Expanding the first line of defense : AIDS, orphans and community-centered orphan-care institutions in Sub-Saharan Africa : cases from Zambia

Abstract

This thesis is about expanding the "first line of defense" for children and families affected by AIDS in sub-Saharan Africa. The overwhelming consensus among actors leading the fight against AIDS, ranging from USAID and UNICEF to local NGOs, is that extended families and communities are the "first line of defense" and will absorb the millions of children orphaned by AIDS. With this basic premise, the thinking follows that 1) families are almost always the best place for the child; 2) primary interventions should be centered on building the capacities of families to care for orphans and; 3) residential orphan care is the least desirable option for children because "orphan care institutions" are inherently "anti-community". I challenge this prevailing wisdom. I argue that this donor-driven approach, loosely termed "community based orphan care", is limited by, among other things, AIDS induced pressures on families and growing numbers of children disconnected from families (e.g. street children). Additionally, the approach imposes a false dichotomy between "the community" and "orphan care institutions". Drawing from case studies of three residential institutions caring for orphans and street children in Zambia, I deconstruct the common perceptions of orphan-care institutions. In particular, I challenge the characterization that they are isolated and disconnected from communities. My findings reveal a more complicated picture in which a subset of orphan care institutions share objectives and practices with the prevailing donor model of community-based orphan care - such as mobilizing local volunteers to care for orphans. I describe this neglected subset as "community-centered orphan care institutions" and explore the various ways in which they are embedded in and support communities. I assert that as the AIDS epidemic expands and the orphan crisis worsens, community-centered orphan care institutions must serve as key actors in expanding the first line of defense.