The Case Of Zimbabwe Health And Social Care Essay
Chapter 1 Introduction
Background to Research
Structure of Project
Chapter 2 The contributory factors of HIV/AIDS on the children of Zimbabwe
2.1 Governance’s contribution to the spread of HIV/AIDS
2.2 Poverty contributes immensely to the spread of HIV/AIDS
2.3 Exploitation and drug abuse are factors nurturing HIV/AIDS
2.4 Mother-to-child transmission of HIV/AIDS
Chapter 3 The Impact of HIV/AIDS on the children
3.1 Social impacts
3.2 Economic impacts
3.3 Psychological impacts
3.4 Failed Health System
3.5 Adult and Child mortality
Chapter 4 Interventions on HIV/AIDS affecting children
4.1 Role of Government
4.2 Role of Non Governmental Organisations (NGO)
4.3 Treatment and testing
4.4 Campaign and education
Chapter 5 Children’s Rights and how they impact on HIV/AIDS amongst children
5.1 Right to education
5.2 Right to freedom from discrimination
5.2 Right to protection from abuse, neglect and exploitation
5.3 Right to self expression and self determination
Chapter 6 Conclusion and Recommendations
6.1 Findings and Analysis
The Human Immunodeficiency (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continues to result in increasing numbers in children being orphaned and made vulnerable by HIV/AIDS (Saito et al, 2007). Although most age groups have been affected by this deadly disease, children are the mostly affected. This is because some children are losing both parents at a very tender age after they get affected by HIV/AIDS. Consequently as Zimbabwe has one of the highest prevalence of orphaning in the world today, this pandemic has caused panic, unrest and grief for many people because of the trauma it increases and the resultant trail it leaves behind in particular for children. According to the World Vision (2008), children orphaned or made vulnerable by HIV/AIDS are more likely to be malnourished, less likely to be educated and more likely to be abused and suffer severe psychosocial distress. HIV/AIDS in Zimbabwe remain as one of the major contributor of poverty and suffering for children. HIV/AIDS amongst children in Zimbabwe has been a rampant problem since time immemorial yet it has remained veiled in obscurity. According to the figure issued by Ministry of Health and Child Welfare in Zimbabwe (2011), there were an estimated number 1.2 million adults and children living with HIV/AIDS.
HIV/AIDS has been exacerbated by poverty in Zimbabwe. In most poor parts of the country caution is not being considered in relation to the birth process. A survey carried out by UNICEF revealed that most children are victims because of the Mother-To-Child Transmission (Chandisarewa et al, 2007). There are no effective mechanisms to curb the passing of the disease during pregnancy, delivery and breast feeding. There is inadequate attention to maternal infection of new born babies and subsequent infection children in early childhood. In actual fact very few women receive remedial information on the effects of this disease. A close look at this issue would reveal that due to the economic hardships currently faced by this country; a lot of parents have relocated to other nearby countries or even overseas in search of greener pastures. This is impacting negatively on the way the children are being raised because some are suffering fate in the hands of the nannies. Most children have no parental guidance.
Not only has the issue of culture affected Zimbabwe but as well as most of the Southern African countries. Generally instead of culture acting as a way of ensuring discipline and stability in society, it in-fact has caused disagreements, suppression and show tendencies apparent in African cultural dominance. Most of the African societies have the same cultural and religious beliefs with most countries allowing the existence of polygamy. In some societies this belief is heavily supported with disregard to the impact of HIV/AIDS. One man is allowed to have as many young wives as he can possibly handle without the law putting a restraining order on such an inhuman act. In some parts of Zimbabwe, some staunch believers of polygamy who would want to see such an oppressive act being promoted have disregarded the global village that people are now living in. They feel status-quo oriented is better than the contemporary even though ironically the society itself is not stable. This dissertation will therefore take a deeper and more comprehensive look at the effects and impacts of the role of culture in African societies in particular Zimbabwe and how such an act has continued to exacerbate HIV/AIDS amongst the young generation.
