Original Article
AIDS and Human Security in Orphan Adolescents, Sub-Saharan Africa
F. N. Onuoha & T Munakata
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
E-mail address: fnonuoha@yahoo.com■Abstract

Human security has been defined as the dignity, mental peace, and stability of theindividual (UN 2003). This study examines human security factors of adolescentsorphaned by AIDS in two sub-Sahara African countries – Uganda and South Africa. Six
hundred and eighty-eight adolescents aged 10-19 (M=14.1 years) in three groups:
AIDS-orphaned (n=178), other-causes orphaned (n=217), and non-orphaned (n=293) arerecruited from schools, and child support centres in Kampala (Uganda, n=371), andMafikeng/Klerksdorp (South Africa, n=317). Human security factors are food availability,
perceived good health, friendly environment, and education. Others are self-esteem,social support, and foster/parental care. Child abuse, social discrimination, anxiety anddepression are categorized as human security threat factors. The ANOVA showed thatwhile adolescents orphaned by other-causes scored lower human security than did
non-orphaned group, AIDS-orphaned adolescents scored lowest human security in the 3groups. We concluded that although orphans face great human security threat factors,
adolescents orphaned by AIDS face the greater threats.
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Keywords: human security; orphan health; AIDS-orphaned adolescents

1.

Introduction

1.1

Human Security

The traditional concept of security, with roots in the cold-war era, is the territorial protection of thestate against external aggression; in most cases by military power. The result is theunprecedented arms race of the era (for defense and deterrence) that has failed to guarantee
world peace. In the post-cold war era has emerged the contemporary advocacy for paradigm shift
from “state” to “human” security.

Human security is less about armament or surveillance cameras to monitor crime, but more about
the dignity and well-being of the individuals of the nation. It is the totality of grass root foodsecurity, health security, environment/community security, and political security (UNDP, 1994) forthe mental peace and comfort of the individual. Human security not only protects the individualfrom the daily dangers of violence, hunger and poverty, but empowers him/her to overcome these
dangers (UN, 2003). Ultimately, the individual’s security translates to community, state/national,
regional, and international safety.

According to US President J.F. Kennedy, “Political sovereignty is but a mockery without meetingpoverty, illiteracy and disease. Self-determination is but a slogan if the future holds no hope” (UNInternational Journal of Structured Association Technique No.4

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General Assembly, 1961). Human security guarantees 3 freedoms to the individual: freedom fromfear, freedom from want, and freedom to live in a dignified mental state (UN, 2003). These
freedoms are crafted in the UN Millennium Development Goals. Regrettably, one of the greatest
threats to meeting the millennium goals and human security are the challenges of global
infectious diseases, particularly HIV/AIDS.

1. 2

HIV/AIDSOver the centuries, science has resolved the global infectious disease challenges of the time –from the bubonic plague of the medieval era in Europe

to the cholera in Latin America,

pneumonic plague in India, ebola in Africa, dengue fever in Southeast Asia, mad cow in UK,
anthrax attack in USA, SARS (severe acute respiratory syndrome) in China, bird flu in Korea, andswine flu in Mexico, among others – but AIDS that has defied resolution/cure.

“HIV/AIDS is … the greatest weapon of mass destruction on the earth” (Collin Powell, US
Secretary of State, 2004). It is a threat to human peace and security (US National Intelligence
Council, 2000; G8 meetings in Okinawa 2000, in Genoa 2001; UN Security Council, 1999). “The
impact of AIDS is no less destructive than that of warfare itself …. Last year, AIDS killed about 10
times more people in Africa than did armed conflict.” (Koffi Annan, UN Secretary General, June,
2000). In July 2001, the UN Resolution 1308 officially recognized AIDS as the global “risk to[human] stability and security” of our time.
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Since its emergence over a quarter of a century ago, AIDS has claimed more lives than the two
World Wars, the Vietnam War and the Korean War combined did (Washington Post Editorial,
2000). In 2007 alone, about 2 million adults and children died of AIDS, 33.2 million living with thevirus, and 1.7 million new infections reported, worldwide (UNAIDS, 2008). Of these, over 67%
occurred in sub-Saharan Africa (UNAIDS, 2008). Among children and adolescents below 18
years in sub-Saharan Africa, over 12% (or 42 million) of the children are orphans and 35% (or 15
million) of them orphaned by AIDS (UNAIDS, 2006).

