38 CHAPTER 3


teen) living with an ill parent had lower school attendance rates than did double orphans and that the former group had declines in school attendance due to parental illness, while the latter reported increased attendance fol- lowing parental death. Adato et al. (2005) use qualitative research to focus on children before and after the death of parents, noting that orphaning in the context of HIV/AIDS is a process that begins long before the death of a parent. This involves the trauma and fear of imminent and—absent anti- retroviral drugs (ARVs)—inevitable death, and often new workloads and respon- sibilities, withdrawal from school, abandonment, migration, fear, family dis- solution, and stigma, the last of which may prevent parents and children from accessing resources that can strengthen the capacities of children to deal with these challenges. Another unique aspect of HIV/AIDS is multiple and serial deaths within households. All of this can contribute to the impacts on children, including their physical and mental health, and consequently their schooling attendance and performance. These unique disadvantages should be explicitly addressed, and cash transfers on their own will be an insufficient response. A focus on poverty status rather than orphan status does not neces- sarily need to apply to all interventions, such as, for example, mental health interventions that target children who are caring for or have lost parents or suffer from stigma. Haddad and Gillespie (2001), citing Parker, Singh, and Hattel (2000), suggest targeting for poverty but modifying interventions to meet the needs of HIV/AIDS survivors. It may never be possible to completely unravel this picture of relative disadvantage, mapping out all permutations. Even if we accept that orphans or children living with ill parents face unique challenges, and may be worse off than other children in some cases, the evidence of their disadvantage with respect to poverty, health, nutrition, and education is not strong enough, from an evidence and equity standpoint, to justify assisting only orphans. There is also the consideration of stigma—negative effects that can come from the government or other institutions publicly labeling a child an orphan. Meintjes and Giese (2006, 423) found that in South Africa, local notions of vulnerability and orphanhood correspond poorly with international defini- tions. Local notions have negative connotations, derived in part from local translations of the term, associated with abandonment and destitution. These local terms are “steeped in stigma,” and the authors argue that labeling a child an orphan is stigmatizing for the child and an insult to those providing care and support to the child. Furthermore, given the evidence that orphans’ disadvantage varies with factors such as poverty, demographic characteristics, household structure, and orphan–caretaker relations, targeting explicitly to respond to these varia- tions would be operationally and ethically infeasible at a community level.


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