The Children Left Behind

The seven-year-old boy had already lost his mother and sister to AIDS. The sight of his father wasting away in the hospital was more than he could bear, and he stopped visiting. Later, at his father's funeral, when the priest asked the congregation to pray, the little boy looked up to his adoptive father. "How do you pray?" he asked.

Ernesto Loperena, executive director of the New York Council on Adoptable Children, recalls that funeral scene as the start of a warm and loving relationship between the boy and his new father. The boy's adoption in 1993 was the first in what became the agency's AIDS Orphans Adoption Program; since then more than 300 children have benefited from the organization's services. Yet many more remain orphaned, and more and more children are being orphaned by AIDS each day. By the year 2000, between 72,000 and 125,000 children and teenagers in the United States will have lost their mothers to AIDS. One study predicts that, by the year 2001, more than 52,000 children will be orphaned by AIDS in New York City alone.

What will happen to these children? Some have family members who can assume responsibility, but many are left without families to care for them. For many families, financial resources are scarce and adoption subsidies are unavailable. Unless other arrangements can be made, foster care, a system already overwhelmed, becomes the only option.

Studies have shown that foster care is rarely ideal. Foster children, sometimes shuffled from one home to another, often do poorly in school and have trouble forming attachments to adults and other children. And foster care is becoming less of an option. With many households today headed by single parents and so many women in the workforce, fewer families can take on the responsibilities of foster care. As the number of foster families declines, finding qualified people to care for orphaned children becomes increasingly difficult.

Last year's new welfare law threatens to further reduce the number of qualified foster families. In Massachusetts, for example, a 1997 Boston Globe article revealed that at least 10 percent of foster parents may have to abandon their caregiver roles to meet the new work requirements placed on all welfare recipients. Other foster parents across the country may face similar situations as the push to shrink the welfare role continues.

Although adoption is the preferred outcome for children in foster care, research shows that fewer than 10 percent of foster children are ever adopted, despite innovative programs to place children in permanent homes. Moreover, AIDS orphans-who are overwhelmingly African American or Latino, older, and with siblings-fall into the "hard to place" category.

"Behavioral problems are another factor," says Maria Copses, coordinator of the Boston Pediatric and Family AIDS Project at the Dimock Community Health Center. "As a result of the tremendous grief and loss they've suffered, these children can be defiant and unruly. They are receptacles of their family history. Research shows that these children often enter into a new family expecting it to disintegrate."

Children affected by HIV face other challenges as well. In order for children to qualify for social services, says Eileen Ritchie, a program analyst with the Los Angeles Department of Family and Children's Services, they must be labeled as maltreated.

To help address these problems, health care workers around the country are taking action. In New York City and Miami, special programs have been established to care for these children. In Miami, most of the children affected by AIDS have been placed into permanent homes. "Such placements may become more difficult," says Seema Coppersmith, project coordinator for the Children's Home Society, "because we anticipate a significant increase in the numbers of mothers contracting HIV in south Florida."

In recent years, authorities in Boston have taken active steps to help prevent children affected by HIV from suffering further instability and loss. Through the Living Legacy Program-a collaborative program of the Boston Pediatric and Family AIDS Project, the Greater Boston Catholic Charities, and the Hale and Dorr Legal Services Center of Jamaica Plain-physicians, social workers, and lawyers help HIV-infected parents plan for their children's future.

Families are offered a range of services, from support groups to estate planning and guardianship advice. The program trains families how to talk to their children about their illness and how to prepare for the changes that will occur. "We help guide the family along a path that meets their needs," says Copses. "We try to intervene before the children end up in foster care, the juvenile justice system, or the Department of Youth Services system."

-Theresa Cameron is a professor in the School of Planning and Landscape Architecture at Arizona State University.