About 13 million children have lost one or both parents to HIV/AIDS, the vast majority in sub-Saharan Africa. New analysis of data from UNICEF and USAID-supported surveys in sub-Saharan Africa shows that:

• Nine out of ten orphans are cared for by the extended family.
• In southern Africa, more than half of orphans who are not living with a surviving parent, or who have lost both parents, live with their grandparents.
• Households headed by older women are twice as likely to include orphans as those headed by older men.
• Grandparents’ responsibility for orphans is increasing as the epidemic progresses.

Children are often in their grandparents’ care before their parents have died, since many people with AIDS return home in the final stages of their illness to be cared for by their parents, bringing their children with them.

However, the safety net provided by grandparents is stretched very thin. Older people already make up a significant proportion of the poorest, and HIV/AIDS exacerbates the extreme poverty faced by many older-headed households, compromising older carers’ ability to care adequately.

New data from voluntary testing centres in Uganda also highlights older people’s risk of becoming infected, with one in five of those aged over 50 who came for testing being HIV positive. International data on infection rates stops at age 49, and older people are widely ignored by HIV/AIDS-prevention programmes.

"The findings from these data sets provide further evidence of the scale of the impact of HIV/AIDS on older people and the need to include them in policies and programmes to tackle the epidemic," says Fiona Clark, HelpAge International policy officer.

"Policy makers need to be clearer who the home and community-based carers for orphaned children are, and what resources they have, and provide them with adequate financial, social and emotional support, including direct income in the form of social protection and access to foster care grants.

"They also need to recognise that older people are at risk of infection, and that they need equitable access to HIV/AIDS prevention and treatment measures."