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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2005.072280v1 96/8/1429    most recent Submit a response View responses Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Miller, C. M. Articles by Heymann, S. J. Search for Related Content PubMed PubMed Citation Articles by Miller, C. M. Articles by Heymann, S. J. Related Collections Family Health Global Health Social Science Health Policy HIV/AIDS Government

Candace M. Miller, ScD, MHS, Sofia Gruskin, JD, MIA, S.V. Subramanian, PhD, Divya Rajaraman, MPH and S. Jody Heymann, MD, PhD

At the time of this study, Candace M. Miller and S. Jody Heymann were at the Department of Society, Human Development, and Health at the Harvard School of Public Health, Boston, Mass. S.V. Subramanian is with the Department of Society, Human Development and Health, at the Harvard School of Public Health. Sofia Gruskin is with the Department of Population and International Health at the Harvard School of Public Health. At the time of this study, Divya Rajaraman was with the Botswana–Harvard Partnership, Gaborone, Botswana.

Correspondence: Requests for reprints should be sent to Candace M. Miller, Center for International Health and Development, School of Public Health, Boston University, 111 East Concord Street, Boston, MA 02115 (email: candace_miller{at}post.harvard.edu).

Objectives. Botswana has one of the world’s highest HIV-prevalence rates and the world’s highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans.

Methods. We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving.

Results. Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income.

Conclusions. The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswana’s orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.

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