11. Memorandum submitted by HelpAge International
SUMMARY
This memorandum sets out HelpAge International's
concerns and evidence for the International Development Committee's
request for evidence on AIDS orphans, especially in relation to
the increasing role that older people are playing as primary caregivers
of orphans and vulnerable children affected by AIDS.
The AIDS epidemic is having profound effects
on families and communities leading to a dramatic rise in the
adult death rate and in the number of orphaned children. A much-neglected
side effect of the epidemic is the devastating and under-reported
impacts it has had on older people over the last decade. Older
women and men in AIDS affected countries are the primary caregivers
of people living with AIDS, the guardians of millions of Africa's
orphaned and vulnerable children, and are playing a crucial role
in the survival and sustainability of families and communities.
Recent data collated by UNICEF shows that over 60% of orphans
and vulnerable children are living in grandparent headed households
in Namibia, South Africa and Zimbabwe, and over 50% in Botswana,
Malawi, and Tanzania. Yet they do this without the recognition
and support they deserve and in a context of increasing poverty,
food shortages and decreasing community resources. Older people
are excluded from information campaigns and prevention programmes
and neglected in the fight against AIDS.
Households of older carers and orphaned and
vulnerable children are facing increasing economic vulnerability,
lack of access to education and health services and significant
psycho-social and emotional trauma as a result of AIDS. This submission
therefore recommends that the UK Government provide financial
and technical backing to AIDS affected countries to provide direct
income support to families of older carers and orphans and vulnerable
children, support education and health policies and programmes
which are responsive to the needs of OVCs and their older caregivers,
and ensure their explicit inclusion in its HIV/AIDS policies,
programmes and resources allocations.
MEMORANDUM
1. HelpAge International
HelpAge International is a global network of
not-for-profit organisations with a mission to work with and for
disadvantaged older people worldwide to achieve a lasting improvement
in the quality of their lives. With our network of partner organisations
we support older people to become active participants in development
and aim to mainstream ageing as a development issue into policies
and programmes for poverty reduction, HIV/AIDS, human rights and
emergency assistance around the world. This submission is based
on HelpAge International's 20 years experience of working with
disadvantaged older women and men around the world and 10 years
experience in supporting them in their role as primary caregivers
of orphaned and vulnerable children, largely as a result of the
impacts of the AIDS epidemic. HelpAge International's work in
this area is so far concentrated in the Africa and Asia regions.
It is carried out through a network of affiliate organisations
supported by our Regional Development Centres based in Kenya and
Thailand respectively, as well as Country Development Programme
Offices in Cambodia, Ethiopia, Mozambique, Sudan and Tanzania.
This submission will therefore refer mainly to evidence from the
Africa and Asia regions.
Furthermore we draw the IDC's attention to the
written and oral evidence provided by HelpAge International in
2000 to the Committee's hearing on "HIV/AIDS: the Impact
on Social and Economic Development"[142]
Despite specific recommendations to the Department of International
Development by the IDC—calling for "income and social
support for older people affected by AIDS and caring for dependents,"
and "that all HIV/AIDS strategies include explicit policies
and actions to meet the needs of the elderly"—none
of these issues were integrated into DFID's HIV/AIDS strategy
at the time. We hope, given the provision of evidence here and
elsewhere, that this will be addressed in the forthcoming revision
of DFID's HIV/AIDS strategy and that the specific role of older
people caring for orphans and vulnerable children will constitute
an important component of DFID's support to AIDS affected countries
in Africa, Asia and other regions.
2. Ageing and Development in the context
of AIDS
Discrimination and a lack of policy and legislation
on ageing, combined with the declining economic situation, the
impact of HIV/AIDS and the rise in conflict and emergency situations
mean that older people[143]
are denied access to basic rights and services and live in poverty.
This applies particularly to older women and widows who are often
discriminated against in issues of inheritance and land ownership,
in particular.
