Table Of Contents:

1) Assessing the Magnitude and Perceived Impact of HIV/AIDS on the Sugar Sub-Sector: A Case Study of Western Kenya Elizabeth Bukusi

2) Emotional Care for AIDS-Orphaned Children in Kenya H. M. N. Kodero

3) The Challenges of Orphan Fosterage in the Era of HIV/AIDS in the North Rift Region, Kenya Joram N. Kareithi, Omar Egesah, Maurice Kong’ong’o

4) A Situational Analysis on Responses to HIV/AIDS Challenges in the Food, Beverages and Tobacco Manufacturing Sectors in Nairobi City, Kenya Philomena W. Muiruri

Abstract:
Assessing the Magnitude and Perceived Impact of HIV/AIDS on the Sugar Sub-Sector: A Case Study of Western Kenya Elizabeth Bukusi

Currently, HIV/AIDS is recognised as an epidemic with devastating effects on morbidity, mortality, health care and costs. The spread of HIV/AIDS is a major constraint to development in affected areas and needs to be given prominence in the development plans of governments and agencies. Unfortunately, the most
devastating effects of the HIV/AIDS epidemic have been concentrated in Sub-Saharan Africa - the region with the lowest access to health care and social and economic safety nets. Kenya, a sub-Saharan African country, rates among the world’s six countries with the highest number of infected and affected individuals. Even then, just like other developing countries, the country is faced with the problem of under reporting HIV/AIDS cases. The latest projections indicate that if HIV infection grows unabated (at about 9% per annum), a total of 2.9 million Kenyans would be HIV-positive by the year 2005; and the cumulative number of AIDS deaths will exceed 2 million. As such, the impact of HIV/AIDS on all sectors of the Kenyan economy is alarming, although some sectors, such as agriculture, are more vulnerable than others by virtue of their labour intensive requirements. It is estimated that the impact of HIV/AIDS in this sector will lower the value of agricultural production between 1.7% and 2.4% by 2010.

The sugar sub-sector is probably one of the most affected agricultural sectors due to its labour intensiveness and its location at the epicentre of HIV/AIDS in Kenya. Despite the intensity of the problem, the majority of studies on the HIV/AIDS epidemic in Kenya have tended to address other issues rather than the impact of this epidemic on the agricultural sector. Unfortunately, even the few that have tried to address the impact of HIV/AIDS on this sector have been rather general and have not made any attempt to tackle the intricate dynamics of the disease on the specific agricultural sub-sectors. This study, therefore, attempted to fill this apparent gap in knowledge by conducting an in-depth analysis of the perceived magnitude and impact of HIV/AIDS on the sugar subsector in Western Kenya. Specifically, the study aimed to: (a) determine the perceived magnitude of HIV/AIDS on the sugar sub-sector; (b) establish the perceived socio-economic impact of HIV/AIDS-related morbidity and mortality on the sugar sub-sector and; (c) evaluate intervention measures designed to cushion the sub-sector against impacts of HIV/AIDS.

To achieve these objectives, we used a triangulation of methods. In the collection of primary data, the study employed both quantitative and qualitative methods to capture the dynamics of the issues under investigation. The quantitative method used was interviews using a structured questionnaire.
Qualitative methods included: key informant interviews with departmental managers, clinical/medical officers and welfare association officials and; Focus Group Discussions (FGDs) that enabled discussants to deliberate on a wide range of issues under investigation. The discussions were conducted with company workers, household individuals and contracted farmers. Quantitative data was analysed using the Statistical Package for Social Science (SPSS).

