HIV/AIDS has highly contributed to the increasing number of orphans and vulnerable children (OVC). UNAIDS estimates there are 940,000 orphans (aged 0-17) in Uganda due to HIV/AIDS. Uncared for orphans and other vulnerable children can lead to further spread of HIV as OVC especially girls get involved in sexual activities for material benefit.

Orphan Burden
The standard definition of an orphan in Uganda is a child below 18 years of age who has lost one or both parents (UDHS, 2001). Some sources however define an orphan as a child below 15 years who has lost one or both parents. The UDHS (2001) report reveals, 14% of children in Uganda under 18 years of age are orphans. Among these, 3% have lost both parents (double orphans), 8% have lost their fathers only and 3% have lost their mothers. Currently the number of orphans in Uganda is estimated at 20% of all children below 15 years of age. With the HIV/AIDS morbidity and mortality, the number of orphans has increased tremendously than before and it is projected to increase further.

Challenges Experienced by Orphans and other Vulnerable Children
The problem of orphans and vulnerable children is increasing daily and reaching crisis level in Sub Saharan Africa. The UAC (2001) reported that Uganda has the highest proportion of AIDS orphans in the whole World. The death of one parent or both comes with serious implications on the child. In fact children begin experiencing the impact even before the parent dies. The challenges experienced by the orphans and vulnerable children can be clustered as follows: psychosocial; lack of food and increased nutrition; inadequate health care; fewer opportunities for schooling and education; increased child labour; loss of property and exposure to HIV infection.

Psychosocial Impact:
Orphans and vulnerable Children often suffer from severe psychosocial problems. These children may be increasingly disadvantaged although not intentionally, because older guardians are less able to provide discipline and adequate socialization or even to address the basic needs like food, clothing, shelter and health care, all of which have got psychosocial impact on them (Dunn, et.al., 1991). Psychosocial disturbances among orphans have the potential of affecting their outlook towards the whole concept of life if no effective interventions are put in place. 

Lack of food and Increased Malnutrition:
There is a close link between families where orphans and vulnerable children come from and food security. In fact in such families especially those affected by HIV/AIDS, plantations have reverted into bush due to lack of labour.

Inadequate Health care:
Orphans and vulnerable children face inadequate health care due to the economic pressure on the family. It is worse in those families that have been affected by HIV/AIDS and those in war and conflict areas. Fewer opportunities for schooling and education: The orphans and vulnerable children are less likely to access education opportunities because of costs involved. Even though the government has come up with the Universal primary Education certain costs still remain to be met by the family. It is worse for those families that have been hit by HIV/AIDS.

Increased Child Labour:
Child labour has been an on going phenomenon in the Ugandan society for a long time though worsened by the onset of HIV/AIDS. Children who have been orphaned or vulnerable get involved in work as a means of survival. There is an increasing number of children especially girls seeking jobs of housemaids or bar attendants. It has also been well documented that children in the labour market tend to enter the market at an early age which affects their growth and well being (FUE, 2001; Wakhweya et al., 2002; Ministry of Labour and Social Affairs, UCOBAC and UNICEF, 1993).

Loss of Property:
Stories of loss of property by orphans have been well documented (FAO, 2002, Asingwire, 1995, 2000 ;). This problem is mainly due to the parents’ failure to write wills. On the other hand widows and orphans are illiterate and ignorant of their legal rights which relatives of the deceased take advantage of to grab property.

Exposure to HIV infection:
The condition of the poverty these children find themselves in compels them to engage in activities that expose them to the risks of HIV infection. This has become more apparent with the emergence of child headed households. Wakhweya et al., (2002) reported that due to inadequate parenting, children in child headed households may miss the psychological support needed from an adult. Such children are more likely to engage in pathological behaviors like criminal activities, drug abuse and engage especially in risky behaviors that increase their vulnerability to HIV infection.

The statistics presented above only highlight the situation in Uganda. The situation in Sudan, the Democratic Republic of Congo and Botswana is not very different. Both Sudan and the Democratic Republic of Congo have gone through a period of civil conflicts. There is no doubt that where civil conflict exists, the spread of HIV/AIDS is accelerated with no corresponding preventive and care services. On the other hand, Botswana has one of the highest infection rates in Africa.

The Response of the Government to the Situation of Orphans and Vulnerable Children
The government of Uganda, since 1990s has enacted or formulated many policies and legislations whose implementation has a strong implication on the welfare and development of children including orphans and vulnerable children. These include the Constitution of Uganda (1995), Children’s Act (2003), Local government Act (1997), Universal Primary Education (1996) and PMA (2000). The cumulative effect of these government initiatives is a favorable policy, social-economic environment for effectively addressing the problems of orphans.

In these entire documents, specific attention is given to the issue of orphans. Realizing that the family and local community provide ideal environment for child upbringing, the Uganda AIDS Commission since 1993 has advocated for the following policy on orphans: “The care of orphans and other needy children shall be the primary responsibility of the nation and the local community.”

Similar policies though not stated here have been formulated in the three countries Bethesda International will be expanding to namely Sudan, the Democratic Republic of Congo and Botswana. Taking advantage of these favorable government policies, Bethesda International will aim at complimenting the existing efforts by focusing on the most vulnerable children.