The government of Zimbabwe has since dropped the welfare approach that they once had when they entered into power in 1980. The ZANU PF government has since neglected the social welfare of people and instead concentrate on the politics, empire building and ensuring their personal interests are upheld at the expense of people who voted them into power. Hospitals have therefore been a death paradise rather than a blissful place which they once were. The health delivery system was since neglected and a close analysis of the government budget has reflected that the Defence Ministry receives the highest amount of allocation every year. In fact if a family has a very sick relative, it has proved better to practise home-based care than hospitalising that person under the negligent of heavily underpaid and under-motivated hospital staff. These high levels of people living below the poverty line have increased and even the HIV/AIDS levy that the government has been collecting from ordinary citizens has been used in other unruly ways politically motivated projects. The children affected with this diseased have not benefited from this scheme as a result. Most of the children lead very miserable lives eventually die without proper care yet it was their parents’ hard work they failed to enjoy.
Background to Research
This dissertation intends to critically assess the causes and impacts of HIV/AIDS on children based in Zimbabwe taking into consideration the role of the Government, non-governmental organisations in reducing the HIV/AIDS epidemic. It aims to identify the gaps missing for HIV/AIDS orphans in order to improve their upbringing, and also being heard, noticed and treated the same in society like any other human being.
I decided to choose this topic after visiting Zimbabwe
In order to understand the different perspective of our social world, we use sociology theories that help to find asimple way of viewing our world with some consistency to determine a particular phenomenon (Mooney et al, 2007).
Such theories like functionalism and interactionist rely on epistemology, ontology and methodology in answering research questions (Crotty, 2003), despite their commonality, both theorists have different assumptions regarding the nature of social reality which inter-connect different epistemological assumptions regarding the study of social science.
This research draws on the functionalist perspectives which assumes that the truth consists of cause and effect law which are both external to the human minds (de Mont and Melrose, 2012) By applying this first statement, the research clearly highlights the cause of HIV/Aids and its effect especially on the children and orphans in Zimbabwe. This perspective is founded on the key thesis that society is integrated, connected and conscientiously collective. It identifies that if illness becomes a social phenomenon it begins to affect society’s performance disables continuity. By becoming sick, it affects the fulfilment of one’s role in society. Hence health of a nation becomes a prerequisite for functionalist perspective in determining the smooth functioning of society because it is built up of different institutions based on a sustainable family unit (O’Donell, 1997)
Such is the impact of HIV/Aids on Zimbabwe that is has demarcated the pillars of the nation. The perspective offers how such impact could be addressed to reduce the impact on children with HIV/aids. If such a part of family connectedness fails, then the whole society becomes dysfunctional. Functionalist therefore decipher various parts of society that are suppose to cordially fit together in order to formulate some form of response in order to determine action that might result in retaining to some form of normalcy. Where interactionists tend to focus on opinions, they do not offer or encourage participants to respond without reservation. Functionalists however are more prevalent and disregard issues that are irrelevant within a broken system in order to reform some upper order (Miller, 2000).
The research will conduct a quantitative approach as the project seeks to assess the causes and impacts of HIV/AIDS on children especially in finding the number of children being affected by this disease. As children affected by HIV/AIDS are considered vulnerable persons, it was not advisable to conduct a primary research. This research will then conduct a secondary based research mainly due to time consumed in getting ethical considerations to conduct a primary research. Although secondary research is relatively cheap and easily accessible, it is also an excellent way to examine large scale trends, attitudes and views.ref Information will be library based basically using the peer reviewed journals, reports, articles, books and online sources. Web searches were conducted using ebsco-host and discovery.
Vast information from the internet and written electronic information was also used. This is because most of this information is very recent and updated regularly and as a case of Zimbabwe, most information is easily accessible online. This helps give the researcher a wider base of argument, comprehensive material as well as authentic documents. Online slideshows were also used as they are real and full of evidence. Newspaper articles were used as these prove to be authentic and revealing individual perception of the impact of HIV and AIDS on children. The Conventions and agreements on children’s rights as per the United Nations Charter were also used in order to reveal the legal aspects of this issue. Some documents written by inter-governmental organisation such as UNICEF were also considered as they have taken a noble stance to try and get rid of the problem. There were some difficulties encountered in sourcing information from text books as they proved to be dated, as at any given time exist few academic texts to assist researchers with ideal set of data (Badke 1990; Krathwohl 1997).
The project will be based on secondary research, which with the nature of the topic, it is impossible to conduct a primary research because of the time constrains in getting ethical approval and distance limitations. Although using secondary data, ethical considerations have to be obliged. According to Social Research Association (Ethical Guidelines, 2003), even if information that contradicts my understanding of the question, it cannot disregard and dismiss the information. The researcher has had to prevent their own biases from influencing the interpretation of information or data gathered in the course of the research. Although the data may be inaccurate, old and out of date, one needs to consider the credibility of the source of data collected (Mann 1998).
