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III. The Impact of HIV/AIDS

The global HIV/AIDS epidemic, which has claimed over twenty million lives including 3.1 million in 2004 alone, has had a devastating impact on children’s right to education. At the end of 2004, an estimated fourteen million children had lost one or both parents to HIV.  The overwhelming majority of these orphans were in sub-Saharan Africa. In addition, of the estimated 39.4 million people living with AIDS worldwide in 2004, 2.2 million of them were children under the age of fifteen. Some 640,000 children were newly infected with HIV in 2004 alone.⁴³ Girls are disproportionately affected, with HIV prevalence among girls four to seven times higher than among boys in many countries of eastern and southern Africa.⁴⁴

HIV/AIDS affects children’s right to education in numerous and overlapping ways. In some cases, overt discrimination against AIDS-affected children can directly impede both their access to formal schooling and the treatment they receive in the classroom. Such discrimination is often driven by ignorance on the part of parents, educators, and community members, and fueled by school systems and officials that fail to address the problem and ensure the inclusion of such children.

In India, where the government estimates that at least 5.1 million people, including hundreds of thousands of children, are living with HIV/AIDS, Human Rights Watch found that discrimination in education is common against children affected by HIV/AIDS.⁴⁵ Teachers and principals may separate these children from other students or deny them admission entirely; parents may threaten teachers that they will keep their children at home if other children suspected of having HIV are allowed into the school. Many teachers and parents still lack accurate information about HIV and believe that the virus can be transmitted through casual contact. The loss of a family wage earner to AIDS can also leave families unable to pay their children’s school fees.

Anu, a six-year old Indian girl whose parents had both died of AIDS, was sent home from kindergarten in 2003. Her teacher told her older sister to tell her “please not to come again to the school.” Her grandfather told Human Rights Watch, “The teacher didn’t allow her to come to school because she believes that Anu is HIV-positive. I believe that other parents were talking among themselves, so the teacher said she shouldn’t come.”

Even if allowed to attend school, many children affected by AIDS face discriminatory treatment. Another Indian girl, aged ten, was HIV-positive and had lost both of her parents to AIDS. She told Human Rights Watch:

When I went to school, I sat separately from the other children, in the last mat. I sat alone. The other children wanted to be with me, but the teacher would tell them not to play with me. She said, ‘This disease will spread to you also, so do not play with her.’

She stopped going to school in the fourth grade.

Social stigma also fuels discrimination against children affected by HIV/AIDS in Russia, home to one of the fastest-growing and potentially massive AIDS epidemics in the world.⁴⁶ HIV-positive mothers told Human Rights Watch that one of the biggest problems they face is finding a daycare center or kindergarten that will take their child. The director may be willing to take the child, but once other parents find out that an HIV-affected child is at the school, they put pressure on the school to have the child expelled. As a result, many parents go to great lengths to hide their own or their child’s diagnosis.

In part because of intense social pressures, up to 20 percent of children born to HIV-positive women in Russia are abandoned at birth. These children are often placed in specialized orphanages for HIV-positive children or warehoused in hospital wards with no stimulation or opportunity for education. One nationally recognized expert on the care of HIV-positive children told Human Rights Watch that as many as half of all children abandoned throughout Russia by HIV-positive mothers linger in hospitals indefinitely. Many of these children lie in barren rooms; their only contact with the outside world is a nurse in a mask and rubber gloves. The resulting psychological and developmental delays may mark the child for life. Even if eventually transferred to the Russian orphanage system, the child may be diagnosed as mentally disabled, deemed “ineducable” and transferred for life to psychoneurological internaty with little or no opportunity for education.⁴⁷  

Beyond discrimination, the combined effects of poverty and HIV/AIDS can lead many families to withdraw their children from school in order to supplement their family income. This is especially true in sub-Saharan Africa, home to the overwhelming majority of the world’s children orphaned by AIDS. In a study of heavily-AIDS affected communities in Zimbabwe, 48 percent of primary school-age orphans had dropped out of school, most often at the time of a parent’s illness or death.⁴⁸ One study in Kenya compared 5,200 children whose parents had died of AIDS with the same number of age-matched children who were orphaned by other causes. The AIDS orphans had significantly lower rates of school enrollment and retention than did other orphans.⁴⁹

Rose, age eighteen, described the combination of poverty and stigma that forced her and her siblings to withdraw from school after their mother became sick from HIV.⁵⁰ “When our mother was sick and couldn’t care for us, all of us had to drop out of school,” she said. “First we tried to stay in, but when we were irregular in attendance, we were caned [beaten by a teacher] for that.” Linda, an HIV-positive mother in Nairobi, said, “My children come home from school saying that the other children abused them because of my illness.”

Children who are pulled from school may be forced to work under hazardous conditions, to eke out a living in the street, or even to succumb to labor trafficking or forced military service. They may be deprived of clear and appropriate information about HIV transmission and safer sex, thus increasing their risk of HIV infection. A twenty-two-year-old Kenyan woman told Human Rights Watch that she became the head of her household at age seventeen when her mother died of AIDS:

I tried to do anything to keep us going—I made chapatis and sold them, I washed cars, and now I’m working for a woman with a small kiosk, but I don’t think it’s going to last.  The government should lend money to people so they can start a business and be self-reliant.  I may have to go into prostitution, and then I know I will get HIV and die.  I would rather have a real business, but it’s not easy.