Africa and Asia are currently home to over 360
million people over the age of 60, many of whom live in rural
areas, with little or no social security provision and with a
declining support base in their families as migration, HIV/AIDS,
conflicts and other factors undermine the traditional support
systems. The over 60s represent the fastest growing age group
on both continents, especially among the over 80s (the oldest
old). Africa's older population is set to nearly double by 2015
and increase nearly five fold by 2050—this despite the impacts
of AIDS deaths. In countries such as South Africa and Botswana,
where HIV prevalence rates are among the highest in the world
(30% to 40% of 15-49 year olds), it is the period between now
and 2015—the date set for the achievement of the Millennium
Development Goals—which will likely see the highest number
of deaths in the middle generation. This will leave a larger proportion
of older people and very young children to make up the backbone
of families and communities dealing with the impacts of HIV/AIDS.
Furthermore, an ageing population is also predominantly a rural
and female population as older women outlive men across the globe.
3. The impact of HIV/AIDS on older women
and men
The AIDS epidemic is having profound effects
on families and communities leading to a dramatic rise in the
adult death rate and in the number of orphaned children. More
than 26 million people in sub-Saharan Africa and nearly 10 million
in Asia are living with HIV/AIDS. As a result 11 million children
under 15 in sub-Saharan Africa have lost one or both parents to
AIDS, accounting for 32% of all orphans world-wide.[144]
A much-neglected side effect of the epidemic is the devastating
and under-reported impacts it has had on older women and men over
the last decade. HIV/AIDS strikes at the heart of family and community
coping mechanisms for the old and young. Many older women and
men in Africa and Asia are facing the task of providing for themselves
as well as their sick adult children and orphaned grandchildren,
at a time when they themselves expected to be supported by these
same family members. A study undertaken by the World Health Organisation
on the impact of HIV/AIDS on older people in Zimbabwe found that
71.8% of caregivers were over the age of 60 and 74.2% were women.
[145]Older
people are taking on the multiple roles of caregivers, homemakers
and income earners whilst dealing with their own hardships and
losses at the hands of the epidemic, without adequate support
and resources to do so.
4. Growing numbers of children orphaned by
AIDS live with their grandparents
Even before their adult child has died, older
people are often the ones to take on the care and guardianship
of the grandchildren, who may be HIV positive themselves. Households
made up of older people and orphaned children are an ever more
common feature in AIDS affected countries in Africa and Asia.
Recent data collated by UNICEF shows that over 60% of orphans
and vulnerable children are living in grandparent headed households
in Namibia, South Africa and Zimbabwe, and over 50% in Botswana,
Malawi, and Tanzania. Furthermore, the overall percentage of orphans
living with their grandparents has increased from 44% in 1992
to 61% in 2002 with a relative drop in those living in the "other
relatives" category.[146]
(See figures 1 and 2 in Annex 1.) A large proportion of these
grandparent households are also female headed.
At a local scale these numbers can be even starker.
HelpAge International has been running a programme to support
older carers of orphans and vulnerable children in Tete Province,
Mozambique since 2001. The numbers of older carers and orphaned
children identified in the relevant project sites have increased
by 330% and 287% respectively over the first two years of the
project. This amounts to an average increase of 130 orphaned children
a month under the care of older people. Over 70% of the older
caregivers are women. All of them are poor and all of them struggle
to access support from Government and non-governmental HIV/AIDS
programmes.
Whether the international community acknowledges
it or not, older women and men are the ones who have risen to
the challenge of the orphan crisis. HelpAge International therefore
seeks to promote the needs and rights of older people and support
the crucial role older women and men are playing in the survival
of their families and communities. HAI programmes in countries
including Cambodia, Kenya, Mozambique, South Africa, Sudan, Thailand,
Uganda and Zimbabwe combine income generation and promotion with
support and advice to older carers of people living with AIDS
and orphans and vulnerable children. The core aim of this effort
is to ensure families and communities can stay together.
