Zimbabwe is a source, transit, and destination country for men, women, and children trafficked for the purposes of forced labor and sexual exploitation. Large scale migration of Zimbabweans to surrounding countries has increased – as they flee a progressively more desperate situation at home – and NGOs, international organizations, and governments in neighboring countries report that some of these Zimbabweans face human trafficking. Rural Zimbabwean men, women, and children are trafficked within the country to farms for agricultural labor and to cities for forced domestic labor and commercial sexual exploitation. NGOs believe internal trafficking increased during the year, largely due to the closure of schools, worsening political violence, and a faltering economy. In 2008, Zimbabwean security forces consolidated their control of mining in the Marange region, forcing members of the local population to mine for diamonds. Between the March 2008 presidential election and the June 2008 run-off, youth militias controlled by Robert Mugabe’s ZANU-PF political party abducted and held an unknown number of women and girls, particularly opposition supporters, in sexual and domestic servitude at command bases.
Zimbabwean women and children are trafficked for domestic servitude and sexual exploitation, including in brothels, along both sides of the country’s borders with Botswana, Mozambique, South Africa, and Zambia. Young men and boys are trafficked to South Africa for farm work, often being forced to labor for months in South Africa without pay before “employers” have them arrested and deported as illegal immigrants. Small numbers of Zimbabwean men are trafficked for work in Mozambique’s construction industry. Young women and girls are lured to South Africa and potentially other countries with false employment offers that result in involuntary domestic servitude or forced prostitution. Men, women, and children from the Democratic Republic of the Congo, Malawi, Mozambique, and Zambia are trafficked through Zimbabwe en route to South Africa.
The Government of Zimbabwe does not fully comply with the minimum standards for the elimination of trafficking and is not making significant efforts to do so. The government made minimal progress in combating trafficking in 2008, and members of its military and the former ruling party’s youth militias perpetrated acts of trafficking on local populations. The government’s anti-trafficking efforts were further weakened as it failed to address Zimbabwe’s economic and social problems during the reporting period, thus increasing the population’s vulnerability to trafficking within and outside of the country.
Recommendations for Zimbabwe: Cease the use by members of security forces of local populations for forced diamond mining; prosecute, convict, and punish trafficking offenders; advance comprehensive anti-trafficking legislation; formalize procedures for interviewing victims and transferring them to the care of NGOs; and launch a broad awareness-raising campaign that educates all levels of government officials, as well as the general public, on the nature of trafficking and the availability of assistance for victims.
The government did not provide any data on its anti-trafficking law enforcement efforts during the year, including any data on prosecutions and convictions of traffickers. Zimbabwe does not prohibit all forms of trafficking in persons, though existing statutes outlaw forced labor and numerous forms of sexual exploitation. Forced labor offenses are punishable by a fine or two years’ imprisonment, or both; these penalties are not sufficiently stringent or commensurate with those prescribed for other grave crimes. The government reported in 2007 that it was drafting comprehensive trafficking legislation; however, the draft was neither publicly available nor introduced in Parliament during the last year. Parliament was not sworn in until August 2008 following March elections; the newly elected parliamentarians have not yet formed the committees that review and propose legislation. The government failed to provide information on anti-trafficking law enforcement activities conducted during the reporting period. The Ministry of Justice reported that none of the cases investigated in 2007 was brought to trial during 2008. The government did not provide specialized anti-trafficking training for law enforcement officials.
The growing number of illegal migrants deported from South Africa and Botswana, combined with a crippling lack of resources, severely impeded the government’s ability to effectively identify victims of trafficking among returnees. The Department of Immigration required all deportees returning from South Africa via the Beitbridge border crossing to attend an IOM-led briefing on safe migration, which includes a discussion on human trafficking and IOM and NGO assistance services. The reception center’s social workers – who are employed by the Department of Social Welfare, but funded and trained by IOM – screened the deportees and referred them to NGO shelters; one trafficking victim was identified through this process in 2008. The District Council of Beitbridge employed one child protection officer and convened a child protection committee to coordinate programs and resources on issues relating to children. In May 2008, IOM opened a second reception center at the Plumtree border crossing for Zimbabweans deported from Botswana. Although the government has an established process for referring victims to international organizations and NGOs that provide shelter and other services, in 2008 the government primarily depended on these organizations to identify trafficking victims and alert the authorities. However, the Zimbabwe Republic Police’s Victim Friendly Unit referred three victims to IOM during the reporting period. The government generally encourages victims to assist in the prosecution of traffickers, but is not believed to have prosecuted trafficking offenses during the year. Likewise, the government did not inappropriately incarcerate or otherwise penalize victims for unlawful acts committed as a direct result of being trafficked. It could have offered foreign victims relief from deportation while they receive victim services and their cases are investigated, though there were no cases of victims receiving such relief in 2008. With the exception of deportees from South Africa and Botswana, the government’s law enforcement, immigration, and social services do not have a formal system for proactively identifying trafficking victims among vulnerable populations.
