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The Social Impact of Aids in the United States
no one is yet symptomatic, are not eligible to receive services from the division, and no special attention may be devoted to their HIV-related needs, such as prophylactic treatments that might delay progression of illness.
Some other within-state differences faced by HIV-infected children are more deliberate and more dramatic in their scale. As noted above, a child living with a foster family will receive vastly greater financial support from the state than a child living with a biological parent: in Florida, $2,621 each month to the foster mother, $211 in AFDC payments to the biological mother. The child living with his or her mother remains in poverty; the other child joins the middle class. Wide disparities exist even in the social services that these HIV-infected children receive. In New York, for example, a caseworker with Leake and Watts Children's Home will carry a caseload of only 9 to 12 HIV-infected foster children, even though the children are living with well-trained foster parents, while a caseworker for an HIV-infected child living with his or her mother will have a caseload of 15 to 30 children.
The gap in expenditures on HIV-infected children living with and living apart from their biological parents is, from one perspective, easy to explain, but it rests on assumptions about family responsibilities and the responsibilities of others that are rarely examined. In this country, states do not expect to have to pay biological parents to help them care for their children. When governments provide modest cash payments through AFDC and support for food through food stamps, most Americans think of the benefits not as compensation but as charity—the ''dole"—or, at best, a social investment in the future of children (Marmor, Mashaw, and Harvey, 1990). In contrast, except in the context of adoption, government not only expects to have to pay strangers to take care of the children of others but also to pay them amply to take care of other people's children who are sick. The high payments for foster care for HIV-infected children have been based largely on an estimate of what it would take to attract a decent quality of care for a very needy group of babies. Foster care payments to third persons have always been higher, even for robustly healthy children, than AFDC payments to biological parents. With AIDS, the disparities are simply at their greatest. And the gap in the rate reveals a deep irony: a child is much better off when supported by the state to live with strangers than when supported by the state to live at home, although the latter is the setting governments claim to prefer. Legislators and policy makers extol the nuclear family, but in the context of AIDS they create a set of financial arrangements under which a mother who deeply loves her child might decide that she can show her love best by placing the child in foster care. Conversely, state officials, facing the huge difference between the payments to biological and foster parents, have an incentive to create policies that