1.3

Orphaning

Adolescents orphaned by AIDS may experience unique human security threat factors (Chitiyo,
Changara, and Chitiyo, 2007). In sub-Saharan Africa, they face dual sad experiences: first, they
are affected by AIDS when parent falls sick and they have to shoulder stressful responsibilities
such as nursing ailing parent and/or engage in income generating activities; next they areaffected by orphaning when parent dies (Gillespie, Norman, & Finley, 2005). These adolescentstend to grieve longer before parental death than other orphans, owing to the human wasting,
AIDS-defining illnesses that often precede death (WHO, 2005). Because of the moral shame andlife-terminality associated with AIDS, children left behind by AIDS-deceased parents may
encounter higher externalized (Cluver, Gardner, & Operario, 2008) and internalized (Nyblade etal., 2003) social stigma/discrimination than children orphaned by other reasons. It is oftenInternational Journal of Structured Association Technique No.4

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believed that AIDS-orphaned children, like their departed parents, may be HIV-positives who may
die earlier than the “normal” children.

According to the UN, the distinctive social characteristic of AIDS is that it is more likely
than other causes of death to create double orphaning - the loss of both parents (UNAIDS,UNICEF, & USAID, 2004). In South Africa and Uganda, double orphaning is four times more likely
in AIDS-affected homes than in other homes (UNAIDS, UNICEF, & USAID, 2004). Studies ofadolescent parental loss report that orphans tend to encounter such human security threat factors
as social depression (Furukawa, Yokouchi, Hirai, Kitamura, & Takahashi, 1999), personality
disorders (Paris, Zweig-Frank, & Guzder, 1994), anxiety/insomnia (Tweed, Schoenbach, George,& Blazer, 1989), hopelessness, and frustration (Mbozi, Debit, & Munyati, 2006).

Abebe andAase (2007), however, disagree. They argue that the symptomatic construct of orphans are
media-induced stereotyping, orchestrated by academic scholars of traditionalist persuasions.
Most orphans have the resilience and agency to get on with the challenges of life following
parental death (Abebe & Aase, 2007).

The purpose of this study is to examine the human security of sub-Sahara Africanadolescents orphaned by AIDS. Human security is defined as mental peace and stability of theindividual (UN, 2003; UNDP, 1994). The design is people-focused rather thanhardware-concerned. Thus it captures the main thrust of human security – the individual. We
hypothesized that adolescents affected by AIDS may show lower human security factors thanInternational Journal of Structured Association Technique No.4

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those orphaned by other reasons.

2.

Method2.1

Participants

The initial study participants are 957 sub-Sahara African adolescents in Uganda (n=474) andSouth Africa (n=483), recruited from 9 community schools, and 6 NGO child support centres in
two towns – Mafikeng/Klerksdorp (South Africa) and Kampala (Uganda). The World HealthOrganization definition of adolescence as persons aged 10-19 years (WHO, 2003), and the UN
classification of orphanhood as the loss of one or both parents (UNAIDS, UNICEF, & USAID,
2004) guided the study.

The study design has 3 groups: AIDS-orphaned, other-causes orphaned, andnon-orphaned. Participants who responded in the affirmative to the questions: “Is your father
living? (Yes/No); is your mother living? (Yes/No)” are categorized as non-orphans (n=293).
Those who responded “no” to either question are asked the cause of death: “1. HIV/AIDS,
Others,

3. Don’t know.”

2.

Responses 1=HIV/AIDS (n=178), and 2=Others (n=217) are so

categorized. Those who “don’t know” cause of parental death (n=269) are excluded from thestudy.

2.2

Ethical consideration

The Uganda National Council for Science and Technology (UNCST), the School ofInternational Journal of Structured Association Technique No.4

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Economics & Decision Sciences, North-West University, South Africa, and the Department of
Human Care Science, University of Tsukuba, Japan, approved the study protocols, which
required confidentiality, anonymity, and voluntary participation of the study participants (Mann &Tolfree, 2003).