The government did not conduct anti-trafficking information or education campaigns during the reporting period, and there remained a general lack of understanding of human trafficking across government agencies, especially at the local level. Senior government officials occasionally spoke, however, about the dangers of trafficking and illegal migration, and the state-run media printed and aired warnings about false employment scams and exploitative labor conditions. During the year, all four government-controlled radio stations aired an IOM public service announcement eight times each day in five languages during peak migration periods. The inter-ministerial anti-trafficking task force took no concrete action during the year. Anecdotal reports indicated that the worsening economy reduced the demand for commercial sex acts, though there were no known government efforts to reduce the demand for forced labor or the demand for commercial sex acts. Information was unavailable regarding measures adopted by the government to ensure its nationals deployed to peacekeeping missions do not facilitate or engage in human trafficking. Zimbabwe has not ratified the 2000 UN TIP Protocol.
Tanya, 14, sometimes sits so still it seems that she’s in another world. Her frame is slight and fragile. But in her tattered black T-shirt and faded denim skirt, she appears worldly wise. She describes what she does to stay afloat in Zimbabwe’s tide of troubles.
Tanya:’Its better to die of AIDS than hunger’Long read: 6 minutes
Tanya, 14, sometimes sits so still it seems that she’s in another world. Her frame is slight and fragile. But in her tattered black T-shirt and faded denim skirt, she appears worldly wise. She describes what she does to stay afloat in Zimbabwe’s tide of troubles.
Andrew Kokotka ‘The streets of Harare are my home.’
Sitting in the shadow of a closed shop front, Tanya reaches for some morsels of bread on the floor beside her, always on the lookout for movements around her.
‘I was 10 when my parents died of AIDS-related diseases almost five years ago. First to die was my mother, who was buried in her rural home of Bindura. The death of my father – a soldier – followed. When my daddy died he had been struggling with diseases for about five years.
‘Soon after the death of my father I was evicted from the house where my parents lodged in Mbare [a densely populated suburb]. I went to stay with my grandmother who lives in Mabvuku [another high density area]. There were 10 of us children staying there and we had all been left by deceased relatives. Life was difficult because, being an old woman, my grandmother had no means of sustaining herself and all of us at the same time.’
The tears she has been holding back now burst forth. ‘When I was living there, I had to do all the routine household chores like sweeping the house, doing the dishes and the laundry, before bathing and going off to school. It was not long before I was forced to drop out of school because my grandmother could not afford it. Where do you think I could get money for school fees when there was no-one working in the whole house? But I have a dream: to go back to school and learn how to speak English – good English. I can already speak a little bit of English just to beg from white people.
‘Life is not easy on the streets. How can you talk to people who are hungry?’
This is Tanya’s indirect way of asking for money: ‘I have not eaten anything since yesterday morning… and I want money to take my “sister” to the hospital.’
Special guidelines used for this edition To protect the integrity of the children in this edition and their stories, we followed guidelines worked out beforehand by street children’s charities. All the children consented to talk with our reporters after being told where and how their stories would be published. Their views have been recorded without censorship. They have been able to withdraw from the project at any point and strike out things they decided not to share with a wider audience.
Names have been routinely changed. Photographs were taken with the active participation of the children. Where sexual exploitation was an important aspect of their testimony or where children were not comfortable being photographed, visual anonymity has been maintained.
Her ‘sister’ is another street child – Joyce – who sits beside her and listens to her every word. ‘She has not been well for some time. She has njovera [a Shona word for sexually transmitted infections (STI)].’
Joyce puts her finger on Tanya’s mouth to get her to shut up. Then Joyce says accusingly: ‘She is also suffering from njovera… Tanya tell the truth!’ The girls accuse each other of having an STI. It finally emerges that Joyce has the infection. Tanya explains how she got it. ‘The streets are full of people who want to hurt and use other people, especially those of us who are younger. So you have to be ready and you must always watch out for yourself. Men pick us up here – not just common men. Joyce was picked up by a man who was driving a Pajero.’
Joyce interjects: ‘The old business guy asked me to take a bath before he slept with me the entire night. The man did not use a condom, because he said that if he did he would only give me a few dollars.’
Tanya nods to show that Joyce is telling the truth and continues: ‘The guys usually ask us to bathe before we have sex with them. Sometimes they give us food… with luck some money as well. We are not doing this because we enjoy it. We know the risks involved but we are poor and hungry and there is not much else we can do.
‘Some sugar daddies [older men involved in relationships with young girls, sexually abusing them for money] are our clients because they have the money to give us. I know it sounds scary but just think of yourself in the same situation: what would you do if you were a street kid with the chance to make $20,000 [Zimbabwean dollars, about US$3] just for having sex with someone?
‘Even if they don’t use a condom, it’s not like I was ever going to make much out of my life anyway. I don’t see myself ever leaving these streets and having a better life, so I might as well do something that will help me to survive for the moment as tomorrow is another day.
‘I’m afraid to visit the hospital for HIV tests. But if I cannot have sex with these men, eventually I’ll die of hunger. It is better to die of AIDS than hunger.’
As she speaks her eyes show the telltale signs of a person who has had no decent sleep in a long time. Her eyelids look heavy and she explains that she spends most of her nights half-awake warding off potential bullies and rapists, while the days are spent rummaging through bins and rubbish heaps in search of edible scraps.
‘We hate cops. We’re not best of friends because they sometimes beat us up, accusing us of loitering and littering the city. My life is one of constant fear of being caught by the police and being returned to the “camps”.’
