TARGETING FAMILIES AFFECTED BY HIV AND AIDS 35


rapid reduction in children’s nutritional status. The Community and House- hold Surveillance system from six southern African countries (C-SAFE and WFP, cited in Greenblott and Greenaway 2007) found that households with orphans were not more food secure than those without orphans, although this analysis did not take into account how many orphans were in a household. An earlier review by Rivers, Silvestre, and Mason (2004) found evidence that households caring for one orphan were less food insecure than households without orphans but that 40 percent of households with more than one orphan were food insecure, with child hunger. Several other datasets collected by inter- national NGOs also found that households with multiple orphans or those with orphans and other HIV and AIDS-affected children were more food insecure than households without orphans (Greenblott and Greenaway 2007). Hallman (2004) shows that, controlling for wealth and other factors, orphanhood con- fers an added risk of unsafe sexual behaviors. New evidence based on analysis of Demographic and Health Survey (DHS)


data from five countries (Stewart 2007), using sample sizes up to seven times larger than previous studies, found that orphans do not necessarily have poorer nutritional outcomes than nonorphans when age, sex, household wealth, and household demographics are controlled for. The main factor consistently and significantly affecting nutrition is wealth, and in some cases the relation- ship of orphans to the household head. The study did not find any pattern indicating that orphans were overrepresented in poorer households, but the evidence is again mixed. Within the poorest two quintiles, there is evidence of orphan disadvantage in Tanzania and Zambia, where orphans in blended households (those with orphans and nonorphans, where discrimination would be more expected) had greater evidence of stunting than did nonorphans. In Kenya, those in blended households had lower weight-for-age z-scores (WAZ) where they lived in grandparent-headed households, consistent with findings elsewhere that discrimination is affected by distance in kinship ties, where the de facto household heads may be aunts or uncles. Other findings further complicate the picture: nonorphans in blended households were better off than nonorphans in nonblended households, providing further evidence that fostering households may have greater capacity to care for children than households that do not take in children. These results are all for younger children who may be more easily assimilated than older children. Stewart (2007) notes that the probability of being an orphan and of suffering nutri- tional deficits that translate into anthropometric indexes increases with age. If children are more easily assimilated at earlier ages, one might expect more evidence of discrimination with respect to education, especially because school expenses may be high, older children are needed to work or care for the ill, and education may seem more expendable than food. The question of


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