Interviewers were Luganda (Uganda) and Xhosa/Afrikaans (South Africa) speaking
research collaborators. When expedient the interviewer-administered questionnaire method was
adopted for the low educational level participants; otherwise the self-report method was
dominantly used. The first method required the interviewer to read out the question items in thelocal language to the respondent, and filled out the questionnaire on his/her behalf. In the second,
the respondent completed the questionnaires unassisted. The interview duration lasted
approximately 45 minutes per session at the end of which the respondent received a ball pen.

2.3

MeasuresFood availability, perceived good health, education, friendly environment, self-esteem, social
support, and foster/parental care as human dignity enhancing factors constituted the humansecurity measures. In contrast, factors such as child abuse, social discrimination, anxiety, anddepression are human security threats (UN, 2003).
We utilized Schwarzer and Schulz (2000) Received Support Scale, as adapted (alpha=.72),
to estimate perceived social support received by the adolescents. The measure positively
associated with self-esteem (r = .42, p < .01) and negatively with anxiety (r = -.37, p < .01). The
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measure requires the respondent to “think about person(s) that is closest to you - your friend(s),guardian(s), or parent(s)/foster parent(s) - how does this person treat you?”

Typical items are:S/he “is there when I need him/her; shows love to me; takes care of my financial needs; ingeneral, I am satisfied with the way s/he treats me.”Self-esteem is estimated with the Rosenberg (1965) Self-Esteem Scale, the most utilizedmeasure of the favorable/unfavorable perceptions of the self (Blascovich & Tomaka, 1991). The
Cronbach alpha for the Scale in the present study is .60, which compares favorably with the value
found by Lorenzo-Hernandez and Ouellette (1998). The measure shows negative associations
with anxiety (r = -.34, p < .01), and social discrimination (r = -.38, p < .01), suggestive of its
validity.
We assessed foster/parental care with the Parker, Tupling, and Brown (1979) Parental
Bonding Instrument (PBI). The PBI assesses both parental care and parental over-protection.
Support for the reliability and validity of the PBI has been reported (Neale et al., 1994).

Weutilized the “care” subscale (alpha = .82) which estimates empathy, affection, warmth, andindependence in the present study. Typical items include parents/foster parents: are affectionate
to me; understand my problems and worries; let me do things I enjoy doing; enjoy discussing
things with me; give me as much freedom as I want.

We utilized the anxiety subscale of the renowned General Health Questionnaire (GHQ-28,
Golderberg & Hillier, 1979) to estimate anxiety. The subscale (alpha = .82) negatively (r = -.34, p
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< .01) correlates with self-esteem, and positively (r = .40, p < .01) with the Weissman, Orvaschel,and Padian (1980) Center for Epidemiological Studies Depression Scale (CES-DC), as adapted.
The CES-DC, which test-retest reliability and concurrent validity are adequate (Faulstich,
Carey, Ruggiero, Enyart, & Gresham, 1986) measures depression. Sample items on the Scale(alpha=.77) include: “I was bothered by things that usually don’t bother me; I didn’t feel like eating,
I wasn’t very hungry; I wasn’t able to feel happy, even when friends tried to make me feel good; I
felt like I was too tired to do things.”
The 1995 Detroit Area Study Measure of Discrimination as modified (alpha = .77) measuressocial discrimination. In your daily life, compared to other people around you, do you: Feeldifferently treated?

Feel unfairly treated?

things others are allowed to do?
typical questions.

Made to feel inferior?

Prevented from doing

People behave as though they are afraid of you? – are the

The measure correlates positively with depression (r = .38, p < .01), but

negatively with social support (r = -.27, p < .01).
The Child abuse scale measures the physical, verbal, sexual, and labor dimensions ofchild abuse (Bagley & King, 1990). For example, are you - physically beaten in a manner you
consider unfair; verbally abused in a manner you consider unfair; forced to “sleep”/have sex withanyone; forced against your wish to work on the farm for someone? The alpha reliability of themeasure, which discriminates depression (r = .22, p < .01) and self-esteem (r = -.27, p < .01) is
0.76.
Food availability. On a scale of 0 to 3 times, respondents rated their daily meal intake.
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Perceived good health: On a score of 0=don’t know, 1=sick, 2=a little sick, 3=good health,
respondents rated their perceived health status. We scored If currently attending school as Yes=2,
No=0.