Tanya remembers vividly when she and her friends were picked up and beaten by the police and then dumped many kilometres from Harare. ‘The police bundled us up and left us for dead. We spent the entire night at the police camp. And some of the police officers forced us to sleep with them. They promised to free us if we complied with their demands, so I slept with one of the cops. Like anybody else I want to survive.
‘At home they call me Tanyaradzwa, but here on the streets I’m better known as Tanya. I’m a sister to many, a friend to a few, and a “wife” to some. We have been sleeping in this park for the past four years.’
I'm a sister to many, a friend to a few, and a 'wife' to some
The main entrance of the park is adorned with a billboard urging residents to keep the city clean and maintain its reputation as the ‘Sunshine city’. ‘There is nobody who can come and claim this place. This other boy [another street child] wanted to remove me from this place but I fought him off. For your information I’m a good fighter. I fear nobody, nobody!
‘We scavenge in the rubbish bins for food and beg for money. But the amount we get from begging is not enough. Sometimes people give, sometimes not. It is not good to beg. It makes me feel real bad inside. We’re sometimes hired for amounts ranging from Z$20,000 for a short time to Z$150,000 [$27] if you want our service for a whole night. We also earn money by working at a nightclub on Nelson Mandela Avenue that opens as early as 12 noon.
‘It is bad on the streets. Sometimes it is very cold and wet. We cannot eat properly. We often get sick. We eat junk food from the rubbish – what you call leftovers. We go through the bins when the shops close. You often get chips in the bins – sometimes a bit of old salad. But we go very, very hungry and we have no proper clothes to wear. If I can find someone who can assist me, I’ll go back to school. After school, then I want to find work. I don’t know what, anything good.
‘And when I have money, I will not forget all the people on the streets. Perhaps I’ll give them clothes to wear when it’s cold. Perhaps I’ll help them get food. I cannot ever forget the others on the streets because it is so bad.’
Tanya spoke to Stanley Karombo, a correspondent with Inter Press Service and Voice of America radio.
This first appeared in our award-winning magazine - to read more, subscribe from just £7
To help you understand the breadth of the problem, please read below.
The estimated number of street children in Zimbabwe is 12,000. They are the casualties of the country’s HIV/AIDS tragedy in addition to the economic and political turmoil. UNICEF reports that 34 per cent of adult Zimbabweans are HIV-positive. Life expectancy has dropped from 52 years in 1990 to a shocking 37 years. One million Zimbabwean children have already been orphaned as a result of AIDS-related deaths alone. Most of the estimated 300 people who die from AIDS-related illnesses each week are unable to afford treatment and are usually sent home to die after a brief and rarely helpful stay in hospital. (Zimbabwe has for the past four years experienced acute shortages of hard currency and essential imports, including medicines.)
With African traditions of communities caring for children eroding under such pressure, the orphans are often left struggling to care for their younger siblings. Street children face the constant threat of violence – often sexual. The Women’s Coalition of Zimbabwe reports that 19 per cent of all women in the country had been raped in their lifetime – a percentage that is bound to be higher for those living exposed on the streets. Boys are not immune.
The Government has adopted an ambitious National Plan of Action for orphaned and vulnerable children aimed at providing basic services for at least a quarter of the country’s orphans by the end of the year. The chances of success, however, may be judged by the Government’s track record in other areas.
March 29, 2004
Posted to the web March 29, 2004
REPORTS of organised human trafficking and smuggling gangs in Zimbabwe are
disturbing and call for swift action to nip it in the bud before the problem
gets deeply rooted.
Scores of foreigners, mostly Asians of Pakistan origin have been smuggled
into the country, where they perceive huge opportunities to engage in
Immigration officials and the police have managed to bust trafficking rings
involving nationals from Pakistan, Rwanda, Burundi and Somalia.
Evidence abounds in the country of the organised human trafficking rings
whose roots have been traced back to such countries as Pakistan.
One Pakistani arrested in Harare recently has allegedly confessed to have
paid US$500 to trafficking ring leaders after which he was taken to a lodge
in the capital city where he joined several others from Pakistan waiting to
get their papers "processed".Suspected Burundi and Somali human traffickers
have also been arrested for smuggling scores of foreigners into the country
using forged documents and charging their victims US$1 000. Some Congolese,
Ban-gladesh and Nigerian nationals are also under investigation.
Some of the illegal immigrants who have been caught in Zimbabwe were found
to be in transit to South Africa, where they believe it is easier to find
jobs and lead a better life.
Three Zimbabweans have been nabbed after being implicated in the racket for
processing fake work permits and travel documents of people that have been
smuggled into the country.
Human trafficking is probably the fastest growing area of crimes in the
world and the scourge, which is rampant in Europe, is now spreading fast in
Africa, eclipsing the more risky and now less lucrative drug trade.
The United Nations estimates that world-wide, gangs who are often one step
ahead of investigators, make US$7 billion annually from trafficking in
humans, and at least 700 000 people are smuggled from their home countries
But for the majority of the victims of human trafficking, promises of wealth
and better life often turn out to be modern-day slavery.
