Since HIV/AIDS was discovered in 1981, more than 20 million people have lost their livesto the virus. Nearly 40 million people are currently living with HIV/AIDS, including nearly 2.2million children under the age of 15. Ninety-five percent of those living with HIV/AIDS reside indeveloping countries. Sub-Saharan Africa remains the most affected continent with 1.9 million ofthe 2.2. million infected children. (1) A joint study conducted by the U.S. Agency for InternationalDevelopment (USAID), the United Nations Children's Fund (UNICEF), and the Joint United NationsProgram on HIV/AIDS (UNAIDS) found that at the end of 2003, 15 million children under the ageof 18 had lost one or both parents to AIDS, with 12.3. million of them found in sub-SaharanAfrica. (2) Between 1990 and 2003, sub-Saharan Africa's population of children orphaned by AIDSincreased from less than 1 million to more than 12 million (3) . Due to the 10-year time lag between HIV infection and death,experts predict that without the availability of anti-retroviral medications orphan populations willcontinue to grow for at least two decades after a country has reached its peak HIV infection rate. In Uganda, for example, although the epidemic has been on a steady decline, from 14% in the late1980s to 4.1% in 2003, the number of orphans under the age of 15 continued to climb for 10 yearsafter the country's infection rate peaked. Experts report that the number of orphans is only nowexpected to decline in the country, from 14.6% of Ugandan children in 2001 to a projected 9.6% in2010. (4) Thailand, longhailed for having significantly reduced its HIV/AIDS rate, is still witnessing an increase in childrenorphaned by AIDS. In 1995, there were 63,000 children who had lost their parents to AIDS. In 2001,the number increased to 289,000, and in 2005, an estimated 380,000 are expected to lose theirparents to AIDS. (5) The term "AIDS orphans" is used in the title of this report to facilitate recognition of theissue. However, those that serve children affected by HIV/AIDS caution against the use of this termbecause they believe it further stigmatizes the children. Consequently, the terms "orphans andvulnerable children" (OVC), "children affected by AIDS," and "AIDS-affected children" will beused hereafter to refer to "AIDS orphans." (6) The growing population of children orphaned by HIV/AIDS is a concern, because had it notbeen for HIV/AIDS, the global percentage of orphans would be declining instead of increasing. Bythe end of 2003, 43 million children (12% of all African children) were orphaned in sub-SaharanAfrica, 12.3 million (32% of all African orphans) of those were due to AIDS. Although Asia had alower number of children orphaned by AIDS in 2001, 1.8 million (2.8% of all orphans), it had amuch larger overall orphan population than sub-Saharan Africa, with 65 million orphans. (7) Some have expressed concernthat Asia's relatively large population hides its significant population with HIV/AIDS. For example,although India had a seroprevalence. (8) rate of less than 1% at the end of 2003, 5.1 million people wereliving with HIV/AIDS at that time. (9) This is almost as many people who had the virus in South Africa(5.3 million) at the end of 2003, which had a seroprevalence rate of 21.5%. (10) Children living in high seroprevalence areas may see a decline in access to education or inthe quality of education. A 2000 study found that an HIV-infected teacher loses approximately sixmonths of professional working time before succumbing to the virus. (11) This has had a significantimpact on heavily affected countries such as Kenya, where teachers are dying faster than they canbe trained and replaced. Kenya faces the loss of 6,570 teachers annually due to HIV/AIDS, whichtranslates to 18 teacher deaths per day. (12) In the Central African Republic, almost as many teachers diedof AIDS as retired between 1996 and 1998. As a result, nearly two-thirds of the schools have closeddue to staff shortages. (13) Heavily affected communities produce lower crop yields due to a reduction in land use (those whoare ill with AIDS are often too weak to farm), and a decline in the variety of crops grown. Theinfrequent use of fertilizers in the fields often results in a decline in soil fertility, increases in pestsand diseases, and a decline of external production outputs, including cash crops. (14) As a result, countriessignificantly impacted by HIV/AIDS have experienced a rise in child mortality and a decline in thegains made in child survival over the past decade. For example, child mortality