The toll of HIV/AIDS on households is severe. Although no part of the population is unaffected by the disease, it is often the poorest who are most vulnerable to HIV/AIDS. The devastating affect of AIDS further impoverishes the poor. HIV/AIDS strips families of income-earners, and the families of those that die have to find money to pay for their funerals. Many of those who die leave behind spouses or partners who are themselves infected and in need of care, and children who struggle to survive without a parent. In many cases, the presence of AIDS means that entire households will dissolve as parents die and children are sent to live with relatives.

Households coping with an AIDS-infected member are often forced to reduce spending on necessities. The most likely expenses to be cut are food, clothing, electricity, and schooling. As the uniforms and school fees become unaffordable for the families and the child’s labor is required in the household, children (especially girls) are often removed from school. A nourishing diet goes a long way in sustaining health, yet people are often forced to cut their food spending. This undernourishment makes them more susceptible to illness and disease, accelerating the AIDS virus and leading to a rapid deterioration of health.

HIV primarily affects young adults, particularly women. If South Africa’s epidemic remains the same, the population structure will distort; there will be far fewer people in mid-adult years, and fewer women than men aged 30-50. The majority of households in South Africa are headed by women. These households are often significantly poorer than those headed by a man or those that have both parents.

Typically, half the people with HIV become infected before they are 25, developing AIDS and dying by the time they are 35, leaving behind a generation of children to be raised by grandparents or left on their own in child-headed households.

Impact on Children
As the number of adults dying from AIDS continues to rise, an increasing number of orphans will grow up without parental care. AIDS is generating orphans so quickly that family structures can no longer cope. Traditional safety nets of families and communities caring for their own, are unraveling as more young adults die of AIDS-related illnesses. Those providing care are typically already impoverished, often elderly, and have often depended financially and physically on the support of the very person who has died. Families and communities are struggling to fend for themselves, let alone take care of orphans.

Often both parents are HIV+. This has led to more children being orphaned by AIDS in Africa than anywhere else. Many children are raised by grandparents or are left on their own to run households. On top of that, HIV/AIDS is the leading cause of death in South Africa for children under the age of 5.

AIDS causes children to not only lose their parents or guardians, but it often causes them to lose their childhood as well. As parents or other family members become ill, children take on more responsibility to earn an income, produce food, work around the home, and care for family members. Many children are required to leave school in order to fulfill these responsibilities.

A decline in school enrollment is one of the most visible effects of the epidemic. This has a long-term effect on efforts of HIV prevention as, statistically, a basic education ranks among the most effective and cost-effective means of preventing HIV. The decline in school attendance is due to a combination of factors including:

• The removal of children from school to care for parents and family members
• An inability to afford school fees, uniforms, and other expenses
• AIDS-related infertility and a decline in birth rate, leading to fewer children
• More children are themselves infected and either do not live long enough to start school or do not survive the years of schooling

If a shortage of money requires a family to withhold a child from school, typically a female child is kept behind even if she is more intelligent. This stems from deep-seated cultural mindsets about the lesser value of women.

Impact on the Community
HIV/AIDS has dramatically affected the labor force in South Africa, setting back economic progress and development. The majority of people living with HIV/AIDS are between the ages of 15 and 49, in the prime of their working lives. Employers, schools, factories, and hospitals have to train other staff to replace those who become too ill to work. HIV/AIDS is already having a major affect on Africa’s economic development. This in turn affects Africa’s ability to cope with the epidemic.

HIV/AIDS strongly affects school teachers and the entire education sector. Teacher absenteeism is increased due to the disease. Teachers with sick families take time off to attend funerals or to care for sick or dying relatives. A high percentage of teachers are infected with HIV themselves, causing increasing periods of absence from teaching. When a teacher is ill, the class may be taken on by another teacher, combined with another class, or left untaught.

In much of sub-Saharan Africa, AIDS is erasing decades of progress in extending life expectancy. Life expectancy reflects the conditions in a community, but it also affects conditions in the community. Average life expectancy in sub-Saharan Africa is now 47 years; it would have been 62 years without AIDS. The average life expectancy in South Africa is projected to be only 36 years by 2010. By that same year the population of South Africa will actually have begun to shrink because of the number of people dying from AIDS.