Young men and women are lured by agents who cash in on the dreams of the
poor to make it big in developed countries or African countries with
opportunities like Zimbabwe, South Africa and Botswana.
In Europe, the majority of the victims are women, who come from eastern
European countries such as Albania, Kosovo, Serbia, and Lithuania. However,
increasing numbers are also coming from Africa, Zimbabwe included.
According to the UN, women have been an easy target for the sex traffickers,
who make promises of well-paid jobs, marriage to well off gentlemen or an
artistic career in the art of exotic dancing, the preferred euphemism for
Once they get to their destination, they soon discover that they are in the
sex trade and their passports are confiscated. The women often work extra
hours to pay off debts and bills of expenses charged by the traffickers.
They are, in most instances reluctant to report the cases for fear of
In Europe, typical areas of work for victims of human trafficking include
domestic service, prostitution and forced labour in factories.
Russian trafficking victims working in the sex industry in Germany, for
example, reportedly earn US$7 500 monthly - of which the trafficker takes at
least US$7 000.
Zimbabwean immigration officials and the police said most of those arrested
without proper documents have been implicated in prostitution,
money-laundering and illegal foreign currency deals.
It has since emerged that foreigners are behind the mushrooming of brothels
in Harare's Avenues area, where strip-tease business has become popular with
Illegal immigrants from such countries like Burundi, Rwanda and Somalia have
entered Zimbabwe through border jumping or under the guise of refugees
running away from civil wars.
Their voyage can chill all but the most desperate. For example, 26 Somalis
recently entered the country at Chirundu border post using fishing boats.
Others risk their lives in squalid and airless truck containers for days
trying to reach their destinations.
While immigration authorities and the police maybe acting to clampdown on
the sophisticated criminal networks of the traffickers, landlords, whose
properties have been used by the traffickers as bases or hideouts are paid
handsomely in hard foreign currencies and will not inform the authorities.
The lure of the scarce foreign currency and profits made in the illicit
activities also make it very possible for traffickers to buy police and
immigration. This also makes the crackdown more difficult.
Despite such hindrances, the authorities should intensify the war against
the human trafficking sharks, whose activities are not only a threat to the
socio-economic system of the country, but also to national security.
However, stiffer sentences for human traffickers, such as lengthy jail
terms, should have a deterrent effect.
Back to Index
Journalists Denied UK Visas
Zimbabwe Standard (Harare)
March 28, 2004
Posted to the web March 29, 2004
IN an unprecedented move, British immigration authorities in Harare have
denied three senior Zimbabwean journalists business visas to the UK on
suspicion that they would not return upon arrival there, The Standard has
The journalists - who include a line editor from The Herald and two senior
editors from the Zimbabwe Independent and The Standard - were told by UK
visa officer Andrew Gerrad that he was not "satisfied" that they were
"genuinely seeking entry for the purpose and period as stated".
The journalists had been invited by British Airways as a routine trip to see
the current travel arrangements for Zimbabweans wanting to visit the UK. "I
have been to England on several occasions and I have never met such
treatment. It's unfair for them to say that I would desert my job and family
to go to UK," said one of the affected journalists.
The Zimbabwe National Editors' Forum (Zinef) said it was "appalled" by the
British embassy's decision to refuse visas for the three journalists.
"Although the three were invited separately, the embassy's entry clearance
office made gross generalisations about them that were both spurious and
prejudicial," said a statement from Zinef.
"No evidence whatsoever was supplied for the assumption that they would not
return to Zimbabwe. All three, to our knowledge, had every intention of
returning to this country. They have jobs and families here."
Efforts to contact the British Embassy for comment were fruitless.
From Africa Recovery, Vol.15 #3, October 2001, page 17
(Part of Special Feature: Protecting Africa's Children)
Malawi battles AIDS orphan nightmare
Communities struggle to provide care, with few resources
By Gumisai Mutume
In a rural district along the shores of Lake Malawi, Ms. Catherine Phiri leads thousands of volunteers in a desperate rearguard battle against HIV/AIDS: feeding orphans, providing homecare, counselling and encouraging people to get tested. For six years, they have worked without financing from outside the area, relying on contributions from fellow villagers in this poor part of the continent.
"We can only bring the kids together once a week for a meal," says Ms. Phiri, founder of the Salima AIDS Support Organization (SASO). "Apart from that, there is very little more we can do because we do not have the money. There is no funding at all for our orphan-care programme." Set up in 1994 in response to the rising number of HIV infections in Malawi, where an estimated one in seven adults lives with the virus, SASO reaches 58,000 households in Salima.
It was only last year that SASO, with its 2,650 volunteers, secured a grant of about $30,000 for its AIDS awareness programmes, but that runs out at the end of the year. "Government helps," Ms. Phiri told Africa Recovery. "But it does not have a dedicated fund for orphan care." After her husband died of an AIDS-related illness in 1990, she publicly declared her HIV-positive status and set up SASO.
There are hundreds of similar community organizations run by volunteers in Malawi, part of an extensive network coordinated through a national orphan-care task force established by the government in 1991. They have set up centres where children play, learn, are immunized and their health is monitored. Village committees assist children in desperate need, especially those looked after by elderly grandparents or parents who are very ill.
