Approaches to addressing the experiences of children and young people with HIV in programming and policy development P romising Practices for Creating Purposeful Linkages between HIV and CP Eliza Jaya and Samantha Chimwariro March 2016

Why link HIV and Child Protection? Antiretroviral therapy (ART) has resulted in dramatic survival improvements for children and adolescents with HIV Yet this vulnerable group remain at high risk of neglect, violence, stigma and discrimination. Children and young people have a right to: Access HIV testing services so that they can access appropriate post-test services Access age and developmentally appropriate information about their own health, including full disclosure Access ART and adherence support Grow up in safe, supportive environments, free of stigma and discrimination

Why link HIV and Child Protection? Yet all too often, children and adolescents are: not brought for HIV testing services early enough, are informed of their HIV status too late are brought for ART too late get inadequate support with adherence experience stigma and discrimination HIV and protection services have commonly been planned and implemented in parallel. Yet the social determinants of health amongst children and adolescents with HIV require a multi-sectorial response if this highly vulnerable group of young people are to be kept safe and healthy.

The Ministry of Public Service, Labour and Social Welfare is the Ministry with the mandate for the care and protection of children in Zimbabwe. Africaid, a local Private Voluntary Organisation, through the National Action Plan for Orphans and Vulnerable Children Phase 2 is in partnership with this Ministry to provide specialist services for those children living with HIV to be confident and to keep safe. Through this partnership, AFRICAID has been able to strengthen the capacity of the Department of Child Welfare and Protection Services Officers in the Ministry to identify and respond to child protection cases of children living with HIV. How did we integrate CP and HIV?

Zvandiri provides community and facility based health, protection and psychosocial support services for children and adolescents with HIV across all ten provinces Through the NAP for OVC, Africaid provides technical support to the Department of Social Welfare in ensuring the implementation of an HIV sensitive Case Management System The Government of Zimbabwe through the Ministry of Public Service, Labour and Social Welfare is implementing the National Case Management System which makes use of Community Volunteers known as the Community Childcare Workers. This child protection System is operational in all districts across the country.

How did we integrate CP and HIV? 1. Capacity building and Strengthening of the Department of Child Welfare and Protection Officers and Community Childcare Workers – Improved capacity to recognise, prevent and respond to child protection violations against children and adolescents with HIV – Community Childcare Workers are volunteer cadres in the Ministry of Public Service, Labour and Social Welfare who identify child protection and welfare cases, including those of children living with HIV in the community and refer to the DCWPS district offices 2. Integration of CATS within the national case management system – CATS are young people with HIV who are trained and mentored to provide information, counselling, treatment support, monitoring, tracking and referral services for their HIV positive peers. – CATS work alongside case care workers at community level to identify, refer and support children at risk to health and protection services (MoHCC and DCWPS) – Improved identification and response to child protection violations in CLHIV 3. Participation at HSCT pay points to promote the identification of vulnerable children and adolescents – Increased referral of children and adolescents to HIV services

Tanaka, 14 years Tanaka was born with HIV; lives with his grandmother Referred by the case care worker to the CATS due to ill health The CATS found Tanaka to be: – Poorly adherent due to lack of treatment support from family – Depressed due to stigma at home by other relatives – Missing school due to ill health, no financial support and household chores – Missing clinic appointments – Tanaka had no birth certificate – Verbal and emotional abuse at home due to the HIV status The CATS – Provided counselling for Tanaka and the Grandmother – Accompanied them to the local clinic for assessment and follow up – Referred Tanaka to the local Zvandiri support group – Referred back to the CCW for BEAM registration as well as birth registration “Tanaka is now a different child. He is happy, takes his medicine, and says he no longer feels alone” Grandmother

What are the main benefits of this approach? The meaningful engagement of young people with HIV in HIV and CP services: ensures the critical relevance of policies and programmes acknowledges their experiences as real respects their right to be involved in issues affecting them recognises that we care what young people think, feel and need is often therapeutic for those involved provides opportunities for young people to gain new skills, confidence and self worth Demonstrates to others in their lives that they are valued, respected, competent and have a critical role to play

What have we learned? The meaningful engagement of young people in HIV and CP policy and programming requires Everyone to be committed and to believe in it – Government, Service providers, Communities, Families Clear policies and procedures which protect young people Robust referral pathways between different sectors Training and supervision for both HIV and CP service providers Training and supervision for young people providing HIV and CP services Continuous reflection, together with young people and families Learning from what worked and what didn’t work

What would we recommend to others wanting to link HIV and CP? This model has been highly effective and is being scaled up nationally but it is not quick, simple or free! – The CATS model is not stand alone. It is integrated within the government health and child protection system – There must be strong systems to support young people so they are actively, meaningfully engaged within service delivery – Training and supervision is essential – weekly ideal, monthly at minimum; by those who are trained to support them – We recognise CATS as critical in the HIV case cascade and case management system and that means we must invest in them. Young people are not free labour! – Policies and procedures should be in place which protect them