The orphan crisis in sub-Saharan Africa has reached desperate proportions. In a region racked with civil war, poverty, and diseases, 12.3 million children have lost one or both parents to AIDS, and orphan numbers are projected to rise to 18.4 million by 2010 (UNAIDS, UNICEF, & USAID, 2004). With 25 million people in the region living with AIDS, overall infection rates are more than 20 percent in seven countries and reach 38 percent in some areas (UNAIDS, 2004a). Although adult prevalence rates in the region appear to have stabilized (UNAIDS, 2004b), AIDS claimed 2.2 million lives, and 3 million people became infected in 2003 (UNAIDS, 2004a). The full impact of the AIDS pandemic hits the hardest in the lives of young children. Although only 10 percent of the world's population live in sub-Saharan Africa, nearly 80 percent of the world's AIDS orphans come from this area (UNICEF, 2003). Each orphaned child has a story and a life.
Although the orphan crisis has been building for more than a decade, the global response has been slow and unorganized. In 2001 Carol Bellamy (2001), executive director of UNICEF, labeled the world's collective response as "the conspiracy of silence." In late 2003 Stephen Lewis (2003), the UN Secretary-General's special envoy for HIV/ AIDS in Africa, expressed grave concerns about the lack of a comprehensive plan for orphans. Fortunately, there are emerging signs that the global community is mobilizing. As a significant step, in 2001 the UN General Assembly Special Session made specific commitments to address the orphan issue, leading to the identification of a model for orphan care: strengthening the capacity of families, mobilizing and strengthening community-based responses, ensuring access to essential services, strengthening government's role in protecting the children, and raising awareness. These core points, first articulated by the widely accepted document Children on the Brink, are to guide the development of national and international orphan care policies and programs (UNAIDS, UNICEF, & USAID, 2002).
Most recently there has emerged a dialogue on possible solutions for African orphans (see Bhargava & Bigombe, 2003; Foster, 2002; Nyambedha, Wandibba, & Aagaard-Hansen, 2003; Williamson, 2003). This article examines some of these beginning efforts and provides a close examination of international adoption as one small but plausible option. It must be clearly understood that adoption is not being discussed as the only or even a priority option; indeed, it must be a last resort for children whose needs cannot be met otherwise.
FAMILY, COMMUNITY, AND GOVERNMENT EFFORTS
The suffering of African orphans is relentless and huge in magnitude. Orphans are more deprived than their national peers of education, socialization, and nutrition (UNICEF, 2003). They face isolation, prejudice, crime, abuse, neglect, child labor, prostitution, exploitation, and HIV infection (UNICEF, 2003). Psychological effects include depression, guilt, fear, and possible long-term mental health problems (Foster, 2002). Orphans living in child-headed household are even more at risk (Foster, Makufa, Drew, & Kralovec, 1997; Roby & Cochran, in press).
In traditional African culture, there were "no orphans," as parentless children were cared for within kin systems (Foster, 2002). Throughout sub-Saharan Africa today, extended families are caring for more than 90 percent of orphaned children (UNICEF, 2003). However, with the death of so many adults, few can afford to support extra children (Bhargava & Bigombe, 2003), and those who take in orphans face worse poverty and challenges in meeting even basic needs (UNICEF, 2003). The once seemingly limitless network of extended family--that expanded through geographic areas and generations--is depleting because of migration, Westernization, demographic changes, and AIDS (Foster, 2000). Many families who take in orphans are headed by grandparents, siblings, or other relatives (UNICEF, 2003). In some cases grandmothers are caring for multiple orphans. One widowed grandmother in Kenya lamented:
In the past, people used to care for the orphans and loved them, but these days, they are so many, and many people died who could have assisted them, and therefore orphanhood is a common phenomenon, not strange. The few who are alive cannot support them. (Nyambedha et al., 2003, p. 306) With the added strains, families are less willing or able to take orphans, and some even take advantage of them (Crawley, 2001; Wax, 2003). In some cultures, unequal treatment of kin children is tolerated because of traditional lines of inheritance and socially accepted family roles (Rutayuga, 1992). UNICEF in Kenya found that some orphans were treated poorly, abused, forced to work, and discriminated against (Crawley). These unfortunate developments underscore the need to provide more support to kin and protection for children in kin care rather than dismissing their central importance.