Friendly environment is estimated with the question: Is the person you are living withkind to you? Yes=2, No=0.

Human security factors (25 items, alpha = .86) are the summation of food availability,
friendly environment, good health, currently attending school, social support, parental/foster care,and self-esteem scores.

Human security threat factors (24 items, alpha = .87) summatedchild abuse, social discrimination, anxiety, and depression scores.

3. Analysis

We performed the alpha reliability of the human security factors to estimate the internalconsistency of the measures. Table 1 shows Pearson’s directional association of the factors withhuman security to establish the validity of the measures. We executed the ANOVA of humansecurity factors in the 3 groups to estimate the performance of the AIDS-orphaned adolescents(Table 2). We separated the orphan groups into single and double orphan-types, and examined
their human security scores (Table 3).

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4.

Results

Demographic characteristics: Six hundred and eighty-eight (688) sub-Saharan Africa adolescentsof Ugandan (n=371) and South African (n=317) origins validly participated in the study. There
were significantly more females (56%) than males (44%), p < .01. But between participants in thethree groups no significant sex difference was observed [F(1,686)= 0.78, p=.38]. Age wassignificantly different between the three groups – AIDS (M=13.8 years), other-causes (M=14.3
years), and non-orphaned (M=14.2 years), F(2,685)=2.94, p < .05; grand age mean = 14.1 years.
Expectedly, educational levels also varied between the groups, with the non-orphaned showing
the highest education (M=1.64, SD=.73), and AIDS-orphaned showing the lowest (M=1.42,
SD=.69), p < .01.
Other outcomes. Alpha reliability for each of the study measures was admissible (alpha M= .75). The measures also showed admissible discriminant validity (Table 1). Human security
threat factors were significantly higher in adolescents orphaned by AIDS, than in the other twogroups, p < .01. AIDS-orphaned adolescents showed highest child abuse, social discrimination,
anxiety, depression, and lowest self-esteem, social support, and foster/parental care (Table 2).
There was no significant human security risk difference between adolescents whose one parent
died of AIDS, and those whose both parents died of the disease (Table 3). However, each of thetwo groups of AIDS-orphaned adolescents showed lower human security than their other-causes
orphaned counterparts.

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5.

Discussion

The dignity of the individual rests in the self-esteem (Trzesniewski, Donnella, & Robins, 2003).
Self-esteem defines everything about us. It is the foundation of personality (Spritize.blogspot,2006). Self-esteem is more than self-confidence, the knowledge that one can succeed. It is thesum of self-confidence, self-acceptance and self-identity, each of which is desirable for humansecurity. If one is not happy or satisfied with one’s life for reasons one cannot pinpoint, it isprobably because of one’s self-esteem, which might be at a low ebb (Spritize.blogspot, 2006).

In the present study, adolescents orphaned by AIDS showed significantly lowest self-esteem.
They scored significantly highest on the items “felt useless at times, felt unhappy with myself,
people don’t respect me, and overall I’m a failure.” Reasons for their low self-esteem were notobvious. But the Pearson’s association of variables suggests that social discrimination whichshowed the weightiest negative association with self-esteem in the group - followed by anxiety
and child abuse, in that order – might account for their low self-esteem. It seemed likely thathighest social discrimination against the AIDS-affected adolescents, could trigger their highest
anxiety that precipitated lowest self-esteem and human dignity in the group.