Qualitative data was analysed by content and network analysis using ATLAS.ti computer software.
The perceived magnitude of the epidemic in the sugar companies was noted to be quite high. About 56% of the managers observed that HIV/AIDS cuts across all the cadres of workers, while about 92% of the workers interviewed had known a colleague at work who had been infected, or affected, by the disease. On average, each worker knew 10 colleagues who had died as a result of HIV/AIDS. When the workers were asked to rate the seriousness of the problem of the epidemic in their workplace, 64% rated it as very serious, while only 11% rated it as not. Farmers had experienced the problem of HIV/AIDS in their extended families. Those from Muhoroni (56%) are more likely to have experienced the problem than those from Chemilil (26%) or Mumias (40%). While 75% and 49% of the farmers in Muhoroni and Chemilil, respectively, rated the problem as very serious, 65% rated the same in Mumias. Most respondents were fully aware of the negative impact of HIV/AIDS on the sugar sub-sector. They demonstrated, with relatively high precision, the costs that are caused by HIV/AIDS - either direct, indirect or systemic. Some of the impacts mentioned by workers and farmers were: (a) the problem of orphans;
(b) draining of family resources through medication; c) interferences with farming activities due to inability to work, or participation in caring for the sick; (d) loss of farm management skills; (e) psychological trauma on the family; (f) long mourning periods, which slowed down farm activities. On their part, managers pointed out the following: (a) a rise in medical bills since the 1990s; (b) high levels of absenteeism due to sickness, or to enable a worker to take care of sick relatives; (c) working beyond normal hours by the factory workers; (d) loss of skilled labour; (e) psychological trauma due to high morbidity and mortality and; (f) increased costs of advertising and hiring new employees. Contrary to the farmers and workers who thought that the sugar companies were on the losing end due to the impact of HIV/AIDS, 72% of the managers opined that the epidemic has not yet had any impact on the productivity and profitability of the sugar companies. This may be because they still have escape routes from the problem, such as a large reservoir of workforce.

The sugarcane sub-sector in Western Kenya has employed policy and programme intervention measures to cushion itself from adverse effects of the HIV/AIDS epidemic. Some of the policy measures undertaken include: (a) a policy of equality that ensure services are provided to all employees, irrespective of HIV status; (b) no pre-employment HIV/AIDS testing; (c) postemployment testing only done at management level for insurance purposes (those found positive are denied insurance cover or covered at very high
premiums); (d) contracts are used to recruit labourers, instead of hiring on a permanent basis to reduce overhead costs; and (e) retrenchment of the sickly is undertaken in some sugar companies. The programmes for HIV prevention were pointed out as (a) creation of awareness through posters, pamphlets and peer educators; (b) distribution of condoms; and (c) HIV testing through VCT centres in nearby health institutions. The HIV care programmes that were pointed out were the provision of medication through health centres located at the sugar companies, the provision of referrals and the creation of welfare committees to assist families of clan members who die. Although none of the sugar companies had formulated a workplace AIDS policy, the theoretical policy interventions that are employed are in agreement with the international documents that require respect of the human rights of workers irrespective of their HIV/AIDS status. There is need for managers to pay more attention to the disease with a view to reducing further infections. A document on HIV/AIDS workplace policy detailing workers rights with regard to HIV/AIDS testing, medication and general care should be produced and disseminated.

Emotional Care for AIDS-Orphaned Children in Kenya H. M. N. Kodero

This causal-comparative study investigated the effects of residential destination, gender, and separation of siblings during adoption on emotional care for AIDSorphaned children. Participants were 600 orphans and their caregivers residing in extended families, guardians’ homes, and orphanages. Questionnaires were administered to the participants and a sub-sample of 30 orphans and their caregivers were interviewed. Both quantitative and qualitative data were collected and analyzed. Results showed that orphans living in orphanages enjoyed better emotional care than those staying in extended families and guardians’ homes; that female orphans received better emotional care; and that separated and non-separated siblings received comparable emotional care from their caregivers. The belief that extended families are providing quality care to orphans needs to be revisited.

The Challenges of Orphan Fosterage in the Era of HIV/AIDS in the North Rift Region, Kenya Joram N. Kareithi, Omar Egesah, Maurice Kong’ong’o

1. INTRODUCTION
1.1 Background
HIV/AIDS is no longer the mysterious and invisible disease it was and there is information on the devastation it has caused in families and communities all over the world. Consequently, the focus has been turned to the impact of the epidemic and particularly the care for the infected population. There are currently over one million orphans in Kenya (Waldehanna et al. 2005) and this number continues to rise annually as the epidemic takes a toll on the population. Yet there is no clear information on the plight of these orphans in terms of giving care. It is unclear how these affected children cope with the loss of parents, what channels exist to assist them, how the traditional extended family has coped with the challenge, and what the responses are at the community and family level on what appears to be a humanitarian crisis.
This study looks at the challenge of HIV/AIDS orphan fosterage in the North Rift region of the rift valley province of Kenya, using a socio-anthropological approach to fill the gap in knowledge and to contribute to practical solutions to the problem. Like in many other Kenyan societies, among the Kalenjin community that forms the bulk of the population in the region, the care for orphans is a moral obligation rather than an act of kindness. When parents die, therefore, it follows that members of the extended family take in the orphans. The upsurge of HIV/AIDS orphans is, however, eroding this important cultural virtue.