Much of the response to the "orphan crisis"
in the past has resulted in the development of orphanages and
childcare institutions. Not only is this not in the best interest
of the children whose development can be constricted by institutional
life, it is not in the best interest of the older people who may
be left without any family at all. In areas with high death rates
in the adult population, to remove the children into institutions
threatens the very sustainability of the communities themselves.
HelpAge International seeks to strengthen existing family and
community support structures, building on the reciprocal relations
between generations.
5. The consequences for older carers and
orphaned and vulnerable children
Evidence collected by HelpAge International
and the International HIV/AIDS Alliance from programmes and research
shows that households of orphaned and vulnerable children and
their older carers are facing increasing economic vulnerability,
lack of access to education and health services and significant
psycho-social and emotional trauma as a result of AIDS[147]
Economic vulnerability
Older headed households are on average often
poorer than households with younger adults and face more constraints
on their income earning capacity. Average household income for
older-headed households in some communities affected by AIDS in
Kenya was found to be a third of the minimum required household
expenditure in 2003. Research being undertaken by the World Bank
is showing that in some countries in Africa households of older
people and children are amongst the poorest of the poor[148]
The additional financial responsibilities for older people caring
for orphans come at a time when older people's capacity to earn
an income is severely compromised by their physical health, and
gender and age discrimination in employment opportunities. Older
people are also routinely excluded from obtaining the credit they
need to start a small business, because of age discrimination
and lack of assets to offer as security. Furthermore, of the countries
worst affected by HIV/AIDS only three in sub-Saharan Africa (Botswana,
South Africa and Namibia) have comprehensive social protection
measures for older people, in the form of a basic non-contributory
pension. The large majority of older people survive without any
sort of social security support.
All these factors severely undermine older people's
role as primary caregivers of orphaned children and limit their
contributions. Social protection measures, in the form of a low
level of income guarantee can go a long way to offset the additional
financial burden experienced by older carers of orphans and vulnerable
children. In South Africa, non-contributory pensions programmes
reach a large number of poor older people (1.9 million) at relatively
low cost (1.4% of GDP). It is a vital contribution to the household
economy, securing older people's basic needs and in households
with orphans, also paying for the children's school fees, clothes
or medicines. In parallel foster care and child support grants
are available for age-eligible co-resident children, alleviating
further some of the financial burden for grandparents and other
carers who take in orphans. These social protection measures are
vital if families affected by AIDS are to be supported through
the crisis they are facing. However, very often these entitlements
are difficult for older people and other marginalized groups to
access due to complicated administrative procedures and documentation
and lack of information made available. The international community
has been slow to respond and support Governments to establish
and finance these programmes and improve their delivery. If the
Millennium Development Goal to halve poverty by 2015 is to be
achieved, social protection programmes—and cash transfers
to poor households and those affected by AIDS in particular—have
to become a core part of the international response.
Reduced access to education
The economic strain placed on families of older
people and orphans means that older people are under pressure
to engage in income earning activities, and that children often
drop out of school to find work, or because the family cannot
afford the school fees. Even if older carers manage to secure
school fees, they are often unable to cover other essential items
such as uniforms, books and transport costs. As a result orphans
and vulnerable children are often unable to take up their right
to education, even where universal primary education policies
exist and are enforced.
Apart from the existing drive to ensure universal
primary education for all, a number of alternative schooling and
education programmes are being developed to take into account
the changing roles of children and older carers, time commitments
and financial constraints placed on these families. These include
flexible timetables adapted to suit working families and agricultural
seasons, and community, distance and home-based schools. In other
instances non-governmental organizations are working with schools
and older carers to ensure subsidised school fees, materials,
uniforms, and transport are available for orphans and vulnerable
children to enable them to be integrated into schools, and ease
the pressure on older-headed households. Illiteracy levels among
older adults are also very high in these countries and can be
problematic where older people are responsible for school aged
children and administering medicines and health care. Along with
increased commitment to basic education provision for children
adult education programmes that include basic literacy for older
people are urgently needed.