The strongest associate of self-esteem was social support. The preponderance of
psychosocial health literature agrees that social support is a rich factor for human dignity, mental
peace and stability (Uchino, Cacioppo, & Kiecolt-Glaser, 1996). Social support whether tangible(monetary, social participation, material care) or intangible (emotional care, cognitive guidance) isInternational Journal of Structured Association Technique No.430

essential for the affective enrichment of the mind and body. But the AIDS-orphaned participants,in the study, scored least on all domains of this important factor, and in the foster/parental carevariable. Friends and family members showed them least love, least comforted them when theyfelt bad, least took care of their financial needs or helped them do things they could not do. In
general, compared with participants in the control groups, AIDS-orphaned adolescents weresignificantly most marginalized from the available social support in their environment. Perhaps theoutcome to the question “are persons you are living with kind to you” further illustrates theunfriendly immediate social milieu of the AIDS-orphaned participants. Half (50%) of them reported“no”, compared with few (34%) other-causes orphaned, and less (17%) non-orphaned groups thatso reported.
Food insecurity and malnutrition are critical in sub-Saharan Africa, where thevagaries of desertification and famine are not uncommon. But the depletion of the available
productive human labor by AIDS may exacerbate the food situation. AIDS-affectedhouseholds, typically characterized by double-parental loss, are most likely to confront foodand nutritional inadequacy. In this study, over half (53%) of the AIDS-orphaned adolescents
retired to bed daily on one or less meal intake, against 34% and 23%, respectively, in theother-causes and the non-orphaned groups. Any wonder that perceived good health wassignificantly lowest in the AIDS-orphaned group?

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There was no measure of the daily meal intake of parents/guardians to permit aninformed judgement whether the highest hunger prevalence among the AIDS-orphanedadolescents may be attributed to child abuse, social discrimination or their unfriendly
immediate social environment. However, if as many as 23% of the non-orphanedadolescents had zero to one meal daily, then it may be a pointer to the permeating presenceof material poverty in the study population.
Poverty has a symbiotic relationship with human insecurity; each strives on the other.
Thus, locally and internationally, whereas poverty may be the underpin for most economic,
food, health, environmental, community, political and personal insecurity crises, thesecrises themselves produce and deepen poverty. Most intra-community or state

armedconflicts, private/organized crimes, “failed” state syndromes, terrorist actions, drug andhuman trafficking, environmental degradation, infectious disease spread, voluntary andinvoluntary human movements, and many other antisocial human activities that threaten
local, national, regional and global peace are the direct or indirect products of poverty. In
sub-Saharan Africa, poverty is both a cause, and a consequence of AIDS. The sexuallyactive male poor, unable to afford condoms may engage in unprotected sex probably withmultiple partners. The female poor, unable to provide for herself, may indulge in
unprotected transactional sex with multiple partners that may lead to infection.

Infected,

the poor may be unable to afford ARV treatment, may borrow money to meet risingInternational Journal of Structured Association Technique No.4

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hospital bills, may be unable to work on his/farm to guarantee food supply, and may be
fired from work, among other adverse consequences that deepens poverty and humaninsecurity.
According to a model developed in Zambia (Kelly, 2000), AIDS is threatening
education at three fronts: the demand for education (parents); the availability of resources
for education (teachers); and the potential clientele for education (children). With fewer
parents demanding to send their wards to school, fewer teachers as facilitators, and fewer
children/adolescents as clients, the education demand-supply chain is at the risk of acollapse from AIDS. Yet education and human development are central to human security(UN, 2003; UNDP 1994). In the present study, we estimated education by whether or not
one was “currently attending school.” This measure seemed more resourceful than themeasure of “educational level attainment,” which varied significantly in the groups due toage variances. Adolescents orphaned by AIDS were significantly 1.64 times more likely todrop out of school than those orphaned by other causes. Against non-orphaned adolescents,
they (AIDS-orphaned) were 3.48 times significantly more likely, suggesting higher
diminishing prevalence of valuable human capital development in AIDS-affectedhouseholds.
Good health, defined by WHO as not only the absence of disease but a positive stateof physical, mental, and social well-being, is synonymous with human security. Good healthInternational Journal of Structured Association Technique No.4

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is both essential and instrumental to achieving human security. But AIDS-orphanedadolescents in the study scored the least perceived good health condition.
The human security circumstance of single and double AIDS-orphaned adolescentsin the study seemed the same; no significant difference observed. So was the case between
the two orphan types in the other-causes orphaned group (Table 3).