According to Rees (2003), ethics in research relates to informed consent, confidentiality, avoiding harm and exposure and avoiding expectations that may be possible for the researcher. Rees describes confidentiality as a basic ethical principle which is widely used. Literature drawn should be ethical sounding and participants’ personal values should not be ignored. All participants’ identity should be protected at all times to avoid researchers linking the information with individuals.
Structure of Project
The following chapters are organised
2. The contributory factors of HIV/AIDS on the Children of Zimbabwe
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 in Zimbabwe, 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, declining public revenues leading to a de-prioritisation of HIV/AIDS prevention programmes in favour of military expenditure, sexual exploitation and an increase in associated risky behaviour, erosion of public health infrastructure, and the suspension of the 2008 March 29th elections Zimbabwe has been embroiled in a wave of political violence forcing many people to flee their homes in search of refuge and over the same period Zimbabwe tried to take receipt of weapons acquired from China worth millions of dollars ahead of badly needed antiretroviral drugs for HIV/AIDS treatment. Sadly the Zimbabwe government refuses to acknowledge that its people are suffering to the international community and stands in the way of vital of aid from NGOs shunning aid 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. The political and social damage that HIV/AIDS on children can potentially inflict on Zimbabwean society will continue to pose problems for the government for a long time. 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 suffer the impoverishment, because it is precisely the most productive members of families and communities who fall victim to the diseases. All areas of society, such as the educational system and the food production sector, are affected. With Zimbabwe’s inflation soaring at 1000%, prices of commodities continue to increase daily, leaving many people in Zimbabwe living in poverty. Hunter (2003:29) argues that families are forced into poverty by the illness and the resultant death from HIV/AIDS of member. According to her, sickness of a family member pushes it to part with personal fortunes such as capacity goods, land, livestock, and small belongings leaving them vulnerable when more complex problem arises. Loss of work and demand for treatment and basic life survival push family 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 on children in Zimbabwe.
Cameron (1993) highlights the link between HIV/AIDS and substance abuse. She blames the ethical problems such as unprotected sex prostitution and drug abuse which constitute risky behaviour and are usually enhanced through drug abuse. 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. Lose of parents leave 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 (195) 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" (p1693)
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) lame ‘male dominance in Zimbabwean society means professed inability to control sexual desires and magic beliefs’. Equality Now(1998) also highlighted the fact that "in cases of rape a report 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 brides 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), a non-governmental organisation 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 f the individuals concerned, circumcision practises, and the pledging of girls for economic gain (kuzvarira) or as appeasement to the spirits of a murdered person (kuripa ngozi)". According to Equality Now (1998), on the issue of appeasement of the spirits of a murdered person, a young girl may be offered in compensation as a wife to man in a family against which an offence has been committed by her father or brother’ Sexual abuse, rape and coerced sex are all common problems in Zimbabwe putting many innocent children at risk of HIV/AIDS infections. 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 to 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 et al (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 reflects the sad voices of former child sex workers in Zimbabwe. As the economy deteriorates more children are turning 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 can be 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 Girl Child Network 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 mad 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 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 in Zimbabwe
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 mother-to-child transmission (PMTCT) 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.
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. 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 social impact of Zimbabwean children. According to Lamb (2006), a Zimbabwean doctor said that people are dying of AIDS before they can starve to death. Death robes 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 112 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 wills 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 complete 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. Cluver (nd) argued that stigma on AIDS orphans bears a very negative impact particularly to their psychological wellbeing. In her research on Zimbabwe’s neighbour, South Africa, she 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. (REF) 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 in Zimbabwe 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 to 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 (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 countries like 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. Children who miss find themselves in child headed households. Such households are created when extended families fail to adopt orphaned children. Timesonline (2008) highlighted the case of Simbarashi aged 9 who lost his father and mother to HIV/AIDS and is being cared for by his grandmother. Simbarashe describes the hardships he has to endure at his grandmother’s that she cannot afford to buy much food; they only eat porridge in the morning and ‘sadza’ Zimbabwe’s staple food in the evening.