Health impacts
The increased stress on older headed households
who have lost adult children and are caring for OVCs has an impact
on the family's health and well being. Older people's poverty
manifests itself in poor quality housing and living conditions,
poor nutrition and health care. Families of older carers and orphaned
children find it difficult to access health services, especially
in rural areas, due to constraints related to costs of medical
care and transport. Even in countries like Zambia and Kenya where
exemption policies for those under five and over the age of 60
exist, these policies are often not implemented due to lack of
resources and discrimination against older people.
Community and home-based care support provided
by non-governmental, faith based and community organisations are
beginning to address some of the problems facing older headed
orphan households. However, more effort is need to ensure that
health policies that favour older people and young children are
developed and properly implemented. National governments, with
the support of international development institutions, should
provide accessible and appropriate health care services for older
people and vulnerable children, and should develop strong partnerships
with non-governmental organisations for scaling up the provision
of home-based care and community outreach programmes.
Psychosocial impacts
Exclusion is a major problem faced by older
people and orphans living with or related to People living with
AIDS. Social ties and traditional support mechanisms can be weakened
when ignorance and stigma marginalise a family affected by HIV/AIDS,
leaving them feeling ashamed, alone and isolated. Older parents
can suffer feelings of blame, shame and guilt for their children's
situation. They can experience frustration at not being able to
cure their children of a still poorly understood disease, and
the trauma of having to nurse them and see them die. This is further
exacerbated by the stress of bringing up the orphaned grandchildren,
who themselves suffer stigma and exclusion on economic and social
grounds.
The psycho-social effects of the impacts of
AIDS on older carers and orphans and vulnerable children is only
now being recognised and programmes of support are still fragmented
and lacking. Yet community forums and faith based organisations,
supported by non-governmental organisations are making efforts
to explore and implement processes of psychosocial support. These
include home visits and counselling support, community meetings,
theatre and dance activities, awareness raising and fighting stigma
on HIV/AIDS and end of life planning and memory processes. Policies
and programmes that support the psycho-social needs of orphaned
children and their older caregivers, and build on intergenerational
support and communication are urgently needed to strengthen the
resilience and coping mechanisms of these groups.
Exclusion from HIV programmes
Older people seldom have access to information
about HIV/AIDS. Prevention and awareness campaigns are almost
exclusively targeted at young people, and rarely reach out to
older age groups, either as carers or as a possible "at risk"
group. This leaves older people ill-informed about HIV/AIDS and
how it is spread, reducing their own risk perception and compromising
their ability to protect themselves and those in their care. The
emphasis in policy and programming on those infected with the
virus leaves unsupported those who are affected indirectly through
the illness of family or community members. Orphans and vulnerable
children and their older carers have not received the attention
or support commensurate with the size of the challenge facing
them.
Seeing the impact of HIV/AIDS on their communities,
many older people are keen to receive information about it in
order to protect their families and themselves. Older people's
roles as leaders and educators must be harnessed to support HIV/AIDS
education and prevention efforts.
6. International commitments and recommendations
to the UK Government
HelpAge International argues that unless the
impacts of the AIDS epidemic on the growing numbers of older women
and men are acknowledged, and older people's efforts to mitigate
against these are supported, the fight to combat AIDS and poverty
will not be won.
The Secretary of State for International Development
has acknowledged the role grandparents are playing in support
of millions of orphaned children. However, this has yet to translate
into policy prescriptions and programme interventions to support
these older caregivers and the children in their care. Furthermore,
the wider impacts of the AIDS epidemic on older people are still
largely ignored. Unless the United Nations Declaration of Commitment
on HIV/AIDS is realised in its entirety the battle against AIDS
will be lost. HelpAge International would like to draw attention
to the following commitments made by the UK Government and other
UN member states.