The outcome wasagainst popular view that children with no parent may show greater human security threat
factors than those with at least one parent (Onuoha, et al. 2009; UNAIDS, 2004). However,irrespective of whether single or double orphaned, adolescents orphaned by AIDS scoredhighest human security threat factors than did adolescents in the control groups, supporting
the study hypothesis.
The discussion of human security may not be complete without reference to wars as
threats to global security. Wars and arms procurement for state security may continue to remainpart of our human experience. But armed conflicts aid and abet the spread of AIDS. They
generate displaced populations (refugees), many of whom may be single women andunaccompanied children. These women and children are vulnerable to being pressured into
exchanging sex for food or being raped. Also there is a correlation between military presence andcommercial sex boom in most localities. UNAIDS estimates that the military is 2 to 5 times more
likely than their civilian counterparts to contract STD, including HIV, in times of peace; in times ofInternational Journal of Structured Association Technique No.4

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war, they are 50 times more likely (UNAIDS, 1998). A depleted, dilapidated, demoralized armed
force from AIDS inevitably compromises state and global security.

6.

Conclusions

Orphaning is a significant threat to human security. But AIDS-orphaning presents higher humansecurity threats. In sub-Saharan Africa, prior to the advent of AIDS, deaths among persons aged
20-49 accounted for only 20% of overall deaths in the region, against prevailing 60% owing to
AIDS (UNAIDS, 2006). Many of these adults bequeath children and adolescents as
AIDS-orphans, whose human dignity seemed more debased than that of other orphans.
Human security epitomizes “faith in tomorrow” (UN, 2003), but adolescents orphaned by
AIDS face higher uncertainty about the future owing to lower school attendance prevalence rates.
If human security represents “a child who did not die, a disease that did not spread” (UN, 2003),
then adolescents orphaned by AIDS are direst in need of human security owing to their lowest
perceived good health conditions. We did not directly measure poverty in the study. But theinvisible hands of poverty, judged by hunger prevalence was apparent in the population,
especially among the AIDS-orphaned group.
In sub-Saharan Africa, AIDS may negatively impact on good governance required forhuman security. It creates high worker absenteeism, high worker mortality, high demand of
medical goods and services, but lower productivity, and revenue/income tax generation. These
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factors may undermine government financial resources to effectively control the disease, leading
to its further aggravation.

■ Recommendations
AIDS prevention and control for enhanced human security is critical for community, national,
regional, and global peace. Without intensified prevention efforts directed at the ABC (abstinence,
being partner-faithful, and condom use) therapy, 62 million people are projected to be newly
infected by 2015 (Global Health Council, 2009).
Expanded and free access to ARV (antiretroviral) drugs particularly in sub-Saharan Africa,
where need is greatest, is advocated. The US President’s Emergency Plan for AIDS Relief(PEPFAR) fund in which more than 100 countries have received support (Global Health Council,2009) is commendable. Other major international donors for AIDS programs are the World Bank,UNAIDS, and the Global Fund. Unfortunately, as global funding increases arithmetically, global
fund need seems to increase geometrically due to old and emerging new infections.
Recognizing poverty alleviation as a global responsibility is crucial for human security. The
UN Millennium Summit (September, 2000) declaration to reduce global poverty at least by half by2015 is praise-worthy. However, current global economic recession, continued intra-state armed
conflicts and weak governance in Africa and elsewhere may conspire to render the millennium
goals unachievable.
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AIDS-orphaned adolescents are special vulnerable children, requiring distinctive humansecurity protection policy programs■Acknowledgement

We are thankful to the Japanese Society for the Promotion of Science (JSPS) for its
financial grant for this study. We thank Prof P A E Serumaga-Zake, School of Economics &Decision Sciences, North-West University, Mafikeng, South Africa; Dr. R M Nyonyintono, Schoolof Postgraduate Studies, Ndejje University, Uganda and Mr S M Bogere, Department of
Sociology, Makerere University, Kampala, Uganda, for their collaboration in the study. We also
acknowledge the support of members and staff of the South African and Ugandan community
schools/child support centers from where the study sample was drawn. We thank them all.

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