Together we can! Promoting intentional linkages between children’s HIV programming and child protection system strengthening Kelley Bunkers, 4Children With support from Sian Long, Maestral Intl’ September 2015

“We can only achieve an AIDS-free generation by addressing the social and economic factors that continue to fuel and impact the HIV epidemic. Inequity, exclusion, poverty, violence, and stigma continue to increase risk, decrease resilience, and compound the impact of the epidemic.” Global Partners Forum, July Protection, Care and Support for an AIDS-Free Generation: A call to action for all children.

1.To provide existing evidence on how HIV influences child protection risks and how child protection issues can increase vulnerability towards and impact of HIV in girls and boys in different age groups. 2.To learn from existing promising practices from Zimbabwe and Uganda that foster linkages between HIV and child protection actors. 3.To share available tools, case studies, programming ideas and contacts that will facilitate participants’ ability to develop linkages within existing programming interventions. 4.To consolidate new and emerging promising practices from the field. Learning objectives for today

 2013 IATT CABA-commissioned review found:  Children living with and affected by HIV face some unique and specific risks of abuse, violence exploitation and neglect  Child survivors and victims of abuse, violence, exploitation and neglect face increased HIV risks  Every CP actor and HIV actor must prevent, respond and support children affected by these combined risks  Policy makers & practitioners have inherent understanding of links  Now need support in translating into policies and practice Why this study was undertaken

Building Protection and Resilience Prevent and Protect

 Document approaches, interventions & tools that have effectively supported linkages between CP & HIV sectors.  Provide practical evidence-informed recommendations on how to engage more effectively across the child protection and the HIV and AIDS and health sectors.  Update on global evidence (rapid desk review).  Utilise promising practices from three countries to help inform recommended next steps. The study- Prevent and Protect

 Demonstrably meet expressed need of beneficiaries/ participants  Effective & relevant to local context  Ethically acceptable (addresses stigma, rights-based)  Bear fruit in reasonable time;  Likely to be sustainable e.g. (local ownership and leadership, resource allocation); and  Be viewed by core users as promising. Reference: Adapted by the consultants from Family Health International (n.d.) Selection guide for STI/HIV/AIDS Promising and Best Practices. SADC has also defined ‘Best Practices in HIV’ using similar criteria. Selection guide for STI/HIV/AIDS Promising and Best PracticesBest Practices in HIV What is a promising practice

 Nigeria, Zambia and Zimbabwe  Hosted by UNICEF country offices  Review of national policy and programming documents  Identification of potential promising practices  Attempted to identify range of entry points e.g. different target age groups, sectoral entry points, policy & practice  Each country provided 2-3 potential models Country visits

Emerging modelCountryKey focus area Childline Zambia, LifelineZambiaSpecialist child abuse hotline Child Protection Networks, Benue and Cross River States NigeriaChild protection coordination Kasisi Children’s HomeZambiaSupport for HIV+ children living in residential care National Action Plan for Orphans and Vulnerable Children (2011 – 2015) ZimbabwePolicy combining child protection / social protection under HIV umbrella Child protection case management system ZimbabweNational child protection case management UreportZambiaSocial media / counselling on HIV with strong child protection focus Zvandiri, AfricaidZimbabweHIV treatment & care for children and young people living with HIV Emerging models

Post-February 2013 evidence reinforces earlier findings:  HIV+ caregivers face unique challenges in providing protective and caring environment for children.  Orphaned children consistently experience discrimination within home, material & educational neglect, child labour, exploitation by family, emotional/sexual/ physical abuse.  Psychosocial support for children living with HIV improves HIV treatment outcomes.  Physical and sexual abuse in childhood high and significantly increases the risk of HIV in adulthood for men and women.  Growing evidence of need for ‘cash plus care.’ Global evidence update

Lessons from the field Focus on emerging practices

1. Comprehensive framework stimulates multi-sectoral collaboration  Includes investment in national case management for child protection responses alongside child-sensitive social protection  Under national HIV framework  Brings together HIV & CP partners at district level  Enables accountability for both HIV and CP results Example: HIV indicators cross-cutting across all CP and social protection interventions in Zimbabwe’s NAP II Factors that increase synergies

2. Active steps to foster workforce collaboration required for synergies to be made Investment in CP workforce and bringing HIV and CP together as equal actors Fosters mutual respect for roles & responsibilities Recognises role of children, including children living with HIV, as part of ‘workforce’ Example: Zimbabwe trained adolescents living with HIV recognized as part of the health and social welfare workforce, shared referrals increasing Factors that increase synergies

3. Case management is the ‘glue’ that binds HIV and child protection  Increased referrals for HIV treatment & individual CP case management through Zimbabwe’s community- based case management system  Case management provides regular, standardized opportunities for different sectors to meet at local level  Shared reporting could enhance service monitoring between sectors Example: Zimbabwe, Case Care Workers (community volunteers) find around 15% workload is HIV-related; young people living with HIV and HIV service providers attending case management meetings at ward and district levels Factors that increase synergies

