Dimensions of the emerging AIDS orphan crisis in Barbados Funded by the Jacques Parisot Foundation Fellowship Grant Alok Kumar, K R Kilaru, S Forde, I Waterman, G Kumari School of Clinical Medicine and Research, UWI Queen Elizabeth Hospital Ladymeade Reference Unit, Ministry of Health, Barbados.

Objectives: To examine the - level and trends of AIDS orphanhood, and differentials in AIDS orphan prevalence in Barbados.

Methods A retrospective descriptive study. Study period 1991 through 2005. LRU caters to the ambulatory medical care and follow up of all HIV infected people. Hospitalization and inpatient care for all PLWHA is provided at the QEH. Majority of deaths in the HIV infected persons are recorded at the QEH.

Methods Direct estimates of orphan prevalence by recording the children of all the adults who died of AIDS. Case notes for all deaths in PLWHA was reviewed to collect data on their children, supplemented by data collected from their next of kin.

Methods These data was collated by the information obtained from their LRU records. We analyzed the trends and age-patterns in orphan prevalence.

Results During the period 1991 through 2005, 976 (1.8% of the under-18 pop.) children lost either one or both parents 867 (1.6% of the under -18 pop.) lost their mother and 598 (1.1% of the under-18 pop.) lost their father.

Number of children orphaned by AIDS in Barbados during 1991 – 2005 AIDS Orphans Numbers Maternal orphans 867 (89) Paternal orphans 598 (61) Both maternal and paternal orphans 492 (50) Either maternal or paternal orphans 976

Profile of the 867 maternal AIDS orphans Number(%) Age at the time of maternal death < 5 105 (12.1) 5 – 9 204 (23.5) 10 – 14 276 (31.8) > 15 287 (33.1) Gender Females 411 (47.4) Males 456 (52.6)

Profile of the 867 maternal AIDS orphans HIV status at the time of maternal death HIV infected at the time of mothers death 39 (4.5) HIV non-infected at time of maternal death 79 (9.1) Unknown status (not tested) 749 (86.4) Children who have died since maternal death 22 (2.5) Death due to HIV infection 20 (2.3) Death due to other causes 2 (0.2)

Profile of the 187 maternal AIDS orphans who were < 18 years at the time of this report Nos. (%) Age at the time of this report < 5 48 (25.7) 5 – 9 63 (33.7) 10 - 14 76 (40.6) Gender Female 91 (48.7) Male 96 (51.3)

Health care status of 187 maternal AIDS orphans Nos. (%) HIV testing HIV tested prior to maternal death 58 (31.1) HIV tested after maternal death 37 (19.9) Never tested for HIV 82 (43.8) No information 11 (5.9) HIV status of the child HIV non-infected 84 (44.9) HIV infected 11 (5.5) Follow up of the 11 HIV infected orphans Adequate follow up 7 (63.6) None or inadequate follow up 4 (36.4)

Profile of the 187 maternal AIDS orphans who were < 18 years at the time of this report. Living arrangement With Father 29 (15.5) With grand parents 95 (50.8) With other relatives 38 (20.3) With mothers friends 10 (5.3) In public homes for children’s 4 (2.1) No information 11 (5.9)

Cumulative number of AIDS orphans in Barbados.

Summary To this date, nearly a thousand children have lost either or both parents to AIDS before their 18th birthday. Half of these children had lost both parents and nearly nine-tenth were maternal orphan.

Summary Over half of the maternal orphans were in the 5 – 15 age group at the time of their mother’s death. Nearly half of the maternal orphans who were less than 15 years at the time of this report were not tested for HIV. Half of all maternal orphans were being cared for by their grand parents.

Conclusions The burden of AIDS orphans is significant and continues to rise. The majority of them are being cared for by close relatives’ mostly maternal grandparents.