Mapopa N'Goma, one of nine siblings orphaned by AIDS, is now under the care of his grandmother in Kuanda, Malawi.
"The 'grandmother phenomenon' is the dominant orphan programme for the moment, I think, in much of east and southern Africa," says Mr. Stephen Lewis, UN special envoy for HIV/AIDS in Africa. "It is a legitimate extended family arrangement and the kids by and large are related to one another and they are happy in that sense."
"Where they have turned it over to the broader community, rather than a grandmother or part of the extended family, the arrangements are often make-shift and ad-hoc and the kids are struggling," says Mr. Lewis. Of increasing concern to development planners is what happens when the grandparents die and, suddenly, child-headed households dominate.
Many orphans, little money
No one knows exactly how many AIDS orphans there are in Malawi. Estimates put the total number of orphans at 850,000 to 1.2 million, rising to 2 million by the end of next year.
Resources are lacking to handle this growing orphan crisis. The government can only afford to allocate $250,000 for the gender ministry's social welfare department this year, notes Mr. Penston Kilembe, who is in charge of orphan care. "It's inadequate. We need much, much more money than that because we are talking about survival, growth and the development of these children." The government relies on the UN Children's Fund (UNICEF) for 80 per cent of its child-care programme budget.
More than 365,000 Malawians have died of AIDS since 1985, when the virus was first diagnosed in this country of 10.6 million. Life expectancy has plunged from 52 years in 1990 to about 39 last year. The Joint UN Programme on AIDS (UNAIDS) puts the adult infection rate in Malawi at 16 per cent.
The government acknowledges that its support "has been grossly inadequate and the condition of orphans is made worse by extreme poverty and the erosion of extended families." Malawi has, however, been praised for its humane and exemplary treatment of orphans despite the meagre resources.
UNICEF believes that political commitment is growing. President Bakili Muluzi is increasingly supportive of AIDS prevention and care programmes. In speeches, he frequently exhorts people to change their behaviour. He and his vice-president have both adopted AIDS orphans.
In 1992, Malawi became the first country in the region to develop guidelines for orphan care. These are being used as an example in neighbouring countries. They recommend that orphans be kept within their communities, and argue that government should be at the centre of national orphan-care activities.
But the government is losing many of its workers to AIDS. The health ministry estimates that by 2005 between 25 and 50 per cent of workers in urban areas will die of AIDS. While the rates of infection are higher in urban areas, the number of people infected is greater in the rural areas, where 85 per cent of the population lives. There, HIV/AIDS is presenting a daunting development challenge, diverting labour from farming into care provision, increasing food insecurity and threatening the survival of entire communities.
Breaking the poverty cycle
"Our biggest problem is poverty," says Mr. Kilembe. "At least 65 per cent of our people live below the poverty line. Many are unable to take on the responsibilities of extra children because they are already strained." Malawi's average annual per capita income is $200 -- less than half the $500 average for sub-Saharan Africa.
Many of Malawi's poor children are not in school because they cannot afford to go. In 1994 the government abolished tuition fees for primary education, leading to an increase in enrolment from 1.9 million to 3.2 million the following year. But for many, the road ends there. Only a fifth of primary school graduates make it into high school. The danger of a generation of uneducated adults is all too obvious to development planners.
Ms. Elizabeth Hughes, of UNICEF Malawi, says the main approach to orphan care should shift from vocational training to formal education. "When you go and speak to many of these children, they tell you what they really want is an opportunity to go to school," says Ms. Hughes. "We have to find a way of keeping them in school."
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The government of President Robert Mugabe continues to violate human rights without regard to protections in the country’s new constitution. An expected legislative framework and new or amended laws to improve human rights in line with the constitution has yet to materialize. Police violate basic rights, such as freedom of expression and assembly, using old laws that are inconsistent with the new constitution. Activists and human rights defenders, including lesbian, gay, bisexual, and transgender (LGBT) people, face police harassment. There has been no progress toward securing justice for human rights abuses and past political violence, including violence after the 2008 election.
Globally, between 2002 and 2013, there was a 58% reduction in the number of new HIV infections among children (under 15 years of age).1
However progress remains mixed, more than 240,000 children were infected with HIV during 2013 - around 700 new infections every day.2 In addition, millions more children every year are indirectly affected by the impact of the HIV epidemic on their families and communities.
There were 2.6 million children living with HIV around the world at the end of 2015 – the majority in Africa, where AIDS remains the leading cause of death among adolescents. Only 32% of children living with HIV were receiving antiretroviral treatment (ART).3 In 2013, 190,000 children died of AIDS-related illnesses.4
Regular HIV testing, treatment, monitoring and care for children living with HIV can enable them to live long and fulfilling lives. However, a lack of necessary investment and resources for adequate testing, paediatric antiretroviral drugs (ARVs) and prevention programmes mean children continue to suffer the consequences of the epidemic.
Why are children at risk of HIV?Mother-to-child transmission (MTCT)The majority of children living with HIV are infected via mother-to-child transmission, during pregnancy, childbirth or breastfeeding.
It is vital that children who were infected via mother-to-child transmission receive treatment to keep them healthy. Without antiretroviral treatment (ART), a third of children who are living with HIV will not reach their first birthday, and half will not reach their second birthday.5
With funding, trained staff and resources, new infections among many thousands of children could be avoided.
