34 CHAPTER 3


exposed to HIV, because different processes are at work in each case, the fact remains that poverty increases risk and that the poor are less resilient. In this light, interventions that target poverty can also reduce new cases of HIV and in turn reduce poverty. The question of whether orphans are more disadvantaged than non- orphans is the subject of a large body of research, but the answer is also far from straightforward. Some research shows that orphans are more vulnerable and disadvantaged, and other research shows that they are not. These find- ings are not necessarily contradictory but rather are contingent on variables such as the relationships between a child and caregivers, their poverty status, and the household’s demographics and structure. Ainsworth and Filmer’s (2006) review of 102 datasets from 51 countries found mixed results on whether fostering households were poorer or better off than households with- out orphans. In about two-thirds of the studies, paternal orphans were more likely to be in relatively poorer households, whereas maternal orphans were in poorer households in only about one-third of the countries.5 The results varied even more for double orphans; in 10 studies they were in poorer house- holds, whereas in 22 studies they were in relatively richer households. This latter result probably reflects the facts that some deceased parents were from better-off families and that richer households may be better able to care for orphans and thus end up taking more in. With respect to nutrition effects, orphans might be expected to be more malnourished than nonorphans because they came from households with very ill parents caught in the downward economic spiral described earlier or because their fostering households may discriminate against them. A number of studies have found that orphans are more food insecure and malnourished and less healthy than nonorphans (Ainsworth and Semali 2000; Lundberg and Over 2000; Gilborn et al. 2001; Deininger, Garcia, and Subbarao 2003; Rivers, Silvestre, and Mason 2004). To illustrate, a study in Tanzania interviewing 718 children in the early 1990s and again in 2004 found that children who lost their mother before age fifteen suffer a deficit of around 2 centimeters in final attained height and 1 year of final attained schooling and that the effect is causal. Another study in western Kenya of 1,190 children under age six (Lindblade et al. 2003), 7.9 percent of whom had lost one or both parents, found no difference in key health and nutrition indicators except in weight- for-height z-scores, particularly among paternal orphans and those orphaned more than one year. Mason, Musgrove, and Habicht (2003) found that drought in six southern African countries interacted with HIV/AIDS, contributing to a


5Paternal, maternal, and double orphans refer, respectively, to children whose fathers, mothers, or both are deceased.


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