4.0 Interventions on HIV/AIDS affecting children
Interventions help to reduce the levels of transmission of HIV/AIDS. Public health approach remains the most appropriate way to reduce the spread and infection of HIV/AIDS. This helps to promote campaigns by educating people on how to avoid infection or educating the infected people on how to avoid infecting some other people. There are many ways to prevent the transmission and spread of HIV virus. Lack of HIV/AIDS awareness amongst children is a common feature in Zimbabwe (Timesonline, 2008). According to Aggleton (1993) highlights the need to allow rapid and flexible care to families with children living with HIV/AIDS, but Zimbabwe remains challenged as it faces a harsh economic situation and targeted sanctions which often affect ordinary citizens.
4.1 Role of government
According to Pembry (2008) the Zimbabwe government set up the National AIDS Co-ordinations Programme (NACP) in 1987 to carry out several short term and medium term AIDS plans but only announced the first HIV/and AIDS policy in 1999. The implementation of the policy led to the creation of National AIDS Council of Zimbabwe (NACZ), which took over from NACP. The government of Zimbabwe introduced an AIDS levy on all taxpayers to help fund the work of NACZ. While these measures have had a positive impact, the government’s response to HIV and AIDS has ultimately been compromised by numerous other political and social crises that have dominated political attention and overshadowed the implementation of the national AIDS policy. The government’s focus on domestic politics has in recent year’s diverted attention from HIV/AIDS crisis to the rearming of the Zimbabwe defence forces with Zimbabwe spending trillions of its national budgets on defence as id Zimbabwe is at war. The NACZ has also been constrained by poor organisation and a lack of resources. Pembry (2008) highlights that the Ministry of Health and Child Welfare (MoHCW) is responsible for delivering HIV/AIDS care programs and treatment services, including the national antiretroviral therapy programme, with support from various partners. More than 70 hospitals of different sizes operated by the government, nongovernmental organisations and the private sector have been identified for delivering antiretroviral therapy services (WHO, 2005).
4.2 Role of Non-governmental Organisations (NGO)
In any efforts to address the address the challenges faced by children orphaned by HIV/AIDS in Africa and children whose parents are or dying of HIV/AIDS related illnesses, six international nongovernmental organisations (NGOs) came together and establish the Hope for African Children Initiative (HACI) in 2000. The initiative involves organisations already working with AIDS orphaned children in Zimbabwe through community based projects namely Care International, Plan International, Save the Children, Society of Women and AIDS in Africa, World Conference on Religion and Peace and World Vision. There are many other operating across Zimbabwe that are being led by people who help HIV positive families cope with the disease. SOS Children’s village established by SOS Kinderdorf worldwide in Bindura, Bulawayo and Harare coordinate AIDS out-reach programs which reach out to about 6000 children every year (SOS online, n. d.).
Children who have lost both parents and now live with grandparents, older siblings or other relatives, as well as those whose parents are seriously ill are prioritised for assistance. Specially trained counsellors and care givers visit HIV/AIDS affected families and teach them about the basic health and nutritional needs providing them with food, school fees, basic medical treatment, counselling and psychological support. Support offered extends to housing and living conditions improvements. The SOS works in collaboration with the Ministry of Health and Child Welfare and the District AIDS committees put up by the NACZ to develop programmes that help strength families. Non-governmental organisations have been on the fore front on promoting micro economic interventions in Zimbabwe. Butler (2000) highlighted that a project carried out in Mashonaland East Province by the Uzumba Orphans Trust, supported by the United Methodist Church, assisting 1,500 AIDS orphans in Zimbabwe to remain in their homes by providing regular community care givers. Under the project the Trust entrust orphans with fields, or farmland plots that are worked by community volunteers. All produce is then sold, and the proceeds are managed by the Trust to provide housing materials and school fees for the member orphans. Such micro-economic project helps children to be self sufficient, self dependant and boasts their income. It also safeguards them from poverty threats given the harsh economic climate that is prevalent in Zimbabwe at the moment.
4.3 Treatment and testing
As part of the HIV and AIDS testing and treatment, Zimbabwe has tried to encourage voluntary testing and free provision of medicines for the affected people but efforts are always hampered by Zimbabwe’s declining economy, resulting in declining shortage of antiretroviral drugs (ARV) which are used to treat HIV/AIDS virus (Pembry, 2008). Some medical experts in Zimbabwe have argued that treatment received in Zimbabwe is usually a temporary protection against opportunistic infection; it won’t save a life as proved by the high rates of HIV/AIDS deaths. Many AIDS patient in Zimbabwe turn to traditional healers, who advocate the use of herbs they say help relieve symptoms associated HIV/AIDS. Access to experimental drug trials and health care remains limited to few and privileged individuals. Hunter (2003) brings to light the campaigns by Medicines San Frontiers (Doctors without borders) against super powers which threatened Zimbabwe with economic sanctions which could have reduced access to medicines vital for people living with HIV virus. Zimbabwe is one of the countries using cheap imported homemade genetic anti-retroviral drugs which help to reduce treatment cost and expand distribution of drugs.