International Commitments made:
— The Declaration of Commitment on
HIV/AIDS signed at the United Nations General Assembly Special
Session (2001) commits member states to "ensure the development
and implementation of multi-sectoral national strategies that
address . . . gender and age-based dimensions of the epidemic"
and "strengthen family and community-based care". It
further commits governments to implement "national policies
and strategies . . . [that] provide a supportive environment for
orphans and girls and boys infected and affected by HIV/AIDS"
and "review the social and economic impact of HIV/AIDS at
all levels of society, especially on women and the elderly, particularly
in their role as caregivers."
— The Madrid International Plan of
Action on Ageing (2002) commits all UN member states to the "Review
the economic impact of HIV/AIDS on older persons, particularly
in their role as caregivers, as agreed in the Declaration of Commitment
on HIV/AIDS," and to "introduce policies to provide
support, health care and loans to older caregivers to assist them
in meeting the needs of children and grandchildren in accordance
with the Millennium Declaration."
— The Africa Union (AU) Policy Framework
and Plan of Action on Ageing (2002) commits AU member states to
"protect the rights and needs of older people affected by
HIV/AIDS and other epidemics, including the recognition that older
people . . . are the major providers of care for those who are
sick and for orphaned grandchildren."
— The Millennium Development Goals
(2000) commit UN member states to halving, by 2015, the number
of people living in extreme poverty and halting and reversing
the spread of HIV/AIDS.
The UK government has yet to fulfill its commitments
to these international agreements and to provide the much needed
support to orphans and vulnerable children and their caregivers
in countries tackling the HIV/AIDS epidemic. DFID must support
the inclusion of OVC and their older caregivers as a priority
issue in its HIV/AIDS strategy and Country Assistance Plans as
well as in Poverty Reduction Strategy Papers, which guide resource
allocations made by DFID Field Offices. The UK government must
also ensure that DFID support for national governments enables
them to implement the Declaration of Commitment in its entirety[149]
Based on the above evidence HelpAge International
therefore recommends that the UK government:
— Provide financial and technical backing
to AIDS affected countries to provide direct income support to
address the financial needs of older carers of orphans and vulnerable
children, including through social-protection schemes.
— Provide support and financial backing
for the development of innovative education programmes, including
support to governments to develop better access to schooling for
children and adult literacy in older headed households.
— Make sure that policies and programmes
designed to meet the health needs of families affected by HIV/AIDS
include older people and orphans and vulnerable children.
— Develop policies and programmes that
address the psychosocial needs of older carers and orphans and
vulnerable children including end-of-life planning methods, counseling
and awareness raising efforts.
— Provide older people with information
and training on HIV/AIDS and the rights of children and older
people, including the development of older people's roles as community
counselors and educators.
(A copy of the report by HelpAge International
and the International HIV/AIDS Alliance, entitled "Forgotten
Families: Older people as carers of orphans and vulnerable children"
(2003), was also submitted to the Committee.)
March 2004
Annex 1
UNICEF data on older headed orphan households[150]
Annex 2
CASE STUDIES
ACCESS TO
SOCIAL PROTECTION
IN SOUTH
AFRICA
Pauline, a widow of 87, lives in Memelodi Township,
Pretoria, South Africa. She lost her daughter to AIDS two years
ago who was the last of Pauline's four children to perish. Now,
bereft at losing her entire brood, Pauline has three young grandchildren,
aged seven to 13, to look after. "If the parents leave the
children you just carry on with it. You have no choice,"
she says. "I have cared for children all my life. I do the
cooking and the washing and the ironing and mending. If I stopped
I'd be paralysed. I need to keep active."
Pauline survives on a pension of 630 Rands (US$79)
a month, almost two thirds of which goes on rent, and a foster
care grant of a similar amount. "I spend every cent I have.
There is nothing to save." But this is a happy home. "We
love grandma because she is very patient telling us right from
wrong", says Fikile, her 13 year-old granddaughter. "I'd
love to play football with my granny, but she can't." says
Jabulani, Fikile's nine year old brother, seemingly amazed that
there are limits to her skills and stamina.