In Togo, some experts observed a cycle of HIV infection whereby orphaned girls left school to work abroad as domestic workers, only to return home years later HIV-positive.  Many orphans were recruited by child traffickers and left abandoned in transit to their country of destination, leaving them at high risk of sexual violence and exploitation.  Trafficked girls who escaped their predicament sometimes found themselves living in the street or forced to sell sex to survive.

It is perhaps not surprising, given long-standing gender imbalances and discrimination in education, that girls are often the first to be withdrawn from school when families become impoverished by HIV/AIDS. In Zambia, where an estimated 16.5 percent of the adult population is living with HIV,⁵¹ school completion rates for girls were 10 to 15 percent lower than for boys in 2000.⁵² The costs of education often preclude poor families from educating all of their children, and when forced to choose between educating a boy or a girl, the girl is often the one who must drop out. When a parent falls ill, this bias is exacerbated, and it usually falls on girls to cut short their education and take care of the ailing parent and assume responsibility for the other siblings. Girls may also be pressured to drop out in order to provide additional income for the family when ill family members can no longer work.⁵³

In 2001, in Kenya’s heavily AIDS-affected Nyanza Province, girls made up only 6 percent of those who are promoted to grade five. In contrast, in Eastern Province, which had the lowest rate of HIV prevalence of Kenyan provinces, 42 percent of those passing into grade five during the same year were girls. Education officials attributed the disparities to the spread of HIV/AIDS and noted that twenty years previously, before the epidemic’s impact was felt, the numbers of boys and girls advancing to grade five were roughly equal.⁵⁴

Traditionally, orphans in sub-Saharan Africa have turned to their extended family for assistance with their basic needs. However, HIV/AIDS has placed unprecedented strains on the traditional extended family. AIDS-affected children who live with extended family members may experience discrimination in the allocation of scarce family resources, often due to the stigma associated with HIV/AIDS. Others may be sexually exploited or forced to work in prostitution by the very family members meant to be caring for them.  Particularly in countries with school fees, the cost of sending every child to school can be prohibitive, and distant relatives may be the first to be withdrawn.

Ensuring access to education for all children, especially girls, should be a central part of all countries’ response to HIV/AIDS. However, access to education is not enough. Children who attend school may still face sexual abuse by their teachers, which increases their risk of HIV. Many schools fail to provide young people with age-appropriate HIV/AIDS education, often because of moral qualms about sex and HIV transmission. The expansion of U.S.-funded “abstinence until marriage” programs, which have a record of censoring information about condoms, safer sex and the risk of HIV infection within marital relationships, leaves young people throughout the developing world without the tools and information they need to protect themselves from HIV.⁵⁵

As AIDS impoverishes more families and produces new generations of orphans, its impact on children’s right to education is only likely to intensify. By 2010, the number of orphans in Sub-Saharan Africa alone could reach twenty million.⁵⁶ An estimated 12 percent of all children in sub-Saharan Africa are already orphans, compared to 6.5 percent in Asia and 5 percent in Latin America and the Caribbean.⁵⁷ While piecemeal efforts exist to mitigate the worst effects of HIV/AIDS on children, these efforts are grossly incommensurate with the scale of the problem. Investing in children’s right to education is an important first step that would avoid the greater long-term costs of not educating children and leaving them vulnerable to a range of human rights abuses.

Recommendations

• Governments should enact and enforce laws proscribing all forms of discrimination based on real or perceived HIV status, including discrimination in access to education. Educate and sensitize teachers and school officials about the causes of HIV transmission, the importance of maintaining confidentiality about HIV status, and the harms to AIDS-affected children of denial of education.

• Governments should take steps to strengthen the ability of extended families to care for AIDS-affected children and provide them with formal schooling. Provide targeted educational subsidies and waivers of school fees to all children at risk of not enrolling or withdrawing from school because of inability to pay. Ensure that women caring for AIDS-affected children have access to adequate resources for child care and education, including by promoting their economic empowerment and equal access to family property.

• Governments should prosecute all forms of sexual violence against children, including violence in schools. Ensure that all rape survivors have access to timely post-exposure HIV prophylaxis.

• Governments should provide factual and comprehensive information about HIV prevention, including the causes of sexually transmitted HIV and methods of prevention, to all children.  Ensure that school curricula do not censor factual information about condoms and safer sex, and that school children are informed of the risk of sexual violence (including by teachers) and the risk of HIV transmission within marital relationships.  Ensure that children out of school have equal access to information about HIV prevention.

• Governments should address gender inequalities that lead girls to be withdrawn from school to support families affected by AIDS. Ensure that programs to combat child labor, particularly child prostitution and child domestic labor, have a clear HIV/AIDS component. Educate families and communities about the importance of keeping girls in school as a safeguard against HIV infection.