Aggleton (1993) expressed the need to consider the advantages of breastfeeding since most women in Zimbabwe cannot bottle feed safely due to the cost and lack of adequate sanitation. She argues that in many developing countries bottle fed babies are much more likely to die in infancy than are breast fed babies. It must be noted that breast feeding is still not very safe from infection. Lamb (2006) argues that of the 1.5 million Zimbabweans registered as HIV positive; only 6000 are thought to be receiving drugs. Cameron (1993), talks about the need to educate mothers about prevention of MTCT of HIV/AIDS. A point taken from Buyer (1990), Cameron reiterates that men and women could be taught ‘responsibility regarding sexuality, parenthood and use of substances’. Cameron (1993) suggests that offering routine HIV testing before becoming pregnant, at early stage of pregnancy and after birth allowing for appropriate health care planning. Other suggestions include improved diagnosis of HIV infected women and counselling.
4.4 Campaign and education
In Zimbabwe activism has greatly promoted reduction of HIV transmission. In Zimbabwe HIV/AIDS campaigns are through discussions, radio and television, drama, role playing, films, videos, music, poetry and publications. Health officials, religions leaders and pressure groups continue to campaign for responsible sexual behaviour. Recommendations for abstinence monogamous relationships remain a constant appeal. Cameron (1993) argues that activism helps stimulate government to address the needs of children affected by HIV/AIDS, monitor its short comings, filling the gap of what it can do and cannot do. Child mortality reduction from 2009 to 2011
In Zimbabwe campaigns normally target social problems affecting children affected by HIV/AIDS such as child abuse, child labour and sexual exploitation. HIV and Aids awareness is encouraged amongst children by campaigning against child abuse and promotion of HIV/AIDS awareness in schools. Pembry (2008) found that a number of different approaches are being used in an effort to educate and inform people about HIV and AIDS and to convey preventative measures necessary to reduce infection especially amongst children. In Zimbabwe some of these measures include television and radio drama, community groups and HIV/AIDS education awareness in schools often organised by NGOs. Population Services International Zimbabwe (2005) organised a campaign dubbed ‘’don’t be negative about being positive’ aimed at encouraging people living with HIV/AIDS to reveal their HIV-positive status and to share their stories with hope of shedding out stigma. Sherr (1991) argues that psychological interventions reduce the traumatic experience for the child and may actively assist in encouraging cooperation by the child in treatment and medical procedures.
Media role has had a very positive impact on disseminating HIV/AIDS information to all sectors of Zimbabwean society. One of the radio channels has been dedicated to education radio channel giving radio lessons covering HIV/AIDS in rural communities where the majority of the Zimbabwean population does not have access to television. In Zimbabwe these campaigns are also carried out by government in collaboration with NGOs and religious groups. According to a UNICEF (2008), the Zimbabwean Ministry of Public Service, Labour and Social Welfare, the National Faith Based Council of Zimbabwe and launched a campaign against child abuse dubbed ‘‘stand up and speak out campaigns’’.
Efforts of religious groups can be viewed from the work of United Methodist Church (UMCZ) in supporting the Uzumba Orphan Trust. The UMCZ has also been involved with orphaned children through the work being done by the Matthew Rusike Children’s Home, an orphanage set up by the church in the 1950s. Addressing a fellowship in Birmingham in 2011 on a fundraising campaign for the home, Astonishment Mapurisa the superintendent of the home said the home is involved in HIV/AIDS community support project in Gweru, Mutare and Shurugwi towns in Zimbabwe. In light of the ever growing problem of child orphans is vitally important to target HIV/AIDS educational materials towards children since they are the country’s future generation.