Reports have indicated that the poor and old relatives, rather than the well-to-do, care for many orphans (Saoke and Mutemi 1994). Within the poor households, orphans are resented for adding pressure onto already depleted family resources. As a result, they suffer differential treatment with regard to access to resources. Reports indicate that most orphans are deprived of education, parental care, nutrition, shelter, clothing, and the legal protection of their parents’ property (Orubuloye et al. 1995). However, in most of the developing countries, Kenya included, the lack of state- provided welfare services means that the orphans have to be taken care of by the extended family as well as the non-governmental institutions. In this kind of scenario how do foster families and the orphans cope?

The study, therefore, investigated the welfare and situation of orphans in the North Rift region of Kenya in the era of HIV/AIDS, and the extent to which foster families and local   organizations are trying to cope with the problem. The study has attempted to identify the challenges and to offer appropriate recommendations. In order to achieve this goal, the study triangulated different methods of data collection to collect both qualitative and quantitative data. The techniques include: focus group discussions, in-depth interviews, key-informant interviews, informal discussions, observation, documentary research, and a structured questionnaire. These methods were complementary to one another to produce a strong data set to address the issues and answer the research questions.

The study was guided by the Jaipur paradigm that explains the interaction between HIV/AIDS and society. The model is preferred because it focuses on the characteristics of a society that make it susceptible to an epidemic as well as the aspects that make an epidemic have a serious impact on the social and economic organisation of a society. It was, therefore, a useful guide in the analysis of the plight of HIV/AIDS orphans.
The study has contributed to better understand the institutional and cultural responses to the plight of orphans and to make practical recommendations for the strengthening of the existing arrangements. In addition, it has contributed to the academic understanding of socio-cultural transformations occurring as societies respond to the impacts of HIV/AIDS. 

1.2 Statement of the Problem
There is no doubt that AIDS has ceased to be regarded as the mysterious and invisible epidemic. By any account, nearly everyone must have shared the suffering of witnessing dying relatives, neighbours, work-mates or acquaintances. However, the problem of children orphaned by AIDS has come to represent a more tragic manifestation of the pandemic, not only in Africa but the world over. The tragedy has reached such a proportion that HIV/AIDS orphans have been included among the children now referred to by UNICEF as Children in Need of Special Protection (CNSP), or Children in Especially Difficult Circumstances (CEDC). This category also includes children endangered by armed conflicts and other disasters, those exploited through child labour, those who live in the streets, and those who are victims of abuse and neglect (Government of Kenya/UNICEF 1999, 53).

In Africa, the extended family system remains the most viable institution to deal with the challenge of AIDS orphans, given the poor development of state welfare services. However, with a few exceptions (Saoke and Mutemi 1994), the daily reality and experiences of AIDS orphans in Kenya and the challenges foster families face remain unclear. In addition, although the extended family has effectively dealt with the problem of orphans under different circumstances, AIDS orphans, especially because of the magnitude of the problem and the association of the disease with ‘symbolic dangers’, stigma, and morality, pose special challenges to the extended family system. There is a need to understand how the extended family has tried to cope with this problem.
The devastating effects of HIV/AIDS-orphanhood have psychological, social as well as physical dimensions. The effects HIV/AIDS has on children are grim. UNICEF has pointed out that these are manifested by '… a deserted hut collapsing here, a plot overgrown and uncultivated there, a lonely group of children shivering under a cotton cloth at night, a T.B patient praying for a peaceful night’ (UNICEF 1990, 2).  Statistics have shown that the problem of HIV/AIDS mortality is highest in sub-Saharan Africa. Mukwaya (1999, 17) reports that, of the 14 million people worldwide who have died of AIDS, more than 11 million have been Africans, a quarter of them being children.

