An assessment of the prevalence of orphans and the magnitude of their problems and the extent to which HIV-1 is contributing to this was done in a rural population in South-West Uganda with an HIV-1 seroprevalence of 8% among adults. Slightly over 10% of children aged less than 15 years were reported to have lost one or both parents. Loss of the father alone (6.3%) was more common than loss of the mother alone (2.8%). Generally orphans were living with their surviving parent or other relatives but it was also noted in this study that some children with both parents alive lived with relatives as part of the extended family system. HIV-1 seroprevalence rates were higher among orphans than among non-orphans and were up to 6 times higher in the 0-4 year age group. Seropositivity rates were also higher among surviving parents of orphans than among parents of non-orphans. No significant difference in mortality between orphans and non-orphans was observed. During a 3-year follow-up period a total of 169 children became orphans and 43% of these cases resulted from the death of an HIV-1 positive parent. There was a limited effect on school attendance by orphanhood. The HIV-1 epidemic has substantially increased the number of orphans in this community, a finding which is probably typical of many other sub-Saharan African countries. It appears that these orphans were generally well looked after within the community. This coping capacity may, however become overstretched if the epidemic evolves further.
PIP: During 1989-90 the Medical Research Programme on AIDS enrolled 4975 children younger than 15 living in a cluster of 15 villages in rural Masaka district, southwest Uganda, into a 3-year prospective study. It examined the data to assess the magnitude of the problem of orphans and the extent to which HIV-1 is contributing to their problems. In this area, it is common for children with both parents alive to live with other relatives (e.g., grandparents) to help with domestic work. 518 (10.4%) children had lost 1 or both parents. These orphans were more likely to have lost a father alone than a mother alone (6.3% vs. 2.8%). 67 (13%) of the 518 orphans (i.e., 1% of all children) had lost both parents. Orphans 0-4 years old and surviving parents of orphans were more likely to be HIV-1 infected than their counterparts (5.6% vs. 0.9% for non-orphans 0-4 years old; p = 0.01 and 15.4% vs. 6.2% for parents of non-orphans; p 0.001). During the follow-up period, 83 parents of previous non-orphans died, leaving 169 orphans. 42.6% of the newly registered orphans had an HIV-1 positive parent. 98 deaths occurred among HIV-1 negative children (7 orphans, 91 non-orphans). No significant difference in mortality rates among HIV-1 negative children existed. Yet, in the 0-4 year old age group, orphans had a higher, but insignificantly so, 3-year mortality rate than non-orphans (22.1 vs. 15.6/1000 person-years). School attendance in the previous 6 months was slightly lower among orphans than non-orphans (75.5% vs. 83.6%) but the difference was insignificant (p = 0.3). Census data indicate that orphanhood has increased by at least 50% in the last 20 years, probably due to the AIDS epidemic. These findings suggest that the community tends to care well for orphans, but if the HIV/AIDS epidemic continues this coping mechanism may be become overly burdened.