4. Understanding child protection concerns can improve HIV treatment outcomes for children  Consistent feedback – access to HIV testing, treatment and care closely linked to children’s experiences of neglect and abuse at home  Linked referral mechanisms e.g. Ureport  Addressing children’s experiences of treatment neglect through peer-led support groups Example: Zambia UReport SMS referral system can recognize key words related to sexual abuse and violence and make referrals to Childline Zambia and social workers; data can begin to be tracked Factors that increase synergies

5. Engaging adolescents in all phases of adolescent programming improves outcomes  Successful projects intentionally involved children throughout process  Core CP and HIV issues raised by children Example: Zambia Kasisi Children’s Home brings in specialists to help HIV+ adolescents transition from care Example: Zimbabwe Zvandiri programme increasingly child-led by adolescents living with HIV, which has led to recognition from Ministry of Health, with CATS part of national health worker training Factors that increase synergies

6. Understanding and addressing HIV stigma experienced by children makes it possible to identify and respond to child protection risks and barriers to HIV care and support.  Consistent feedback – stigma central to elevated risk of harm for children both living with and affected by HIV  Need to see stigma as a child protection concern in heavily HIV-affected settings  Still insufficient monitoring Example: Zimbabwe Zvandiri programme builds in self-esteem that includes a focus on recognising stigma; health worker training seeks to identify and challenge discriminatory views Example: Nigeria: community-based programmes and health facility programmes all felt that HIV stigma was one of main drivers to not accessing treatment, but so far limited programmes addressing this Factors that increase synergies

7.Improved communication  Successful projects give children a voice  Children consistently express need for parents and caregivers to be the ones who they can talk to  Most effective entry point is childhood, especially early childhood, but few programmes addressing this linkage  Need to monitor results of improved communication for HIV treatment results and for reduced child protection violations Factors that increase synergies

Key entry points

1.Link HIV and child protection policies in one national policy as means to understand interlinked economic, HIV and child protection vulnerabilities faced by children and families 2.Include focus on understanding and addressing HIV- related stigma and discrimination, as children experience them, within HIV and child protection standards, protocols etc. 3.Ensure that children and young people, especially living with HIV, are included in all programming phases, and actively enable their inputs on child protection-related HIV risks e.g. in HCT Key entry points-- building on what works

4.Involve CP experts in national and sub-national working groups on HIV prevention and HIV treatment, care and support, as well as in OVC or impact mitigation groups; and vice versa. 5.Invest in a strong, integrated case management system for all vulnerable children and families, which can measure improved outcomes for HIV-affected children and families 6.Use development of alternative care or family strengthening strategies / programmes as an opportunity to recognise and respond to neglect and abuse of children living with HIV in all forms of family-based and alternative (i.e. residential) care. Key entry points-- building on what works

7.Pay special attention to needs of children from key populations, to provide linked HIV and child protection services. 8.Include one or more specific indicators on HIV/child protection synergies in national social workforce strengthening strategies. 9.Build on global attention on violence against children / GBV to link specialised sexuality & sexual abuse services with CP case management and HIV prevention and treatment programmes. Key entry points-- building on what works

10.Use adoption of revised PMTCT and paediatric HIV treatment guidelines to include priority child CP information & referral protocols into job descriptions, SOPs etc. 11.Include positive parenting to encourage communication and disclosure between parents/caregivers and children and adolescents expertise from ECD, parenting support and HIV prevent, by bringing together ion initiatives. Key entry points-- building on what works

 Must get right balance between moving from welfare- orientated and HIV-targeted OVC programmes to a response for vulnerable children that is HIV-sensitive and not HIV-blind.  Must ensure that CP not interpreted as only HIV impact mitigation – links with treatment are paramount.  Growing need to address and respond to questions on male sexual violence and on sexual orientation despite existing cultural, political & legal barriers. Ongoing challenges

 Practical linkages remain intuitive - practitioners are seeing links, especially stigma / treatment issues & family neglect in their day to day work.  Focus on systems strengthening is an opportunity to enhance and coordinate a system for OVC / CP / other forms of vulnerability.  Growing body of experience on the ground – the sooner this translated into policy, the easier it will be to document evidence & improve results for children. And finally……….

We will break into three groups and each of you will have a chance to hear the experiences of those involved in child protection and HIV policy and practice and how they have intentionally informed linkages within their work.  Government of Zimbabwe, Department of Children’s Services and World Education: Developing a national case management system that facilitates linkages between HIV and child protection.  World Education (Bantwana), Uganda: Strengthening linkages at community level. Peer training between health workers and para social workers.  Zvandiri, Zimbabwe: Ensuring that the voices and experiences of youth influence and inform linkages between HIV and child protection. World Café

Thank you!