNC brings to light the growing problem of child exploitation by older men known as ‘sugar daddies’ who bait young girls with their cash in exchanging for sex in order to pay school fees and favours like good grades in school exams. The case of a 15 year old teenage girl a TV presenter with the local national television network is a typical example of how children can be easily abused by older men. She was made pregnant by a businessman old enough to be her father. Hunter (2003) advocates for change in teenage and sexual norms as a way forward in trying to combat the spread of HIV virus on children. She argues that ‘most new infections occur among young people’. Some seasoned female prostitutes are involved in the sexual exploitation of orphaned and destitute young girls through bonding and the pretence of providing shelter, food and clothing which are basics for life.

Child sexual abuse has resulted in many children contracting HIV/AIDS due to various social reasons. GCN found that more and more ignorant men think that sleeping with virgins cures HIV/AIDS and Sexual Transmitted Diseases (STDs). Many girls have also fallen victims of gang rape, forced marriages and other traditional practice. Some churches force young girls to marry old men as they say they have been instructed by the ‘holy spirit’. Many girls have been forced, under customary law to marry their brothers-in-law and uncles who are HIV positive. GCN reiterates that the girl child in Zimbabwe is six times at risk of contracting HIV/AIDS compared to the boy child; this is a result of the traditional norms which allow for different treatment of girls ahead of boys.

2.4 Mother-to-Child Transmission (MTCT) of HIV/AIDS

According to Pembry (2008), more than 17,000 children in Zimbabwe are infected with HIV/AIDS every year, the majority through mother-to-child transmission. This may occur through during pregnancy, giving birth or breast feeding of the child. Hancock and Carim (1986) predicted the growth and increase in mother-to-child transmission of the virus whilst Zimbabwe lived in denial of HIV/AIDS impact in the 1980s. They urged that more than half the children born to virus carrying couples contract the infection themselves in uterus. In agreement to transmission occurring in the uterus, Bloor (1995) adds transmission during delivery and breast feeding a practice commonly used and encouraged for mothers in Zimbabwe. Bloor (1995) is of the opinion that, breast fed children of HIV positive mothers are twice as likely to be infected as bottle fed children. Mothers mostly vulnerable to the disease are usually very poor and cannot afford recommended bottled milk and milk powders which under the current harsh economy in Zimbabwe remain very scarce and very expensive. Hancock and Carim (1986), raise concern to the fact that mortality is much more certain to be high for children affected within the first year of life. Pembry (2008), highlights Zimbabwe’s effort to reduce MTCT through a pilot programme launched at four sites in 1999 aimed at providing free Voluntary Counselling and Testing (VCT) and give them access to nevirapine, a drug that significantly reduces the chances of transmission occurring.

The ever rising problem of teenage sexual promiscuity and prostitution in Zimbabwe has also contributed to the rise in teenage pregnancies and the risk of MTCT of the HIV virus. Meursing et al, (1995) take us back to the challenges of teenage pregnancies as a result of child rape. He highlights the case one raped girl aged twelve and seven girls between the ages of 12 and 15 either raped victim of incest or statutory rape cases who became pregnant. In these situations girls might have unwillingly put the resultant children at risk of HIV infection if the perpetrators were themselves HIV positive.

CHAPTER 3

3. The Impact of HIV/AIDS on the Children

Foster (2002) suggests categories which can be used to reflect the impact of HIV/AIDS on children in Zimbabwe, namely social, economical and psychological. He argues that the mentioned three impacts of HIV/AIDS on children combine to increase their vulnerability to a range of consequences including HIV/AIDS infection, illiteracy, poverty, child labour, exploitation and unemployment. According to Foster (2002), given the scale of the HIV/AIDS epidemic in Africa, it is not surprising that child-headed households, street children, and working children are becoming more prevalent.

