Southern Africa is the region worst affected by the global AIDS pandemic and also experiences very high levels of migration.
The two countries examined in this paper, Lesotho and Malawi, have estimated adult HIV prevalence rates of 31% and 16% respectively. Both also have long histories of labour migration, although migration patterns have changed significantly since the end of the apartheid regime in South Africa.
The co-existence of high levels of both HIV/AIDS and migrancy in Southern Africa is not entirely surprising. Not only does human mobility play a very significant role in the pandemic’s spread, but migration has been shown to make people particularly vulnerable to HIV infection. A third aspect of the relationship between HIV/AIDS and migration has thus far received much less attention, particularly in Southern Africa: namely, migration that takes place as a result of the pandemic. AIDS imposes heavy costs at a number of levels, not only for those directly infected, but also for their families and wider communities.
Coping strategies must be employed, and these sometimes involve the relocation of households or of individual household members.
Childr en are a key vulnerable group in relation to HIV/AIDS, being affected by the disease in a number of ways. Significant numbers contract HIV themselves, usually at birth or during lactation. Many more are orphaned. Already around 17% of children in Lesotho and Malawi have lost parents, about half of them to HIV/AIDS. Children are affected by HIV/AIDS long before they become orphans, however. Adults with AIDS suffer debilitating illness over a period of months or years, which often reduces household income, imposes medical costs and diminishes the capacity of the household to care for children. Children may be required to take on tasks usually performed by adults - domestic and agricultural work, wage earning and caring for the sick - as well as suffering AIDS-related stigma. Following the death of a parent or guardian, the difficulties children face often increase, with financial
hardship exacerbated by problems relating to inheritance and absence of childcare within the household.
At this, or any other, stage in the course of the disease, children may be required to undertake migration. The fact that extended families in Southern Africa are often dispersed across widely separated households means that many children move considerable distances to live with kin.
A children-focused approach was adopted in this study of Lesotho and Malawi in order to examine: (a) the forms of migration that young people affected by HIV/AIDS engage in; (b) the difficulties they face; (c) the coping strategies they employ and forms of support that are available to them; and (d) the ways in which they might be better supported.
Many children were found to engage in migration, both locally and over longer distances, of whom significant numbers were migrating in response to sickness or death that was likely to be HIV/AIDS related. In many cases migration that was not dir ectly related to AIDS was nonetheless an indirect outcome of sickness or death of family members. Longer distance AIDS-related migration was predominantly urban-torural and in several cases international. Many children engage in multiple moves. Sometimes multiple moves are circular as children move between the households of different family members over the course of a week or between institutions and extended families. The clustering of AIDS-afflictions among families and communities, and the cost of caring
for many children, complicates the migration strategies employed and often separates sibling groups.
In most cases, children affected by AIDS move to live with maternal grandparents. Others live with aunts, uncles, brothers, sisters and sometimes more distant relatives. A minority of AIDS-affected children enter institutions or resort to living on the streets because relatives lack the resources to offer sufficient care. The decision-makers in such situations may be children themselves, who employ migration as a coping strategy.
Three sets of considerations contribute to decisions as to where AIDS-affected children should live: who is responsible for the children; who is able to provide for their needs; and who might usefully employ their capacities. These considerations relate to both the characteristics and needs of individual households, and of children themselves. Children’s needs include shelter, economic support, schooling, supervision and psychosocial support. They are able to contribute to households by helping with domestic and agricultural work, earning wages and caring for the sick - a role that is in growing demand in families affected by HIV/AIDS. Children’s age and gender play significant roles in determining what are thought to be their specific needs and capacities.
Sometimes there are no households within the extended family that are willing and able to provide the care that children need or want. Such children may leave the extended family. Some marry young; others go away to work; some enter institutions and others resort to the streets.
The complex migration experiences of AIDS-affected young people create a range of difficulties related to children fitting into ‘new’ families and ‘new’ communities. When adoption of children into a household is through obligation, as is the case with AIDS orphans, young migrants are often treated differently, particularly if resources are scarce. Migrant children are sometimes given different foods to eat, not adequately provided with clothing, beaten and overworked. Even where foster parents are supportive, divisions may arise, as biological children may not want to share their resources, both financial and emotional,
with ‘new’ siblings. This is especially problematic if they are coming to terms with parental death and need extra attention.
Many children moving to a new home as a r esult of HIV/AIDS are expected to undertake more and different work from that which they are used to. They may perform domestic, agricultural or other productive work, or care for children or sick adults. Some young migrants are incorporated into households specifically as workers in payment for their keep. This changes their relationship with the household, as they are not an equal part of the new family. Other children are sent to engage in wage labour away from their households to support younger children. Children migrating from urban to rural environments find it particularly difficult to adapt to agricultural chores; principally herding in Lesotho and field work in Malawi.
Children moving over long distances need to develop new social contacts and many miss their friends. The trauma of losing a parent
makes integration more difficult and guardians noted that newcomers were often withdrawn and found it difficult to engage with other children. This is exacerbated for those children who have to learn new skills, as work and play are often inter-related. Further, the increasing association between orphanhood and AIDS, makes integration into community life difficult. This was particularly the case in Lesotho where AIDS is more recent and less widespread.
Many children drop out of school after migration, par ticularly those who return to live with rural grandparents. Others move to new schools, but find that they must follow a different curriculum, or even learn in a new language.
Children’s incorporation into new households, new communities and new schools needs to be facilitated, in part to reduce the extent to which they have to undertake repeated migrations. Since young AIDS migrants are supported mainly through the extended family, support needs to be channelled in ways that support the children themselves and the families that receive them. Policy makers should be more questioning of the roles that communities are able to play with respect to incoming children.
Empowering children: many of the difficulties children face could be overcome if they were more familiar with the place and people they were moving to. Discussing their migration preferences with those making the decisions would help to alleviate such problems. For many children, the only way out of a difficult household situation is to move to the streets.
Enabling households: children’s difficulties fitting into new homes are exacerbated by poverty. If the costs of caring for children, particularly school-related costs, were reduced, children would be more readily accepted into households. This would
enable them to stay with those relatives (e.g. grandparents) best able to meet their non-material needs. Furthermore, as most migrations are triggered by economic factors, reduced costs would diminish the need for multiple migrations.
Questioning communities: much policy concerned with AIDS in Southern Africa emphasises the role of the community. In
practice, communities had little involvement in caring for orphaned children. Instead the burden lay with extended family
households, sometimes located in other places. This points to the importance of family units as the appropriate level for targeted
interventions to assist children.