Not only do children carry the emotional burden of watching a loved one suffer and die, but they also experience the trauma of the family unit collapsing, the stigma of AIDS associated to parental death, and a severe decrease in the family's economic power. Several focus group discussions and interviews held with orphaned children and community members from a rural area near Mutare, Zimbabwe, shed light on orphans' concerns, including feeling different from other children, stress, stigmatization, exploitation, schooling, lack of visits and neglect of support by relatives (Foster et al., 1997b). Frequently, a social and self-imposed silence reinforce the feelings of grief, loss, and failure, since it prevents children and adolescent carers to prepare themselves for the death of a loved one or to acknowledge that it will inevitably come no matter how much effort they put into their care (UNAIDS, 1999).
Other research conducted in sub-Saharan Africa found that AIDS orphans experience interruption in their education (Ankrah, 1993; Foster et al., 1997b) and more self-reported depression (Sengendo & Nambi, 1997) than children orphaned due to other reasons or children in intact families. Even though some studies only found a limited effect on school attendance by orphanhood (Kamali et al., 1996), most countries' current indicators show that, when resources are limited, orphans are the first ones to drop school. In rural areas of Zambia, 64 percent of orphans are not enrolled in formal school, compared with 48 percent of non-orphans (UNAIDS, 1999). An orphan enumeration survey of 570 households in and around Mutare, Zimbabwe in 1992 found that orphaned household-heads are likely to be older and less well-educated than non-orphan household heads (Foster et al., 1995).
Orphaned children experience extreme or increased poverty (Ntozi, 1997) and live in fear that they have the disease themselves. Many do. Oftentimes, all this results in abuse and overworked and underpaid employment of young children, as well as in school drop out and a related loss of future. To survive, many children become sex workers and, by so doing, expose themselves, once again, to risk.
Orphanhood has serious implications for child health. Frequently elderly and adolescent caregivers are uninformed about good nutritional practices, oral rehydratation, immunization and diagnosing serious illness and are unable to travel with infants to seek immunization or other health services (Foster, 1998).