More than 15 million children under the age of 18, most of them in sub-Saharan Africa, have lost one or both parents to AIDS. Millions more children are highly vulnerable because their parents are suffering from AIDS or because their families are heavily affected by the pandemic.

Children orphaned or made vulnerable by AIDS (OVC) are more likely to be malnourished, less likely to be educated, more likely to be abused and suffer severe psychosocial distress. In many communities, traditional ways of caring for orphans and vulnerable children, such as the extended family system, are being severely strained by the multiple, mutually exacerbating impacts of HIV/AIDS.

The challenge is to find ways to help communities care for the unprecedented number of children and families rendered vulnerable by HIV/AIDS.

In 2005, World Vision UK reported that OVC face serious risks because of the increased poverty and transgression of their rights resulting from the pandemic. The report focused on four of the countries worst affected by HIV and AIDS in sub-Saharan Africa: Mozambique, Ethiopia, Zambia and Uganda. Of these four, only Uganda has set up a policy to protect OVC.

Growing up so vulnerable increases the likelihood of OVC contracting

HIV as young adults or teenagers because poverty pushes them into risky behaviours, such as prostitution, living on the street, or exchanging sex for food and protection. Lack of education means many will not be aware of the dangers of HIV and a lack of power means most will not be in a position to insist condoms are used.

The World Vision UK report also found that despite promises to the contrary, very little is being done by governments to assist OVC. These children are orphans in the loneliest sense. With no parents and few relatives in a position to care for them, they must rely on other forms of support. Unfortunately there are few of these.

Interviews with children and other community members for the World Vision UK report showed that children who have either lost parents to AIDS, or are living and caring for a sick parent, are profoundly disadvantaged.

They are less likely than their peers to be in school, have access to healthcare, receive adequate meals, have their births registered or their basic needs met. They are also vulnerable to property grabbing and exploitation by others. Click here for full report.

The traditional support networks of neighbours and relatives are already stretched to their limits. In Malawi, one of the worst AIDS-hit countries, one in five people are believed to be HIV-positive, leaving practically no community unaffected.

As HIV is largely a heterosexual epidemic in Africa, when one spouse has it the other more often than not finds he or she is also infected. But silence and stigma means children are sometimes not even told what their parents died from.

It used to be said that in Africa there are no orphans. This is because children without parents were always taken in by family members or friends, but now the numbers of children needing care are increasing rapidly and there are simply not enough adults to care for them. The result is that communities are unable to cope and some children are left to their own devices.

However, an incredible 90 per cent of orphaned children in sub-Saharan Africa have been taken in by family. These families are already struggling so the extra mouths to feed and minds to educate can push a family to the brink. Because the needs increase but the family income does not, families who are caring for orphans are in a more precarious situation than they were previously.

The overall nutrition levels of the whole family are known to decrease, schooling becomes uncertain for all the children but especially the orphans and sadly favouritism towards the household's own children can lead to neglect or even abuse of those seeking care in a new family.

World Vision seeks to provide care and support for OVC through the HOPE initiative. Enabling them to go to school, ensuring they have food and proper shelter and protecting them against exploitation.

makes all the difference. It can mean the difference between a life of extreme poverty and one in which the child is able to provide for themselves and recover from the devastation of being orphaned.

Building a community's ability to care for its children encourages a resolution of problems, enables children to stay at school and increases the whole community's standard of living. This is essential if we are to break the cycle of poverty and the HIV virus.

It is also essential proper drugs and ongoing care and nutrition are made available to parents, keeping them healthier for longer so children don't have to grow up alone.

Community education about HIV and AIDS, its transmission, impact and how to avoid it, is becoming more acceptable and even in the most conservative of environments people are beginning to get vocal about the virus, its prevention and those living with it.

• Click here for more information about the HOPE Initiative or
• Click here for more info about Children in Crisis - HIV and AIDs