Emerging AIDS Orphan Crisis in Manipur

By Dr. L Ranbir / Dr. Ch Shyamsunder *

Manipur, a state in north-east India is having a burden of HIV epidemic. The epidemic which started among the IDUs around mid eighties has invaded many families through heterosexual and vertical transmission resulting in waves of sub-epidemics among women and children.

The sero-prevalence rate among the IDUs and ante-natal mothers were approximately 60% and 1.5% respectively during 1990s. As the epidemic progresses it has produced an orphan population leading to a serious orphan crisis and dislocation in the socio-economic fabric of the families in particular and the society at large.

The present prospective study was conducted to analyze the clinical profile of AIDS orphans and to as sess and analyze the impact of AIDS orphans on the socio-eco nomic structure of the families affected and to suggest remedial measures to address the problem of increasing AIDS orphans crisis.

During the study period from Jan 2001- March 2004, 112 AIDS orphans attending Children OPD and admitted in Pediatrics ward of RIMS Hospital Imphal were examined and their households (65 families) interviewed with regard to category of orphans, their age, sex, HIV status, stage of HIV disease (if infected), nutritional status, treatment received and outcome.

The category of fosterers of the AIDS orphans, total number of children in the households, mode of acquiring HIV by the parents.

AIDS related stigma and discrimination, income support of the family, care and support by the extended family system, community, NGOs and government organizations were recorded and analyzed.

Out of 112 orphans 72(64.3%) were HIV infected and 40(35.7%) were uninfected.

Clinically, out of 72 HIV infected orphans 14(19.4%) were rapid progressors, 46(63.9%) siow progressors and 8(11.1 %) long term survivors.

50(69.4%) infected orphans were in the 3-10 years group. Only 4 orphans could afford ART and the rest did not receive adequate treatment for HIV associated diseases because of financial constraints.

All the children had varying degrees of growth retardation;
56(77.8%) and 12(16.7%) children in the infected group suffered from grade III and grade IV malnutrition respectively.

36(32.1%) children were paternal orphans,26(23.2%) maternal and 50(44.6%) were double orphans.

56(86.1%) fathers were IDUs and 2(3.1%) mothers acquired HIV infection through blood transfusion. Of the categories of fosterers, 60(53.6%) were taken up by grandparents, 24(21.4%) by surviving mothers, 10(8.9%) by surviving fathers and 18(16.1%) by aunties/ uncles.

Financially, none of the surviving parents had any sustainable source of income and all of them depended on extended family support. Non orphan children who live in the fostering households also suffer from the same economic affect.

AIDS orphan is an emerging reality in Manipur. Paternal orphans constitute a significant proportion of the AIDS orphans in the study group although UNAIDS definition of AIDS orphan does not include paternal orphans.

The affected households get economic support from the strong traditional extended family system prevalent in Manipur. However, the disruption in the families and the economic drainage, first by the parents with HIV associated illnesses and then by the AIDS orphan crisis has caused irreparable damage to the socioeconomic fabric of the society.

There is little support from the community, state government and NGOs. There is no simple solution and no single organization can manage the huge problem of AIDS orphan crisis.

There is a need for the world community to unite and develop innovative approach to build community capac ity to address the problem of AIDS orphans.

From our experience we feel that pediatricians should play a pivotal role not only in the overall care, guidance and support of AIDS orphan and their fami lies but also provide proper linkage and coordination among the various state, national and international organizations and agen cies that will go a long away in the care of the affected children as a whole.