The problem of orphans is acute particularly because those dying are in the prime of their lives (UNICEF 1999, 2). Statistics or material deprivation alone can hardly adequately capture the grief and tragedy of orphans. Although studies typically focus on material needs as an important aspect in the welfare of children, their predicament is compounded by the stigma they suffer through association with HIV/AIDS, which affects their socialization. The stigma stifles their social interaction and ultimately affects their learning of social skills, which affects them in adulthood. UNICEF has documented the societal prejudice towards orphans in this era of HIV/AIDS. The insecurity brought upon them by loss of parents and the struggle they undergo in the absence of services and support systems in already impoverished communities are some of the most important obstacles that they have to contend with (UNICEF 1999, 3). 

This study, therefore, examines the situation of orphans from the point of view of the orphans, foster families, the wider society and the institutions that deal with the problem. The aim is to use socio-anthropological insights to have a broader, yet in-depth, understanding of the problem in order to identify obstacles and provide appropriate recommendations to tackle the challenges.
1.3 Objectives of the Study
The overall objective of the study is to identify and assess the challenge posed by orphans to foster families and institutions and how they deal with them. Specifically, the study aims:
1)     to describe the socio-cultural and economic situation of orphans;
2)     to examine the impact of orphan hood on the welfare of children; and
3)     to identify the nature and kinds of challenges families/institutions which foster orphans face and the implication on the welfare of the children.
1.4 Research Questions
1)     What social and cultural problems do orphans face within the immediate foster family/ institution and in the wider society?
2)     What economic problems do orphans face?
3)     What kinds of challenges do families/institutions that foster families face and how does this impact on the welfare of the children under their care?

1.5 Significance of the Study
Studies on HIV/AIDS in Africa have tended to concentrate on behavioural aspects, transmission issues, AIDS progression rates, and patient care. Few studies have published findings on orphan care and especially the challenges the foster families and institutions face (Ntozi and Mukiza-Kapere 1995). This is in spite of the fact that, more than ever, the problem of AIDS orphans is becoming more and more acute as AIDS mortality continues to increase. This study, therefore, brings into focus the nature and the extent of the problems faced by foster families and institutions in their attempts to provide care to orphans.  In addition, the AIDS pandemic has led to the proliferation of a number of NGOs seeking to address the problem through the provision of material support to those affected and the infected through home-based care or through orphanages. It is, therefore, imperative to find out the effectiveness of the institutions the NGOs have set up to address the problems of orphans, and to make recommendations on how they can improve on their services.

1.6 Conceptual Framework 
The success of fosterage of orphans depends on the ability of the foster family or foster institution to adequately take over the role of parents. Parental roles are universally institutionalized and serve to prepare a child for participation in the other institutions of society. When these roles are not fulfilled, the child’s normal development as well as his/her ability to play adult roles in future is negatively affected.
When biological parents bring up a child, they play five important roles (Goody 1971, 331). These are:
 i)     Genitor/genetrix;
ii)     Source of status identity;
iii)     Nurse;
iv)     Tutor in moral and technical skills; and
v)     Sponsor in the assumption of adult roles 
Some of these roles become significant at different stages of the child’s development while others last a life time, but they are universally carried out in a family or a family-like context. Since the fulfillment of these roles is important for the perpetuation of the whole society, societies have evolved mechanisms and organizations to play these roles where the biological parents (true parents) are not in a position to effectively fulfill them. This can occur in two different circumstances.

The first circumstance is where a child’s natural parents are dead. This situation necessitates the voluntary or involuntary substitution of the whole set of parental roles by fictive parents as a moral obligation to the orphan by the next of kin. This is expected to apply in the case of HIV/AIDS orphans. The demands on the foster family by the orphans depend on the age of the child, which determines the roles they should play, and the duration. For the older children the demand may be less, as the primary task is educational, i.e. to train the youth in adult role skills and values of the society. Indeed, the relationship is reciprocal in the sense that the youth is expected to render economic assistance to the foster family. In difficult economic circumstances foster families will easily take in older orphans than the younger ones. The very young children are more demanding as they require rearing (nurturant fosterage); they do not provide economic services, and they need a longer period before they assume adult roles. It is expected that potential foster families will be more reluctant to take in the very young.  

