African Grandmothers Rally for AIDS Orphans
By LAWRENCE K. ALTMAN

TORONTO, Aug. 12 — After burying their children, they must take care of the children of their children. They are the “AIDS grannies” of Africa: women like Matilda Mwenda, 51, of Zambia, who has lost two of her seven children to AIDS, leaving five orphaned grandchildren in her care, along with two nieces who were orphaned when her sister died of AIDS.
Or Priscilla Mwanza, 49, also of Zambia, a widow who is herself infected with H.I.V. She cares for three grandchildren orphaned by AIDS in addition to her own surviving children, 16 and 3, a niece and her aging mother.
Or Alicia Mdaka, 66, from Cape Town, who has seen four of her eight children die — two from AIDS, two from stabbings. Now, along with her four surviving children, she cares for seven grandchildren and five great-grandchildren.
The three women are among about 100 African grandmothers who flew here for a four-day gathering that ends Sunday with a march to the opening of the 16th International AIDS Conference. The gathering, which brought the African women together with about 200 Canadian grandmothers (very few of them dealing with AIDS in their immediate families), is believed to be the first large one dedicated to helping grandmothers cope with the AIDS pandemic.
“We did not know we had this potential until we formed a support group to learn and share,” Ms. Mdaka said.
At first, she said, “I was so angry, feeling guilt, asking how can I live.” But then uniting with other grandmothers in the same situation “made things easier for me.” The pandemic has created an estimated 12 million orphans in Africa, with the number expected to grow to 18 million by 2010. The burden of care has fallen on grandmothers, whose extended families often exceed a dozen children.
Although 40 percent to 60 percent of orphans in some African countries live in households headed by grandmothers, these women have received little financial or other support.
“Governments haven’t the faintest idea what to do,” said Stephen Lewis, a former Canadian ambassador to the United Nations who is Secretary General Kofi Annan’s representative to Africa for AIDS.
“The policies for orphans, more often than not, are a grab bag of frantic interventions, where faith-based and community-based groups try desperately to cope with the numbers, but rarely have either the capacity or the resources,” he said.
His nonprofit Stephen Lewis Foundation (stephenlewisfoundation.org) sponsored the gathering here. As the foundation prepared for the gathering, it learned that a small number of Canadian grandmothers had established connections with grandmothers in Africa, particularly a group called the Go Go Grannies in Alexandria Township near Johannesburg.
“A burgeoning population of parentless children, adolescents and rootless youth is simply overwhelming for every state,” Mr. Lewis said in the lectures he delivered at the University of Toronto last year.
His foundation pays for 142 projects in Africa. Many work with grandmothers to help them form and expand support networks for dealing with the problems of raising AIDS orphans.
The projects also try to develop sustained income-generating projects to pay for orphans’ food, school fees and school uniforms, and for coffins to allow for dignified burials of family members.
The African grandmothers came here from 11 countries. They attended workshops on topics like counseling to help them understand and support children coping with the loss of their parents; helping orphans deal with depression, frustration and stress; building resilience in children and grandmothers; and counseling about the “put-down syndrome,” which the orphans experience when they are constantly told they are inferior or lazy.
Among other things, the women were told to be careful to avoid infection when cleaning the bleeding wounds of children who may be H.I.V. positive.
Ms. Mdaka counsels children about bereavement and advises teachers that when the orphans are moody they may be thinking about the loss of their parents. She also advises other grandparents on how to prepare wills and how to develop skills in sewing and knitting to make money for services they share.
Cherry Matimuna, 53, is a nurse who has adopted four children orphaned by a niece and a nephew who died of AIDS in Zambia. She said she would be resting if there were no AIDS epidemic. Instead, she has come out of retirement to help care for 61 additional AIDS orphans in Kadwe, the same town where Ms. Mwenda and Ms. Mwanza live.
“We’re fighting to create another strong generation,” Ms. Matimuna said.
Twenty-five years after AIDS was first detected, no master plan exists to deal with its orphans.
“What the world fails to recognize is that these children don’t become orphans when their parents die, they become orphans while their parents are dying,” said Mr. Lewis, the United Nations representative.
In the absence of a grandmother or other relative to care for AIDS orphans, the oldest child becomes the head of the household and looks after the siblings.
“Many orphans play, beg for food and sleep on the streets,” Ms. Matimuna said. Some go naked for lack of clothes. As the orphans grow up, some commit crimes. Some become prostitutes, get pregnant and are infected with H.I.V.
The transfer of love, knowledge and values from one generation to the other is gone, and with it goes the confidence, security and sense of place that children normally take for granted, Mr. Lewis said.
So he has concluded that “we must collectively carve out a social security scheme for grandmothers, which will permit them to survive themselves, and secure food, clothing and shelter for their orphan grandchildren.”
Many African grandmothers, he went on, have “made that heart-wrenching trek to the graveyard, many more than once, and yet they speak with a spunk and resilience that is positively supernatural.”
The Canadian and African grandmothers come from vastly different backgrounds but have a common purpose — to learn how to help African grandmothers raise the millions of AIDS orphans.
Mary Anna Beer, 62, a retired teacher from Newmarket, Ontario, became interested in AIDS in the late 1980’s, when friends died of it, and says she began to understand the plight of African grandmothers in six trips to eight countries since 1993. She said she had helped a committee raise nearly $900,000 for the Lewis Foundation and publish a manual advising other groups to raise awareness of AIDS in Africa. (The manual is online at york4stephenlewis.ca.)
Mr. Lewis’s daughter, Ilana Landsberg-Lewis, who runs the foundation, said the gathering had three goals. One was to spread awareness about the plight of the African grandmothers. A second was to get the grandmothers to show the world what they needed, what their agenda was and what response they wanted. A third was to raise money for them.
African grandmothers have always worked hard, farming and preparing meals, nursing the sick and caring for children while parents were working.
But in the AIDS pandemic, many overlook the fact that the grandmothers need help to cope with the added suffering from their losses.
Ms. Matimuna said that as the breadwinner she felt responsible for rearing the orphans in her family; paying for their school fees, uniforms and books; and keeping them from living on the streets.
The orphans call her Mommy, Ms. Matimuna said, and generally cope well, though occasionally the oldest asks if her parents will return. “It’s natural to think about that, and I tell them the truth.”