3.1 Social Impacts

The social impacts of HIV/AIDS on Zimbabwean children revolve largely around the challenges faced by affected children in view of the HIV/AIDS threat and the rapidly deteriorating economic situation and growing poverty(Sesay, 2010; Falola & Heaton, 2007). According to Foster (2002), social impacts mean inadequate parenting, exploitation, abuse displaced and street life. Both adult and infant mortality as a result of HIV/AIDS constitutes a grave social impact of Zimbabwean children. According to Lamb (2006), a doctor said that people are dying of AIDS before they can starve to death. Death denies children of adequate adult care and may exacerbate stigma and discrimination from some members of the extended family. Reproduction for women living with HIV/AIDS in Zimbabwe is greatly influenced by the meaning attached pregnancy and motherhood, as defined by Diane Robinson (cited in Aggleton (1993)). Robinson argues that in many communities the status of woman is judged primarily in relation to their capacity to bear children; thus being unable to have children for some HIV positive women in Zimbabwe. By getting pregnant, HIV positive women put their unborn child at the risk of infection. In Zimbabwe the loss of a mother to poor health or dearth creates the biggest challenges for children because of her family role. The illness or death of a child’s career denies the child many developmental benefits of parenting and it robes children of their childhood as they are forced to engage in adult responsibilities at a very tender age. This creates psychological distress for the children. Caroline at the age of 12 was already looking after her two young brothers Marcus (10yrs) and prince (8 months) after having lost both parents of HIV/AIDS (Timesonline slideshow).

3.2 Economic impacts

As highlighted by Foster and Williamson (2000), one cannot disassociate problems that effect children whose parents become care givers from the economic problems setting in. Economic problems may push the children out of school and will not have adequate food, shelter problems and reduced access to health service. Subsequently death of parents generates challenges for children. Problems with inheritance are common feature as they are likely to lose their supposed inheritance to selfish relatives. Until recently property snatching from vulnerable families was common in Zimbabwe, with clan relatives denying HIV/AIDS orphaned children the right to their inheritance. Rose (2007), highlights the challenges faced by many children when they lose both parents in Zimbabwe. He takes note of the discrimination children face as a result of customary law as they are less likely to possess important documents such as death certificates, land ownership or deed of property that would give them the right to inherit.

In Zimbabwe statute law makes it clear that the children have the right to inherit, but the absence of clear will tradition also gives clan relatives claim to property. There have been many cases in Zimbabwe where relatives have seized property from the widow and children after the father died of HIV/AIDS. Rose (2007) sees customary law in Zimbabwe as the main barrier to children rights to decide and the traditional adult perception that children do not have the mental capacity and maturity to make informed decisions. Children are seen as lacking in the physical strength to resist the forced property seizures. Sadly Zimbabwe recognises these customary laws creating a lot of legislative conflicts with the Zimbabwean statute law. In her report to FAO, Rose (2007) further argues that customary practice and statutory law in Zimbabwe require children to make their claim to property and inheritance through adult guardians denying them direct access to legal and administrative opportunities that might protect violations of their property rights. She goes on to state that many guardians who may themselves be suffering the adverse effects of HIV/AIDS, may refuse to present the children or may actually compete with the children for the same property rights that the children seek to protect.

3.3 Psychological impacts

The psychological impacts of HIV/AIDS on children in Zimbabwe includes depression, guilt, anger and fear resulting in changed behaviour as they try to cope with parental illness or loss through death. Sherr (1991) brings to light some psychological effects of bereavement which affect children as ‘mood change, sadness, crying, sleeping difficulties, withdrawn social behaviour temper episodes’ and for some adjustments disorders. She highlights the importance of psychological care for children with HIV/AIDS in the face of constant hospitalisation, painful medical procedure and the threat of opportunistic infections. Meursing et al (1995), highlights physical trauma for raped girls as some suffer genital and head injuries. Stigma surrounding HIV/AIDS remains as one of the biggest obstacles to the effective treatment and care for children infected and affected by HIV/AIDS (Caldwell, 2000; Clark, 2004; Smyke, 1991). Stigma on AIDS orphans bears a very negative impact particularly to their psychological wellbeing (Cluver, 2008; Campbell et al, 2011). In her research on Zimbabwe’s neighbour, South Africa, Cluver found out that more than one third of HIV/AIDS orphans were teased about the family illness and 38 percent were badly treated. She puts on the opinion that, ‘stigma to HIV/AIDS has the potential to produce tangible improvements in mental health, particularly post-traumatic stresses’.

The loss of family members in particular biological parents and loss of social identity due to HIV/AIDS by some Zimbabwean children generates growing poverty and collapsed traditional family ‘’safety nests’’ leaving them vulnerable to abuse and exploitation. According to Sherr (1991), in the event of death, it takes cognisance that age often has implications for the inputs the bereaved child might need. She argues that for the babies it is the mothering relationship which is disrupted and difficult to replace, however for older children the meaning of bereaved is taken in, based on the child’s social understanding and cognitive development. Hunter (2003), bring to light some of the challenges faced by children who lost parents to HIV/AIDS in Zimbabwe such as forced migration, dropping out school with the hope of either looking for work or taking care of other sick relatives and orphans left in care. People in the rural areas who fall ill or take care of ill family members put their children to work on the farms in a bid to try and subsidise family income.