The second circumstance is in cases where some element(s) of the total parental roles are split off and re-assigned to fictive parents without dissolving the links between true parents and the child. In this situation fosterage is largely voluntary and depends on the resources of the foster families. Unlike in the case of involuntary fosterage, in this situation the foster families are economically strong and the parental roles are shared between the true parents and the foster parents. The economic situation of the natal family, the physical health of the parents, or divorce may necessitate this. The aim is to provide the child with the resources and sometimes the positions that are necessary for the normal development of the child or for his or her assumption of adult roles.

In the context of African societies in general and Kenyan societies in particular the practice of voluntary or involuntary fosterage is embedded in the custom of dispersed child-care systems under which rearing of children, including disciplining and protecting is considered the responsibility of all adults in the community and is not confined to the biological parents alone (Kong’ong’o and Kareithi 2000). Kinsmen in particular have joint claims on one another’s children; this, in practical terms, is manifested in the obligations they have towards the welfare of children in their lineage. These principles are expected to apply in the case of HIV/AIDS orphans and will be the guiding factors in this study.

1.7 An Explanatory Model
The Jaipur Paradigm has been used to illustrate the interaction between HIV/AIDS and societies in Africa (see Fourie and Shonteich 2001, 30-32). The main premise of the model is that in relation to HIV/AIDS, societies are distinct in two parameters distributed on a continuum of susceptibility and vulnerability.

Susceptibility refers to characteristics/ aspects of a society which make it more or less likely that an epidemic will develop. Vulnerability, on the other hand, refers to characteristics of society that make it more or less likely for an epidemic to have serious impacts on the social and economic organisations of that society.

In this model there are two factors that regulate the level of susceptibility and vulnerability of a society. These are the level and distribution of wealth and income, and the degree of social cohesion in a society. It is expected that in a situation of poverty an epidemic will be more likely to have serious impacts on the social and economic organisation of the society. However, with a high cohesion vulnerability will be lowered. In examining the situation of orphans this framework is useful in the identification of the obstacles and aspects that cause the orphans to be vulnerable to abuse and hardships.   

                                                  
1.8 Literature Review
AIDS is, no doubt, one of the deadliest diseases of the modern age, and a major threat to global health. UNAIDS (quoted in NASCOP 1999) estimates that about 14 million people worldwide have already died of AIDS. Another 33.4 million are estimated to be infected. Sub-Saharan Africa bears the biggest brunt of HIV/AIDS scourge. Out of the world’s total, 22 million HIV positive people are estimated to be living in Sub-Saharan Africa (NASCOP 1999, v). In Kenya, reports indicate that, for every eight adults aged 15-49, one is infected (ibid.).
It is not only the mortality caused by AIDS per se which is significant; children orphaned by HIV/AIDS, more than ever, continue to pose a real threat to the socio-cultural fabric of the society. The age-old African extended family system threatens to burst at its seams due to the upsurge of HIV/AIDS orphans (Ntozi and Mukiza-Kapere 1995; UNICEF 1990; UNICEF 1999; Munguti and Kamaara 1999). Statistics indicate that there are nearly close to one million orphans in Kenya (Waldehanna et al. 2005). The number is projected to have reached 1.7 million by the end of 2005 (NASCOP 1999, 24).
Reports indicate that there is a dramatic increase in AIDS deaths, which has resulted in a high number of orphans. A report by the National AIDS Control Programme indicates that in a province of close to six million people, one out of every eight people is HIV positive. Like in many other Kenyan societies, among the Kalenjin community that forms the bulk of the population of the region under study, the care for orphans is a moral obligation rather than an act of kindness. When parents die, therefore, it follows that members of the extended family take in the orphans. The upsurge of HIV/AIDS orphans is, however, eroding this important cultural virtue. Reports have indicated that the poor and old relatives, rather than the well-to-do ones, care for many orphans (Saoke and Mutemi 1994).
1.8.1 Stigma: A Drawback against the Care for HIV/AIDS Orphans According to UNICEF, whereas war, which until recently has been considered a major cause of deaths in sub-Saharan Africa, claimed 200 000 lives in 1999, AIDS claimed 2.2 million lives in the continent. The same publication predicted that by the year 2000, there would be 13 million orphans in sub-Saharan Africa. AIDS has remained a stigmatized condition because it carries many symbolic associations with ‘danger’ (Hardon 1995). These include attributions of pollution, contagion, incurability, immorality and punishment for sinful acts. Those affected and infected with HIV/AIDS are avoided because of the association of HIV/AIDS, in both Western and non-Western societies, with immorality and deviant behaviours such as sexual promiscuity and intra-venous drug use.   

