The term "Orphans and Vulnerable Children (OVC)" is used to describe all children who are judged to be vulnerable and at risk, including children affected by poverty, conflict and HIV/AIDS. The term has replaced terms such as "AIDS orphan", which can be misleading as it implies that children orphaned by AIDS are themselves HIV-positive.
15-million children orphaned by HIV/AIDS worldwide
12.3-million children orphaned by HIV/AIDS in sub-Saharan Africa (about 82% of global figure)
Source: 
UNICEF — Childhood under threat: the state of the world's children 2005
Traditionally the term "orphan" describes a child whose mother or both parents had died, but used in this way it tends to underestimate the total number of orphans or the impact of paternal death, especially within the context of the HIV/AIDS pandemic. Thus, a more useful definition of an orphan is: a child under the age of 18 (some organisations use 15 instead) that has lost either one or both parents. Specifically, orphans can be:
By 2003, 15-million children had been orphaned by HIV/AIDS worldwide. About 80% of these children live in Sub-Saharan Africa and an estimated 1,100,000 in South Africa. By 2010 over 18-million children in Sub-Saharan Africa will have lost one or both parents to HIV/AIDS and the number of double orphans will increase by about 2-million. In addition, millions of children live in households with sick and dying family members. Although not yet orphaned, these children are also severely affected by HIV/AIDS.
The scale of the OVC problem is masked by the time lag between HIV infection and death. Even if all HIV infections were to stop today, it's likely that the number of orphans would continue to rise for at least the next 10 years.
April 22, 2005 — Children are being forgotten in the eagerness to provide antiretroviral treatment to the thousands of people in need of the life-extending drugs.
This is according to Dr Haroon Saloojee of Wits University's Community Paediatrics Division who was speaking this week at the first "Priorities in AIDS Care and Treatment (PACT)" conference.
At best 3 000 children are on antiretroviral (ARV) drugs countrywide, whereas between 30 000 and 45 000 of the country's 230 000 HIV positive children needed the drugs, said Saloojee.
Saloojee, one of the respondents in the historic Constitutional Court case that led to Government being forced to provide Nevirapine to pregnant HIV positive women, said the most basic right, the right to life, was not being respected in this country.
"Even more so in the case of children who cannot toyi-toyi in the streets and do not elect politicians into parliament," he added. ... Read more
The extended family network that has traditionally existed in Africa and South Africa is finding itself increasingly under strain because of HIV/AIDS and poverty – capacity and resources are simply too overloaded to care for the sheer number of children orphaned or made vulnerable by AIDS.
The illness or death of a mother or caregiver can jeopardise a child's most basic needs, such as access to adequate health care, sanitation and nutrition. In a 2004 article in Development Update, Belinda Beresford writes about the particular challenges that lie in providing antiretrovirals for HIV-positive children at Coronation Hospital in Johannesburg. These challenges range from the much more complex process of providing ARVs for children as opposed to adults, to the lack of space in which to run the paediatric ARV clinic. Click here to read the full article.
The death of caregivers from AIDS can put children at risk of further discrimination and isolate them from a community because of the stigma associated with HIV/AIDS. Often the children themselves are perceived to be HIV-positive, which may not necessarily be the case.
Orphans and other children made vulnerable by HIV/AIDS are often exposed to violence, abuse and exploitation. Children, especially girls, that have to drop out of school to work or care for their families often engage in hazardous labour or are otherwise exploited.
The loss of a parent can deprive a child from a family environment which is crucial in the development of a positive self-identity and self-esteem. Because the burden of care and responsibility is likely to fall onto the children in the case of a sick parent or death, these children experience a loss of childhood – in other words, play, rest, and recreation, the opportunity to participate in community, religion, cultural activities and sport. Children who have lost one or more parent experience grief and loss that may not be adequately dealt with in an environment that lacks psychosocial support because of competing pressures.
There is a loss of income when caregivers become sick or die of AIDS. Often children have to forego education and instead assume the adult role of providing for their families. Further pressure can be exerted by increased health care costs and eventually funeral costs.
Under the Child Care Act No. 74 of 1983 and Social Assistance Act No. 59 of 1992 (now the Social Assistance Act No. 13 of 2004) there are two types of grants that are available to assist OVC, depending on eligibility.
South Africa has 2.2-million children on social grants, which does not reach all orphans but does reach a great number. The primary care giver of children under the age of 14, who qualifies in terms of an income-based test, is eligible for a Child Support Grant (CSG) of R190 per month. This is intended as a poverty alleviation grant.
The Foster Child Grant (FCG) provides assistance to the primary care giver of children formally placed in foster care. These children need to be considered "in need of care". There is no means test and the primary care giver receives R590 per month per fostered child up to the age of 18. The mechanisms for securing this grant are much more complex. A child has to be identified as formally "in need of care", thus it is rather aimed at child protection.
R190pm Child Support Grant in 2006.
R590pm Foster Child Grant in 2005.
Source: Budget Speech, 2005.
The FCG is often touted by both government and civil society as the key social security response for OVC. Yet, Meintjes et al. (2004) argue that many children orphaned and made vulnerable by HIV/AIDS are not necessarily formally "in need of care" and so cannot qualify for this grant, creating many inequities in the system. According to Meintjes et al., a much more appropriate response is to implement a universal CSG to all children up to the age of 18 and the removal of the means test. Although this may seem counter-intuitive in the light of the FCG being of a higher monetary value, the authors argue that the broader spread of the CSG would result in a greater net monetary transfer to households and neighbourhoods.
Orphans playing in the playground of Hillbrow Children's Home in Johannesburg where they live. Photo by Pirozzi for UNDPI/UNAIDS.
Yet in South Africa many orphans and children made vulnerable by HIV/AIDS, especially those in child-headed households, are unable to access the child support grant because they lack appropriate documentation. In order to access a grant, the following documentation is needed, amongst others:
Because of home births, or non-registration of births and circumstances exacerbated by the fragmentation of family structures caused by HIV/AIDS and poverty, many OVCs have great difficulty in obtaining these documents and as a result, are not eligible for the CSG. There are community-based efforts, for example the Thandanani Children's Foundation Campaign, "Your Right" (see story here) to alleviate this problem, but the current system still alienates many of these children.
7-million children receive the Child Support Grant in South Africa
Source: State of the Nation Address, 2006.
The feature film Nikiwe (2004) highlights to problem of access to social grants by following the story of three orphans in Limpopo province. (see trailer)
The proportion of child-headed households is small — less than 1 percent — but this figure vastly underestimates the scale of the problem. Though a parent may be formally the head of a household, if s/he is too sick, the burden of care and responsibility often falls to the oldest children. All of the abovementioned psychological, social, economic challenges will be further exacerbated in this case.
Children who have been orphaned by HIV/AIDS in a group home in Gdansk, Poland. Photo by Diez for UNDPI/WHO
In a news article dated 9 December 2004, UNICEF regional director Per Engebak had the following recommendations to improve the response to the OVC crisis:
Childhood under Threat: The state of the world's children 2005 At all Costs? Applying the means test for the Child Support Grant.