Pauline is supported by Tateni Home-Care Nursing
Services, a service of 42 volunteers who visit AIDS affected families
in the community, providing advice and care for the sick patients
and then helping the rest of the family and the orphans after
the parents have died. "Of the 180 AIDS affected families
we are working with, over a hundred are run by grandparents, usually
with only their pension for income" says Veronica Khosa,
founder of Tateni. Her volunteers helped Pauline care for her
daughter when she was ill and arrange for the funeral. They then
helped secure the foster care grant, find school uniforms and
negotiated with the local school to waive the 120 Rand annual
school fee for each of the children until the foster grant came
through. The volunteers bring food parcels and look after the
grandchildren when Pauline is ill.
As well as direct cash transfers to families
of older people and orphaned children, income promotion activities
can be an effective way of supplementing meagre household resources
and supporting the contributions of older carers and children
to their households.
COMMUNITY CREDIT
SCHEMES SUPPORT
OLDER PEOPLE
AND ORPHANED
CHILDREN IN
MOZAMBIQUE
A programme co-ordinated by HelpAge International
Mozambique supports credit committees run by older people and
community members in Tete Province, to support older carers and
young people—over 300, two-thirds of them women so far—to
earn an income and meet their basic needs. Funds have been used
to set up various small businesses, including trade in small animals,
used clothes, fresh-river fish, traditional beer making, and producing
local foodstuffs, such as tomatoes and green leaves. Some older
carers received skills training in basket making, pottery, knitting
and shoe making. The credit committee allocates funds to projects
that benefit the community. Interest on the funds is used to support
the older and most vulnerable community households. Most of the
older carers who received social assistance funds bought school
items for their orphaned children, basic food and clothes for
the household, paid hospital or treatment costs where needed,
or made visits to family members elsewhere.
Amina, aged about 65, has looked after seven
grandchildren since the death of her daughter and son-in-law from
AIDS. Amina explains what she did with the money from the credit
committee: "We bought flour in Tete to make bread, which
is the most popular food I sell. I dream of one day having a store,
but know that I must make profits to buy one in the future. Most
of my profits now go to buy food for the children."
Felix, 15 years old, is the only income earner
in a household of seven, in which he lives with five younger siblings
and 80-year-old great-uncle. Felix dropped out of school to earn
an income herding goats. He bought the goats with funds from the
credit committee. "We wanted to stay together after our parents
and grandparents died of AIDS. I want to go back to school, but
there is no money. I talk to my friends about not being bad, not
stealing things to get money. I must work hard to get a good life
and look after myself not to get the disease my mother and father
had."
OLDER PEOPLE
AT THE
CENTRE OF
HOME BASED
CARE PROGRAMMES
IN SOUTH
AFRICA
MUSA (the Muthande Society for the Aged) is
a well established community based service organisation for older
people in Durban. With a network of volunteers, health workers
and social workers, MUSA provides for the social, psychological,
and emotional needs of older people through local service centres
and outreach services. Since 1989 MUSA has run a Home Based Health
Care (HBHC) programme for older people who are housebound or neglected
by their families. It involves building the capacity of family
members or neighbours through training to reduce hostility against
the older person, and improving their understanding of ageing,
chronic disease, personal hygiene and caring.
It is this programme, which in the late 1990s
brought MUSA into the reality of AIDS. It was no longer a question
of training family members to look after the older people—rather
the older people needed support and training in caring for their
adult children who had returned home with the virus to be cared
for with their own children. MUSA equipped all staff with knowledge
of HIV prevention, transmission and treatment as well as counselling
skills and mainstreamed HIV/AIDS into the HBHC programme. The
volunteers undertake home visits in which they help with the basic
care needs of the patients, but also counsel and support the older
people and the young children, support the families in accessing
state welfare provisions such as the foster grants and child care
grants and basic documentation, support with school fees/items
for the children, collect food parcels and other vital items and
link households to local faith-based or community organisations
where they can seek support.