in Kenya was 205per 1,000 in 1960, and had fallen to 97 per 1,000 in 1990. However, due to HIV/AIDS the rateincreased to 122 per 1,000 in 2001. (15) The majority of children orphaned or made vulnerable by HIV/AIDS are living with asurviving parent, or within their extended family (often a grandparent). An estimated 5% of childrenaffected by HIV/AIDS worldwide have no support and are living on the street or in residentialinstitutions. Although most children live with a caretaker, they face a number of challenges,including finding money for school fees, food, and clothing. Experts contend that effectiveresponses must strengthen the capacity of families and communities to continue providing care,protect the children, and to assist them in meeting their needs. There are thousands of localizedefforts, many of them initiated by faith-based groups, to address the needs of children madevulnerable by AIDS. Proponents argue that supporting these "grassroots" efforts can be a highlycost-effective response, although additional mechanisms are needed to channel such resources. Theyfurther assert that additional resources are needed to expand the limited programs and to support thechildren who are on the street or in institutional care. The plight of children affected by HIV/AIDS is gaining increased congressional attention,particularly through the enactment of P.L. 108-25 , The United States Leadership Against HIV/AIDS,Tuberculosis, and Malaria Act of 2003 , which authorized 10% of global HIV/AIDS funds to be usedfor children orphaned or made vulnerable by the virus (OVC). In the 108th Congress, there wasconsiderable debate on how the funds should be allocated. Many pointed out that activities relatedto children affected by HIV/AIDS should be streamlined. Some wanted to create a coordinator forchildren orphaned and affected by HIV/AIDS in the AIDS Coordinator's Office of the StateDepartment. Still others argued that the scope of assistance should be expanded to include childrenwho are orphaned from other causes, as they are just as vulnerable as those orphaned by HIV/AIDS.In the 108th session, Congress considered four bills that targeted children orphaned and affected byHIV/AIDS, though none made it to full conference. In the 109th session, H.R. 1409 , Assistance for Orphans and Other VulnerableChildren in Developing Countries Act of 2005, passed the House and Senate on October 18, 2005and October 25, 2005, respectively. Ultimately, the bill was enacted on November 8, 2005. The act, P.L. 109-95 , authorized spending for orphan-related programs in FY2006 and FY2007; establisheda monitoring and evaluation system to measure the effectiveness of related assistance activities;directed the appointment of a Special Advisor for Assistance to Orphans and Vulnerable Childrenwithin USAID; and required an annual report on project implementation. The continued increase in international HIV rates is proving devastating for governmentsheavily affected by HIV/AIDS, not only because their most productive populations are beingdecimated, but also because the future of these countries and their children is at risk. Governmentswith significant populations of children orphaned and made vulnerable by HIV/AIDS may be facedwith a range of issues, including surging street children populations, a rise in child labor, childprostitution and other forms of exploitative work, vulnerability to crime, militias and terroristorganizations, a growing population of uneducated and unskilled laborers; and long-term foreign aiddependence. This section will explore some of these challenges, and the implications that they haveon affected countries. As HIV/AIDS rates continue to soar around the world and household poverty deepens,children are increasingly pressured to contribute financially to the household. The streets havebecome the place where children orphaned and made vulnerable by HIV/AIDS often turn tosupplement lost wages, find refuge, and sometimes to find an escape from stigma. While on thestreet, children can be exposed to rape, drug abuse, child labor, (16) including childprostitution, and other forms of exploitation, making them more vulnerable to contractingHIV/AIDS. Children as young as nine years old have been found to be engaged in sex work. (17) While no one seems to know how many children actually live on the streets worldwide, manyreports cite a UNICEF estimate of 100 million. (18) Country reports from a number of heavily affected nations allreport a significant increase in the number of children roaming the streets over the past ten years.