Sexual transmissionThere has been a global decrease in the number of young people who report having sex under the age of 15.6 However, girls under the age of 15 can still marry with their parents’ consent in 52 countries around the world.7 This and other cultural norms lead to children becoming sexually active at a young age, or being subjected to sexual violence.
The lower the age of first sex, the higher the lifetime risk of HIV infection. This is because early sexual debut is often associated with older partners, higher rates of coerced sex and lower levels of condom use.8
Children who inject drugsGlobal and national figures for the number of children under 15 who inject drugs are limited. This is despite studies reporting that some begin to inject drugs as young as age 10.9
Children who inject drugs are more likely to share needles and not access harm reduction services, due to age, making them more vulnerable to HIV infection.
Children who inject drugs are also more likely to be living on the street, orphaned, and out of school. Orphaned and vulnerable children are often marginalised in society, making it difficult to reach them with healthcare and HIV services.10
HIV infection in medical/healthcare settingsAlthough very rare today, HIV infection can occur in medical settings. For instance, through needles that have not been sterilised or through blood transfusions where infected blood is used.
It was reported in 2012 that over the past decade in Kyrgyzstan, 270 children have been infected with HIV in hospitals as a result of doctors not following universal precautions during medical procedures.11
Orphans and vulnerable childrenOne of the most devastating impacts of the HIV epidemic is the loss of whole generations of people in communities hardest hit by the epidemic. In this regard, it is often children who feel the greatest impact, with the loss of parents or older relatives.
An 'orphan' is defined by the United Nations as a child who has 'lost one or both parents'. Worldwide, it is estimated that 17.8 million children under 18 have been orphaned by AIDS, and that this will rise to 25 million by 2015. Around 15.1 million, or 85% of these children live in sub-Saharan Africa. In some countries which are badly affected by the epidemic, a large percentage of all orphaned children – for example 74% in Zimbabwe, and 63% in South Africa – are orphaned due to AIDS.12
HIV programmes focusing on orphans and vulnerable children (sometimes referred to as OVC) are a vital strategy for reducing vulnerability to HIV in children. These programmes focus on supporting carers of children, often older generations, keeping children in school, protecting their legal and human rights, and ensuring that their emotional needs are catered for.13
HIV prevention programmes for childrenPrevention of mother-to-child transmission (PMTCT)Preventing mother-to-child transmission (PMTCT) is one of the greatest HIV medical success stories. Administrating ARVs to mother and child keeps the mother healthy and greatly decreases the risk of passing HIV to the child.
Vertical transmission of HIV from mother to child can be virtually eliminated, as long as expectant mothers have access to PMTCT programmes. For many countries around the world, this is their most successful and important HIV prevention priority.
The 2013 World Health Organisation (WHO) guidelines for PMTCT of HIV state that countries must decide whether to offer all expectant mothers ART for life, regardless of their CD4 count after breastfeeding (option B+); or to offer ART during pregnancy and breastfeeding as a prophylaxis, and only continue ART after breastfeeding if their CD4 count drops below 500 (option B).14
Despite this medical knowledge, pregnant women's access to HIV testing and ARVs is lagging behind. During 2013, around 54% of pregnant women did not receive an HIV test, and were therefore unaware of their HIV status. Of those who did receive a test and were diagnosed positive, 7 out of 10 received the treatment for PMTCT. This helped avert 900,000 new HIV infections in children between 2009 and 2013.15
Breastfeeding is responsible for half of all HIV transmissions from mother-to-child. When formula feeding is not a viable option, women can greatly reduce the risk of transmitting HIV to their child if they exclusively breastfeed and are on treatment. However, only 49% of women continue to take antiretroviral drugs during the breastfeeding stage, compared to 62% of women during pregnancy and delivery, highlighting the urgent need for education about the importance of continuing treatment.16
Schooling and HIV educationChildren should be given age-appropriate, culturally relevant, scientifically accurate and non-judgmental education and information about sex, HIV, AIDS and relationships.
The inclusion of sex and HIV & AIDS education for young children is vital for tackling the stigma surrounding HIV, and to teach others the facts about HIV transmission.17 HIV-awareness programmes are important to encourage openness about HIV rather than silence.18
There are many ways to reach young people; including through social groups, the media, and peer outreach - not just at school.
In addition, all children living with HIV have the right to attend school, just as any other child does. Policies need to be in place to ensure a child living with HIV at school is not subjected to stigma and discrimination or bullying, and that their status is kept confidential.19
Child rightsChildren and adolescents are sharing an increasing burden of the global HIV epidemic. HIV prevention programmes can tackle this issue by ensuring children's rights within society are granted. This includes the right to education, contraception, involvement in HIV programmes, safety from violence, gender equality and a lack of stigma.20
Preventing child marriagesGlobally, around 11% of young girls are forced into marriage before the age of 15. This puts young girls at risk of HIV, as they may be unable to negotiate condom use, or prevent sexual violence. Early motherhood also risks a young girl who may not know her HIV status passing HIV to her baby.21 HIV prevention programmes need to reach young girls who are forced to marry early.
