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Those without kinship ties or whose families refuse to take them in often end up in institutions, forming child-headed households, or simply on the streets. They are the missing face of AIDS, these children left behind.

Before Abraham and I drove out to Vambay Colony I spent a couple of hours at the VMM office in Vijayawada, speaking with Dr. Deeksha Pillarisetty, Medical Director of VMM. The organization focuses primarily on women and children through home-based medical care, support groups, mentoring programs and study/recreation centers.

"They are missing their entire childhoods," Dr. Pillarisetty said of these young orphans. "They go immediately into adulthood at a very young age." Becoming orphaned or sick themselves are not the only ways children are harmed by the epidemic. The impact on their emotional and psychological wellbeing is devastating. "The child-headed households are a particular concern," she continued, estimating that one-fourth of children affected by AIDS live in homes with no adult guardians present. Her eyes and voice filled with intensity, she leaned across the desk and described the trauma these children face alone.

"They are the most common caregivers for sick parents, which impedes their education. Eventually they watch those parents die. And even then, because of the stigma, no one wants to touch them or take care of them." All too often these children must then step into adult roles as guardians of younger siblings or wage-earners to support the remaining family. They may be denied their property and inheritance rights, face discrimination from neighbors, and deal with fears for their own health.

Alarming new evidence by UNAIDS found that orphans and children living outside family settings have a higher risk of exposure to HIV infection due to limited information about prevention, lack of role models and adult supervision, vulnerability to abuse and increased poverty. Girls are especially susceptible because they are more likely to be removed from school to care for sick parents or other family members, and are often the last in the family to receive medical care. Less access to education, sexual abuse and child marriage all place girls at a higher possibility of becoming infected. Loss of family income can push them into the sex trade and lack of control over safe sex, even within marriage, puts them at a disadvantage. Many families marry daughters off at increasingly young ages so the girls will have someone to care for

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