In parallel MUSA is running a programme targeting
traditional healers as important leaders in communities and as
providers of services, especially to older people, to educate
them on AIDS and encourage them to refer families affected by
AIDS to the local clinics. In turn staff at the local clinics
are sensitised to the role and contribution of traditional healers
to the lives of these families. An adult literacy programme, the
first of its kind in South Africa, is taught to older people in
their mother tongue to provide them with a basic level of functional
literacy (basic numeracy, literacy and English) in order to better
be able to care for themselves and their dependents and navigate
the complicated social welfare system.
OLDER PEOPLE
JOIN HIV PREVENTION
EFFORTS IN
CAMBODIA
Om Ean is 59 and the Chairperson of Older People's
Association in a village in Battambang Province, Cambodia. He
is also the deputy chief of the village, which consists of 1,361
people (252 families). HelpAge International has been working
with this and other Older People's Associations like it in Cambodia
to develop projects training HIV/AIDS older people as volunteers
to work in the village. They have received leaflets and information,
and have just selected four volunteers who are now waiting to
receive the HAI training. Ean has already worked with the village
chief to spread information on HIV/AIDS, both by broadcasting
public information and going door to door to talk to people. He
visits the house of families in the village where older people
are bringing up children orphaned by HIV/AIDS. Om Ean is very
clear about the potential role of older people. "I think
older people can contribute in providing information about HIV/AIDS.
Some older people from this and surrounding villages have already
had some training on TB, supported by HAI. If older people speak
about these things, people will listen to them more than they
will to younger people. There are some young people who don't
want to listen to these messages, but we have never really had
problems with teenagers' behaviour here. If I talk to them, they
listen."
OLDER CARER'S
CLUBS HELP
BREAK THE
SILENCE ON
HIV/AIDS IN VIETNAM
In Hanoi in May 2002, a group of older people
participated in a consultation on their role as carers and the
impact of HIV/AIDS on their lives. They found the experience so
useful that since then they have taken action for themselves.
With the help of the Vietnam Women's Union, the older women and
men established an older people's club in Thai Nguyen. At the
meetings, they can freely talk about their experiences and problems,
and can seek support from others in a similar situation. "People
in this group suffer the same pain and the same circumstances,
and we can sympathise with each other. Other people cannot—they
do not understand," says one older woman at the consultation
meeting. The change for these older people has been tremendous.
"This has been the best period in our lives for a long time.
We are so much healthier and happier now," says one of the
women members of the club. The local leaders are now planning
to start similar clubs in other villages.
142 Third report of the International Development Select
Committee HIV/AIDS: The impact on social and economic development
Volume I (Paras 29, 30 and 33) and Volume II (pp 113-118), House
of Commons, Session 2000-01. Back
143
The United Nations defines older people as those over the age
of 60. Back
144
AIDS Epidemic update 2003, UNAIDS, and Children on the
brink 2002 A joint report on orphan estimates and program strategies,
UNICEF and UNAIDS July 2002. Back
145
The impact of AIDS on older people in Africa: Zimbabwe Case
study, Ageing and Life Course Unit, Non-Communicable Disease
Prevention and Health Promotion, WHO, Geneva 2002. Back
146
Africa's Orphaned Generations, UNICEF, 2003. Back
147
Forgotten Families: Older people as carers of orphans and vulnerable
children, HelpAge International and the International HIV/AIDS
Alliance, UK 2003. Back
148
Living Conditions Among Older Persons, K Subbarao, Human
Development Network, Social Protection, Africa Region, The World
Bank (forthcoming 2004). Back
149
See Submission to the International Development Committee Evidence
Session on AIDS Orphans by the Working Group on Orphans and Vulnerable
Children, UK Consortium on Aids and International Development.
March 2004, Ev 93 Back
150
Global Overview of the Situation of Children Affected by HIV/AIDS-Roeland
Monasch, Team Leader, Monitoring and Evaluation, HIV/AIDS, UNICEF,
presentation at USAID OVC Technical Consultation, 3-5 November,
Washington DC 2003. Back
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