5.0 Children’s rights and how they impact on HIV/AIDS amongst children
The need to recognise the rights of the child in Zimbabwe as defined in the international convention on the rights of the child’s equality important to ensure positive child development in the face of the growing threats to ill-health and increased poverty. According to UNICEF (2010), child rights to protection are often violated in most countries creating massive barriers to child survival and development and Zimbabwe is no exception. Children subjected to violence, exploitation, abuse and neglect are at risk of death, poor physical and mental health, HIV/AIDS infection, education problems, displacement, homelessness, vagrancy and poor parenting skills later in life. Rose (2007) argues that, the rights of children in Zimbabwe are also less likely to be covered within the relevant legislation
5.1 Rights to education
In the wake of HIV in Zimbabwe, child like any others elsewhere in the world have the right to education. In some few parts however HIV/AIDS education for children in Zimbabwe is now mandatory in school from the age of 8. HIV/AIDS education campaign in Zimbabwe have primarily targeted young people as a result of growing numbers of youth living with HIV/AIDS being infected during adolescence of young adulthood. Timesonline (2008) agree with the fact that education is highly prioritised and priced in Zimbabwe, " a legacy of Mugabe’s celebrated early war, when he built schools and promoted one of the best education systems in Africa" , offering access and free education to all. Contrary to Sherr (1991), who argued that some child would refuse to go to school and display lack of interest in school most AIDS orphans in Zimbabwe remain quiet enthusiastic and determined to continue going to school even when they are aware they cannot afford the fees because they see the school as a safe haven where they get comfort, food, friends and above all a window of hope. The case of Caroline, who despite carrying after her brother due to HIV affects his eager to go school, highlights the enthusiasm of children in Zimbabwe when it comes to education and their future hopes. Zimbabwean education system has also suffered many set back with a huge number of teachers either dying of HIV/AIDS or leaving the country for work abroad. A crack down on teachers during the 2000 parliament election saw brutal campaign, forcing many rural teachers to quit and move to urban towns where they felt much safer. Such a campaign left a huge vacuum in rural education vital for the HIV/AIDS programmes and campaigns. This also increased levels of illiteracy in the country.
5.2 Rights to freedom from discrimination
Rose (2007) is of the opinion that children are more likely to be discriminated against in customary practise as they are often denied the right to make decision regarding property use and inheritance. As previously described by GCM, girls as compared to boys are more likely to be discriminated against in customary practises and denying them the rights to inherit parental property, the right to access property without the consent of male relatives, rights to act as the administrator of the estate. Such unfair treatment of the girl child undermines the children’s right to equal and fair treatment and protection leaving them vulnerable to exploitation and abuse putting to them under threat of HIV/AIDS.
5.3 Right to protection from abuse, neglect and exploitation
Children have the right of protection from abuse, neglect, exploitation and discrimination. Rose (2007) argued that "many orphans particularly those affected by HIV/AIDS are poorly integrated with their communities, and are subjected to abuse, exploitation. For example, force child labour and trafficking, and are exploited for their land and property." She adds that though "the united nations convention on the right of Child’s desirable stipulated that children should be protected, and it desirable guarantees to children specific rights to and against certain things, the overall focus of the United Nation Convention Rights of the Children (UNCRC) is arguably no longer completely relevant to the current international context of HIV/AIDS." Rose 2007 explains the reduced relevance of the UNCRC in a least four respect. He is of the opinion that the "UNCRC emphasizes children physical and emotional vulnerabilities, without paying much attention to their economic vulnerability and it also emphasise that children’s caregivers must provide for them but it does not acknowledge that many potential caregivers are unable to provide for the children (largely due to the HIV/AIDS pandemic) and that children may therefore need to provide for themselves." In his argument Rose castigates the ‘UNCRC for not acknowledging that the children’s caregiver may discriminate against them, and not acknowledging that discrimination against children may be sanctioned by national laws, as when children are not guaranteed their property rights, when it focuses on discrimination." Rose (2007) argues that although the United Nations Conventions on the Rights of the child ‘mentions children’s material, psychosocial, legal and human rights, it does not mention their property and inheritance right."
5.4 Right to self expression and self determination
According to Rose (2007), in matters concerning disposal of their inherited property, "children have little or no choice in such matters. Few children are consulted about the disposition of their family’s asses, and those children who are living with HIV/AIDS may very well discover upon reaching adulthood that at least some of their family’s assets where alienated during their childhood without their knowledge or consent." Children should fully exercise their rights to self expression and determination and they must be given the opportunity to participate in the community and make decisions that affect their childhood and development. A number of children have been abused over a long period of time and failed to report such cases because normally their do not have the right to express their views. In most cases the child is suppose to be quiet and is not allowed to make any contribution and if the child tries to then it is viewed as ill-mannered. A right to self expression among children who prove to make life easier for children – however compared to western societies where children are accorded the right to self expression, making independent decisions and encourage openness, life is safer and worthwhile for children. Ironically in Zimbabwe, even the older people have no right to self expression and assembly; it becomes even more complicated whether such a privilege can then be extended to children.