HIV/AIDS orphans, therefore, have to endure a life of distress and isolation before and after the death of their parents. Reports have indicated that the shame, fear and rejection that often surround people affected by HIV/AIDS exacerbate the distress and social isolation (Saoke and Mutemi 1994, 9; UNICEF 1999).

The stigma and irrational fear has not only resulted in rejection but also denial of access to social, educational as well as health services to the orphaned children.  Whereas it follows that sero-positive HIV/AIDS orphans should be the ones receiving great and intensive care in orphanages, finding homes for them sometimes becomes a problem because of discrimination. Reports indicate that orphanages, because of fear that they will contaminate other children, may not accept HIV positive orphans. Some orphanages may not be willing to take them in lest donors withdraw their funding. This is because of the assumption that donors might see these orphans as ‘bad investment’ (UNICEF 1990).  On the other hand, some institutions do simply reject them for lack of facilities to take care of chronically ill children. In some hospitals their admission has been discouraged because they are seen as a heavy financial burden and because they might occupy much needed beds (UNICEF 1990, 7). This leaves home-based care for the HIV/AIDS orphans as the most conceivable option.

1.8.2 Effects of HIV/AIDS Orphanhood on Normal Childhood Development
The Convention on the Rights of the Child (CRC), a United Nations document which was adopted in 1989, spells out the rights of the child to include the right to education, health, development, and protection from exploitation and harm (Government of Kenya/UNICEF 1998). However, reports indicate that HIV/AIDS orphans have been denied all these rights due to prejudice and neglect by their guardians and the community.

Children of HIV-positive parents endure long periods of suffering before the death of their parents. They undergo grief and horror of watching parents waste and die. But before the death of their parents they have to look after siblings as well as care for ill and dying parents. This is the kind of experience which, no doubt, can exhaust even the strongest of adults.   

Due to vulnerability brought upon them by the loss of their parents and the prejudice resulting from the social stigma of being associated with HIV/AIDS, orphans suffer differential treatment both in orphanages and in the context of extended/foster families within which they are living. Reports have indicated that orphans shoulder heavier workloads and are treated more harshly than foster families’ own children. They are often more malnourished, stunted and illiterate. They are shunned due to fear that they harbour HIV. Their paltry inheritance may be seized by those who take care of them (Mukwaya 1999, 17; UNICEF 1990). The HIV/AIDS-orphaned girl-child is particularly in a more vulnerable situation than the boy-child. This is because they carry with them the social prejudice, which has already been identified to ‘hobble’ many women in poor countries (Mukwaya 1999; Hardon 1995).

There is a  common myth in some African communities which links the cure for HIV/AIDS to sexual intercourse with a virgin girl. Many HIV/AIDS orphans have fallen victim to men holding onto such appalling myths (Mukwaya ibid.). The same report points out that adolescent girls in sub-Saharan Africa are six times more likely to be infected by HIV/AIDS than boys of the same age. Local daily newspapers in Kenya also carried reports on sexual abuse of orphaned girl-children. Meuresing et al. (1995), in a study carried out in Matabeleland in Zimbabwe, reported that some traditional healers advise their clients who seek luck in farming, business, gambling or other momentary affairs to secure this luck by having sex with very young girls. Girl orphans would readily present ready targets to such kind of men. The other factor predisposing girl-child orphans to sexual abuse and exploitation is their financial as well as emotional deprivation. It has been observed that the want for emotional as well as financial support exposes the orphaned girls to the lure of child prostitution and exploitation as a way of earning a living (UNICEF 1999; Saoke and Mutemi 1994). Besides, even when they are not forced into prostitution, girls rather than boys, would be the first ones to be forced out of school to help at home and work in the fields when the family resources dry up as a result of HIV/AIDS death (Mukwaya 1999, 18).