Family support for children living with HIVKinship structures are already strong in many African countries where children are most affected by HIV. As a result, families often provide a more long-term, stable form of care for a child who is living with HIV, or has been orphaned by AIDS, than an institution or care programme.22 It has been emphasised that taking children away from their families should be a last resort, as families are more likely to be a source of emotional support.23
Supporting a family holistically can be the best way to ensure a good quality of life for the child. This should include social protection schemes that provide external assistance to poorer families in areas where HIV prevalence is high. Such schemes are now seen as a valuable part of improving the lives of children affected by HIV.24
Financial support for children living with HIVReduced household income combined with increased expenses (for example for treatment, transport, funerals) can push families into poverty, which has negative outcomes for children in terms of nutrition, health status, education and emotional support. By reducing a household’s economic vulnerability, children benefit from better nutrition, the opportunity to go to school instead of work and better access to healthcare.25
A successful social protection measure is a cash or income transfer. These are cash disbursements to individuals or households identified as highly vulnerable. The number of these programmes doubled in Africa between 2000 and 2012, supporting US$10 billion worth of transfers during this period.26
To ensure that children are the focus of these transfers, some programmmes have conditions. For example, one programme in Ghana requires households to keep children in school, register with the National Insurance Scheme, and bring children to health facilities for regular check-ups.27
HIV testing for childrenThe 2013 WHO treatment guidelines state that infants born to women living with HIV should be tested for HIV within two months.28 However only 42% of infants were tested under these guidelines during 2013.29
It is essential that infants are then re-tested for HIV when they cease breastfeeding, because breastfeeding can be a route of HIV transmission from mother to baby.30 Many HIV-positive children in low and middle-income countries remain undiagnosed. For example, one estimate from Kenya suggests that only 40% of children with HIV are diagnosed.31
Although HIV testing in children at health facilities is recommended by WHO, it is not well implemented. Screening children for HIV at inpatients sites and nutrition clinics, alongside testing in the context of PMTCT programmes, provides the best opportunities for diagnosing HIV infections in children that might otherwise go undetected.32
Barriers to HIV testing for childrenInvestment into point-of-care technology needs expanding, to enable infants to be diagnosed at the clinic they attend, enabling them to start treatment as soon as possible.33 Starting treatment early has shown to have greater long-term health benefits.34
In many rural, inaccessible areas, HIV testing is simply unavailable. Healthcare professionals must use clinical diagnosis instead, to ascertain the child’s HIV-positive. Unfortunately this results in a lot of infections going undetected.35
Access to antiretroviral treatment for childrenWHO 2013 treatment guidelines state that all children below the age of five who are diagnosed with HIV should begin antiretroviral treatment (ART) immediately, regardless of CD4 count.
When this happens, the likelihood of death for a child living with HIV declines by 75%, but only if the child is given ART within its first 12 weeks of life.36 Nonetheless, 76% of children who could be benefiting from this therapy in low and middle-income countries are not receiving it.37
Children ideally need to be given drugs in the form of syrups or powders, due to the difficulty of swallowing a tablet. However, they are more expensive. As a result, carers often break adult tablets into smaller doses, running the risk that children are given too little or too much of the drug.38
Barriers to HIV prevention, treatment and care for childrenAntiretroviral treatment adherenceChildren have to take antiretroviral treatment (ART) on average 20 years longer than adults do, heightening adherence issues. As more children are growing older with HIV, the vastly inadequate services for older children are coming to light.
This includes the complexity of adhering to treatment whilst going through puberty when children want freedom not strict medical regimes, confusion around ARV regimes as they grow out of child treatments and into adult ones, and a lack of targeted services for age groups that do not fall strictly into ‘children’ or ‘adults’.39
Globally, around 80% of children are retained on treatment at 12 months - almost equal to the rate among adults.40
Loss to follow-upMany children simply stop turning up for healthcare check-ups to receive treatment. A study involving 13,611 children from low-income countries in Asia and Africa found that at 18 months after initiation of ART, 5.7% had died, 12.3% were lost to follow up, and 8.6% had transferred to other clinics. Loss to follow up was much greater in West Africa (21.8%) compared to Asia (4.1%).41
Children are more vulnerable to being lost to follow up than adults because they rely on their parents or caregivers to gain access to healthcare services.42 Some of the reasons children are lost to follow up include lack of caregiver contact information, stigma and counselling challenges, the burden on patients to return for results, and weak follow-up within clinics.43
Antiretroviral treatment costsAlthough the cost of first line therapy for children has reduced dramatically due to the availability of generic drugs, if a child develops drug resistance and needs to begin a second course of drugs, treatment becomes far more expensive.
WHO qualifies new antiretroviral drugs suitable for children regularly, but without access to cheap generic versions of them the majority of children living with HIV will not benefit.44 The incentive for pharmaceuticals to develop paediatric drugs is also diminishing as the number of infants born HIV-positive is declining rapidly.45
HIV disclosureMany caregivers delay telling a child about their status, because they are anxious about the child's wellbeing, are concerned about being blamed, and are worried about stigma from the community.