3.4 Failed health system

Failing health delivery policies in Zimbabwe has allowed many of the HIV/AIDS child cases to develop into fully blown AIDS due to poor health service facilities. Most HIV infected children are caught up in the harsh reality of a declining health system in Zimbabwe. This results in diminished child development amongst children affected by HIV/AIDS and loss of household support and livelihood activities. Miller (1987) argued that children infected with HIV virus may be more vulnerable to contracting common childhood infections such as measles, cold sores and herpes. They may suffer more complications from these diseases because of their reduced ability to fight infections. Sherr (1991) reiterates the point that children with HIV virus are vulnerable to opportunistic infections which is quite true of most HIV/AIDS cases involving children of Zimbabwe.

Lack of adequate hygiene and sanitation safety measures pose the risk of precipitation transmission amongst children due to levels of social interaction at school and at home whilst caring for their sick parents and in social community grouping in the event of accidents allowing for the contact with bodily fluids. Zimbabwe’s health profession has suffered many setbacks with a huge number of doctors and nurses dying of HIV/AIDS (Chitima et al, 1996). That has put a serious strain on the country’s medical services and facilities and undermines the provision of free medical help especially for HIV/AIDS orphans in rural settings. According to Lamb (2006) many medical personnel choose to leave the country for developed nations where their skills are better paid. He also found problems of under staffing and shortage of vital health personnel such as surgeons and paediatricians at major hospitals in Zimbabwe with casualty sections almost closing down due to staff shortages in Bulawayo. Lamb (2006) also cited lack of adequate hygiene, sanitation and safety measures posing high risk of getting infected and deteriorating services and working conditions

3.5 Increased demand in labour

Sickness often affects the earning capacity and the ability to produce food resulting in loss of income and food insecurity (Watts et al, 2007). According to UNICEF (2000), children are driven into the world of work and exploitation by poverty and inadequate education, exacerbated by the effects of HIV/AIDS as changes in family composition and child roles take charge. In some cases children as young as ten years of age are often used on farms where they are exploited and given poor wages despite losing their parents at very tender age. The sugar, tobacco, tea and cotton farming sectors have benefited a lot from child labour in Zimbabwe employing mostly children between ages ten and seventeen to farm and harvest for an equivalent loaf of bread’s price as pay. Children are having significant care responsibilities such as preparing food, cleaning and other menial chores as well as providing moral and physical support for their ill parents (Bauman et al, 2006).

In some cases the unequivocal impact on education of HIV/AIDS children is very significant. Some children assume parental care responsibilities, food production and with poverty increasing, are likely to be affected. There is likelihood that the weight of parental illness or death also had a negative impact on school performance resulting in failure, repetition and likely dropout (Badcock-Walters, 2002).

3.6 Adult and child mortality

HIV/AIDS impacts with a devastative effect on the lives of Zimbabwean children. Cameron (1993) argues that; AIDS heightens people’s fears about death. The disease has a trial of fertilities which children equally affected as shown by statics indicating levels of child mortality in Zimbabwe. There has been a marked decline in HIV incidence among children from 30% in 2010 and estimated to be less than 5% by 2015.(FIGURES). Aggleton (1997) agrees that many infants die as a result of HIV/AIDS related diseases in their first years of life. Orphaned with nothing to eat some children end up being forced to migrate to big towns in search of a new life where they are greeted with homelessness, vagrancy increase street living and crime for survival. Hunter (2003) highlights the case of a boy who lost both parents then moved to stay with an uncle who also died and then ended up with his grandmother. She could not afford to send him to school and he ended up on the harsh streets to survive, a situation which is often true for most AIDS orphans in Zimbabwe.

Foster (2002) takes a look at the traditional practice of orphan’s inheritance by relatives which seems to have reduced and replaced by alternate safety nets being provided by grandparents. He also argues that in Zimbabwe where formal government supported social safety nets exists, they have generally been ineffective at delivering services to the destitute and marginalised especially to those impoverished or remote rural communities. Some children find themselves heading households. Such households are created when extended families fail to adopt orphaned children.