1. Programing to Meet the Changing Roles of Orphans and Vulnerable Children Renee DeMarco USAID/Ethiopia December 5, 2011 OWN, SCALE-UP & SUSTAIN The 16 th International Conference on AIDS & STIs in Africa 4 to 8 December 2011, Addis Ababa www.icasa2011addis.org

2. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN “Given the variability in individual, family and contextual factors across settings, application of a preset minimum package of PEPFAR-funded interventions or services for all children would be unrealistic and costly.” PEPFAR, State of the Program Area Report, January 2010

3. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Informed Response to Changing Roles of OVC Know your epidemic Know your country Know your children

4. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Epidemic Considerations-Global View 2.1 million children, under age 15, living with HIV 5 million children ages 15-24, living with HIV (vast majority female) 9,000 new infections annually (15-24) 17.5 million children lost one or both parents, even more children living in HH with chronic illness UNAIDS 2009, UNICEF, 2010

5. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Epidemic Considerations Generalized (chronic illness, disability) Mixed (transactional sex) Concentrated (young MARPs, criminalized behaviors)

6. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Country Considerations Social Economic Status (per capita) Strength of safety nets Disease burden Man-made and natural disasters Population distribution, migration patterns Social/cultural norms

7. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Country Considerations Too early marriage Transactional sex is the norm School drop out rates Policies re: disabilities, child protection Influence of religion/spiritual beliefs Gender-specific expectations

8. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Know your Children—Life Cycle UNICEF, Taking Evidence to Impact, 2011

9. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Mixed Epidemic/Know your child Population Council/Ethiopia, March 2010

10. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Ethiopian Children Reasons for being on the street (many children gave at least 4 of these factors) Retrak/Ethiopia, June 2007-June 2009

11. The 16 th International Conference on AIDS & STIs in Africa, Addis Ababa OWN, SCALE-UP & SUSTAIN Conclusions Consider a three-way analysis Overlay factors of living with HIV Bundle programming more extensively (HIV/AIDS with child survival, ARSH, family planning, democracy and governance, education)