It is important for a healthcare worker or carer to disclose a child's status to them, to prevent the child feeling isolated and finding out their status accidentally, or in public. It is thought that disclosure gives a child greater mental stability and health.46
Psychosocial wellbeingMany children living with HIV experience tough life events that could affect their psychosocial wellbeing, such as losing caregivers to AIDS-related illness, stigma, shock about their status and not understanding the importance of adhering to treatment.
To mitigate these events, it is important to encourage children to have a positive outlook on life, which can be helped by making full use of services such as support groups.47
Childhood illnessesChildhood illnesses, such as mumps and chickenpox can affect all children, but since children living with HIV have weakened immune systems they may find that these illnesses are more frequent, last longer, and do not respond as well to treatment.
An estimated 74,000 children died from tuberculosis (TB) in 2012. However, this number is thought to be much higher as many countries only report HIV as the underlying cause of death, with tuberculosis as the contributory cause.48
The future of the HIV epidemic among childrenChildren are disproportionately affected by the HIV epidemic, and continue to be left behind in the provision of life saving antiretroviral treatment. Considering the success rates of providing a pregnant woman with ARVs to prevent mother-to-child transmission of HIV, it is unfortunate that not all pregnant women living with HIV are benefitting from these drugs.
Moreover, testing and treatment opportunities for children need to be scaled up to bring them in line with the adult population.
Alongside this, there needs to be greater access to the drugs that can prevent mother-to-child transmission, appropriate testing, efficient linkages to care and treatment, and support for the families and communities that provide the material, social, and emotional foundation for a child’s development.
Photo credit: ©AVERT by Corrie Wingate. Photos are used for illustrative purposes. They do not imply any health status or behaviour on the part of the people in the photo.
A 41-year-old South African man was arrested for human trafficking after being caught trying to smuggle 16 Zimbabwean children into South Africa on Thursday, SA police said.
Police stopped the Cape Town man in Mahikeng with 16 children, aged between 4 and 16, spokesperson Sergeant Karen Tredoux said in a statement.
Two of the girls and a boy managed to run away. The remaining 13 - five boys and eight girls - were taken to the Mahikeng police station.
Harare, June 23, 2012 ---An increasing number of Zimbabwean man and women are being lured into forced labour overseas and other African countries, a new United States government report says.
According to the recently released Trafficking in Persons Report 2012 compiled by the State Department, Zimbabwe is one of the countries that have done nothing to stem human trafficking.
“Zimbabwean women and men are lured into exploitative labour situations in Angola, Mozambique, the United Arab Emirates, Malaysia, Nigeria and South Africa with false offers of employment in agriculture, construction, information technology and hospitality, some subsequently become victims of forced labour or forced prostitution,” the report says.
Women and girls are also lured to China, Egypt, the United Kingdom and Canada under the false pretences where they are subjected to prostitution.”
The report adds that Zimbabwe is also a major destination for trafficked people from Bangladesh, Somalia, India, Pakistan, the Democratic Republic of Congo, Malawi, Mozambique and Zambia.
Some of the human trafficking syndicates use Zimbabwe to transport their victims to South Africa.
Those that stay in the country especially the Chinese end up being victims of forced labour
“Chinese nationals reportedly are forced to labour in restaurants and mines in Zimbabwe,” the report said.
“Women and children from border communities in neighbouring countries are trafficked to Zimbabwe for forced labour, including domestic servitude and prostitution.
Please see this YouTube video on A Zimbabwean Exodus - 12 July 2007
AT least 15 women are raped daily in the country, according to latest statistics supplied by the Zimbabwe National Statistics Office (ZimStat).
However, there are fears that the number could be higher as some cases go unreported.
The ZimStat report, titled Quarterly Digest of Statistics, says 2 195 cases of rape were reported in the first five months of the year. But it is in May where the statistics are gory, as 470 women were subjected to sexual assaults. This translates to 15 women being raped daily or an equivalent of one woman abused every 90 minutes.
Evince Mugumbate of the Women and Aids Support Network (WASN) said the high figures were testimony to the work women’s groups were doing in educating people on their rights and to report cases of abuse.
“Before, there was shame and stigma associated with reporting rape, but more women are more educated and are coming out to report,” she said.
“Women are now enlightened, educated and brave to report these cases.”
Mugumbate said it was a scary thought that women were being raped, but the statistics did not capture the whole picture as a number of cases went unreported.
The statistics reveal that in January, 427 women were raped, while in February 428 were abused.
In March, 425 women were abused, with the number rising to 445 the following month and peaking at 470 in May. However, this could be a slight improvement from 2011 figures, where a total of 5 449 cases were recorded — easily the highest figure compared to the two preceding years.
In 2010, 4 450 cases where reported while in 2009, 3 481 cases were recorded.
Mugumbate challenged the government to do more to look at the reason why the cases were high and what could be done to bring incidents of rape down. Also during the first five months of the year, 940 cases of indecent assault were recorded, as compared to 472 in the corresponding period in 2011.
A total of 1 610 cases of indecent assault were recorded in 2011, with 2 484 and 1 124 in 2010 and 2009 respectively. Anele Ndebele of the Matabeleland Aids Council said the statistics were a cause for concern as it invariably meant there was an increase in the transmission of HIV.
“You tend to believe that when rape takes place there is no protection and this may in turn lead to an increase in the rate of HIV transmission,” he said.