Although strengthening the family remains the primary goal, community efforts have coalesced to provide support for orphans and other vulnerable children and families. Thousands of local organizations and informal groups help through small business efforts, rotating credit and loan groups, grain-loan programs, and self-help groups (Foster, 2002; Menting, 2000; UNAIDS et al., 2004). They also help by paying school fees, giving psychological support, food, and clothing (Foster, 2002); distributing donations; raising community crops to pay for school fees; and visiting vulnerable orphans (UNICEF, 2003). Often from faith-based or women's groups, these community-based organizations (CBOs) care for orphans with cultural sensitivity and relevancy, but little funding (Foster, 2002). Such was the efforts of a group of community activists we observed, organized under the pastor of their church to assist terminally ill mothers in rural Mozambique. Because the CBO had no funding, their assistance was limited to visiting and comforting the women, cleaning their huts and surrounding areas, washing the families' clothes, and caring for the children. Their plea to the government and international community was to assist them with the means to provide urgently needed food and medical care for the families and children (personal communication with Pastor J. Antonio, July 24, 2004, Maputo, Mozambique). Financially supporting and working alongside CBOs is essential, as it leads to community empowerment, program acceptance, access to caregivers, and better support of children (Foster, 2002; Sayson & Meya, 2001).
At national levels, some countries have hastened to establish national plans for orphan care. Malawi was the first to form a multisectoral policy on orphans, the "National Task Force on Orphans" (Smart, 2003), and Uganda's "Hope Never Runs Dry" provides guidance, resource allocation, and a framework for implementing programs at all levels of society (UNAIDS et al., 2004). Unfortunately, factors, including financial strains, the stigma of HIV/AIDS, and lack of orphan visibility, have slowed the policy development in other countries. At the end of 2003, six--only 15 percent of sub-Saharan African countries--had developed a national orphan care policy, and eight nations were actively formulating such plans (UNICEF, 2003). To best serve orphans, policies need to be integrated with health, education, and development programs, and must seek to protect children as well as offer essential services (UNAIDS et al., 2002). Besides cooperation within each country, collaboration is essential with other nations, nongovernment organizations (NGOs), and private, community, and donor groups to develop and deliver services for orphans (Smart; UNAIDS et al., 2002).
Multinational organizations, international agencies, and NGOs have also been involved in raising awareness and providing support. Publications and conferences conducted through the United Nations on orphans and AIDS issues raise awareness and encourage nations to act. Globally, $5 billion (US dollars) was raised for AIDS-related spending in 2003, although an estimated US$20 billion will be needed by 2007 for care and prevention (UNAIDS, 2004c). Continued and increased international support is critical, in the forms of financial and material resources, commitment, and awareness (UNICEF, 2003).
Ideally, CBOs should be assisted at the grassroots level (Bhargava & Bigombe, 2003; Sayson & Meya, 2001), by NGOs with specific child welfare missions. An example of such a CBO initiative for orphan care is found in the Action for Children (AFC) program in Uganda. Sponsored by Holt International, a U.S.-based child welfare agency, and implemented by Action for Children, a CBO in Kampala, Uganda, it provides family preservation services to more than 300 families and 1,500 children. The objectives of the program include housing, education for children, securing an income source, health and nutrition, participation in community life, psychosocial well-being, and opportunity for peer mentoring. AFC uses supportive family care, community child care counseling, grandparent action support, children's clubs, and micro-credit (Action for Children, 2003; personal communication, with J. Nyeko, president, Action for Children, Kampala, Uganda, and B. Dahl, African program director, Hok International Children's Services, Eugene, Oregon, November 6, 2004).
Some children in Uganda are less fortunate, as we found in 2002 that children were picked up from the streets of Kampala and housed in delinquency facilities until a more permanent solution could be found with the assistance of NGOs. Some governments are faced with the difficult decision to care for children in temporary makeshift or institutional settings. In Kenya, where 650,000 children have been orphaned by AIDS (UNAIDS et al., 2004), hundreds of orphans were rounded up from the streets and put into "social halls," underground spaces in which...