Recommendations and conclusion
Although the Zimbabwean government has shown long term commitment to mobilize and strengthen community efforts on HIV/AIDS still has not done enough to ensure that the levels of HIV/AIDS are decreasing. They have received a lot of support from the international community in particular the united nations and its agencies and other non-governmental organisations and intergovernmental organisation working closely with HIV/AIDS towards increased better international aid. Aggleton (1997) highlights the need to create childcare services aimed at reducing stress and overwork for affected parents allowing sustainability of family unit longer. Zimbabwe can learn a lot from lessons drawn from other countries if it is to effectively combat HIV/AIDS such as Uganda and Kenya which have acknowledged the existence of HIV/AIDS. Zimbabwe should wholly acknowledge the existence of this deadly disease and instead of contracting on improving arms they should try to improve the general standards of their citizens.
Corruption has hit Zimbabwe and so far according to statistics Zimbabwe has registered the highest levels of corruption in the world. This is mainly because of the exacerbating levels of poverty as highlighted in chapter 2. Most people have engaged in corrupt activities because of poor living standard. Even the distribution of antiretroviral drugs has since been realised as unfair and discriminatory. A fair and transparent free distribution and provision of treatment and dispensing of antiretroviral drugs and care for children affected by this disease would also help the situation in Zimbabwe.
Education on safe sexual practises for young people within their schools and vocational curriculum through the Ministry of Education, Sport and Culture should be made mandatory in Zimbabwe. Cultural issues that give an impression that discussions on HIV/AIDS are a taboo should be done away with. Miller (1987:54) is of the opinion that infected procedures should be understood and rehearsed in schools since some children face the challenges and difficulties with controlling bodily secretions due to HIV infections. Basically all the teachers should be trained on how best they can impact this knowledge to their pupils and students. The HIV/AIDS should be included in their curriculum and made mandatory for every college and university student. As long as a multi- pronged approach to eliminate HIV/AIDS is adopted then there is need to raise awareness among all Zimbabwean citizen both the old and the young because this disease is not discriminatory.
The rehabilitation and care for children affected by HIV/AIDS through informal and formal training and education can also be useful to the vast numbers of people affected by this disease. The Ministry and Child Welfare and the National Aids council of Zimbabwe should ensure close collaborations in order to deliver better services and best practice in health provisions for HIV/AIDS affected children. Zimbabwe can learn from countries like USA which provide clear guidelines for care for HIV infected children and adolescents or those suspected of being HIV infected, a factor missing with Zimbabwe’s own health policy undermining child care (Andrews and Novick (1995). Child Protection Law enforcements procedures in Zimbabwe should be crafted to safeguard those unaffected from deliberate infection from those diagnosed and harsh sentences imposed on those convicted of child abuse. Child rights can be best addressed through Rose (2007) in his following laid out recommendations;
"The CRC should be updated to account for the changed circumstances of children ‘living with HIV/AIDS’ First it should expand the definition of vulnerability to cover more fully economic vulnerability, and it should also expand the definition of violence against children to include harm against future interests. Second it should expand the concept of protection to incorporate the idea that children’s need for autonomy and self-determination may require protection. Third it should expand the definition of caregiver. Fourth, it should specifically guarantee children’s property rights in order that all children are equipped to secure their present and future livelihoods’ (pp. 17).
Inter-governmental organisations and non-governmental organisations should assume a more proactive role to solving problems because they are a part of the civil society organisation that keeps checks and balances on the governments of most states. However, all the parties should be involved in the fight against HIVAIDS especially the state actors and the non state actors as well as the citizens of Zimbabwe. The rights of the children should be promoted with them being given the right to express their own views and expression. The society has no respect for children’s rights especially the girl child who is suffering from physical to sexual abuse. Generally the girl child has no right to express their view and in most cases they are subjected to cultural torture such as forced into marriage for the family to gain money in return during times of famine and hardships of the family.
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