1.8.3 The Extended Family System and the Challenges of Orphans
For generations, there has existed in African communities a deep-rooted kinship system. The extended family network of aunts and uncles, cousins and grandparents has served as an age-old social safety net for orphaned children. This kinship system has been resilient even to major social changes. However, the increased number of orphans due to HIV/AIDS mortality has put a lot of strain on the extended family system.
The pressure is so much that the little resources available have been stretched to the limit, and those left to take care of the orphans are themselves old and invalid, needing as much care, if not more, than the children themselves (Mukwaya 1999; UNICEF  1999; Saoke and Mutemi 1994).
The already precarious situation of orphans is compounded even more by absence of social support systems out of the realms of the extended family framework. Basic social services provided by governments are largely inadequate. Orphans, therefore, accumulate even greater burdens of responsibilities as heads of households when grandparents, other guardians or caregivers die.
There is, therefore, a need to formulate policies to address the problems of orphans as well as the plight of the affected caregiver. The policies should be feasible and culturally acceptable to the care needs of the orphans. They should ensure that the basic rights of children are respected and fulfilled. The findings of this study seek to present a basis on which such policies can be made.


A Situational Analysis on Responses to HIV/AIDS Challenges in the Food, Beverages and Tobacco Manufacturing Sectors in Nairobi City, Kenya Philomena W. Muiruri

The HIV/AIDS epidemic poses a major challenge to the manufacturing sector in Kenya, as it impacts negatively on firms’ revenues. They face the threat of reduced performance due to the large numbers of employees falling sick as HIV/AIDS takes its toll at the work place. HIV/AIDS is a work place issue as it threatens productivity, profitability and employee welfare, posing a major development challenge. Worker attrition due to sickness and death, the corresponding costs to firms for providing health benefits and recruitment costs to replace employees are all impacting negatively on business costs and performance. Today, the survival of many businesses depends on the mechanisms put in place to address HIV/AIDS within and around the work environment.
The main objective of the study was to assess firms in the food, beverage and tobacco sector and their perceptions of the impacts of HIV/AIDS in the workplace, responses to these challenges and involvement with surrounding communities in Nairobi City, Kenya. The study was a descriptive survey that utilized an in-depth approach. Primary data was collected using a questionnaire administered to management, focus group discussions held with employees at lower levels and key informants. The sample size comprised 42 firms. Data analysis involved computations of summary statistics and content analysis techniques. 

The findings indicated a general consensus that firms were concerned about the financial cost of HIV/AIDS to their operations. There was reduced productivity manifested through AIDS-related deaths, absenteeism and loss of skilled workforce. Prolonged morbidity and mortality of employees increased firms’ expenditure on medical care and funerals, hence reduced profits. Costs of production increased through recruitment and training of new staff and employee benefits. The medium to large firms had the highest percentage of increase in production costs, disruption of business operations and reduced productivity.

Responses to AIDS by the firms, particularly in implementation of work place programmes, were ‘piecemeal” with only a few large firms having HIV/AIDS policies.  The small and medium firms appeared to be underestimating the impact of, and reacting slowly to, the HIV/AIDS pandemic. Firms with better quality workforces, those with large numbers of unionized workers and those concerned about absenteeism tended to do more about HIV through prevention activities and pre-employment health checks. Most firms had HIV/AIDS prevention programmes, while only a minority offered Anti-Retroviral treatment to its employees infected with HIV/AIDS. Challenges to setting up these programmes were identified as lack of information and technical assistance, stigmatization, considering HIV/AIDS as a moral and a health problem and lack of financial resources. The study recommends that companies invest in a HIV/AIDS workplace policy encompassing prevention, care and support programmes to stem declining business productivity and profitability. This requires that the National AIDS Control Council and its partners develop programmes and provide assistance for scaling up of private sector HIV/AIDS workplace intervention in terms of funds, technical assistance and information resources, including provision of guidelines and tools.