1. Title Slide Heading Lucy Hillier RIATT-ESA Intergenerational issues between older caregivers and children in the context of AIDS A study by Regional Interagency Task Team on Children and AIDS – eastern and southern Africa (RIATT-ESA) and HelpAge International

2. Background to Study In 2009 more than 10 mill children had lost at least one parent to AIDS (UNICEF 2009). 40%-60% of children orphaned by AIDS are cared for by older carers (UNICEF 2007).

3. Objectives of the Study Identify intergenerational issues for older carers and children orphaned by AIDS; Identify policy gaps, lessons learnt, and good practices in support mechanisms to enhance intergenerational relationships.

4. Methodology Two parts: 1)Literature review of published and grey literature from the region; 2)Qualitative research using focus group discussions (FDG) with: a)older carers (M/F), b)children orphaned by AIDS under the care of older carers in seven countries in eastern and southern Africa.

5. Methodology continued For the older carers: FGDs with guidelines and lead questions; Semi-structured questionnaire for collection of demographic and socio-economic information from each of the participants; 3 separate focus group discussions were held for males, females and a combined group of males and females in each site; 133 older women carers and 123 older men carers took part.

6. Methodology continued For children: A child-centred participatory approach that took into account the age and stage of development of the children; In each country an urban and rural site where possible. Two separate groups with ideally 12 children each were engaged; 261 children aged between 10 and 18 who had been orphaned by AIDS and were living with older carers participated in the research workshops.

8. Study Sites The field research with both old carers and children was conducted by HelpAge International (HAI) partner organisations (Sept 2009 to June 2010) in: Ethiopia, Uganda, Kenya, Mozambique, Zimbabwe, South Africa Previous research from a similar process in Tanzania with the Kwa- Wazee project were also incorporated into the final report.

9. Data Analysis All activities were recorded and the information transcribed and translated into English; Themes were generated from the raw material; Themes and patterns were identified from group work and then across the groups in different sites.

10. Findings The care in these homes is largely reciprocal “I love to do this (cleaning) work because it helps my grandmother and it helps to keep my house clean and prevent diseases.” ; Households with older caregivers and the children for whom they care for have many challenges lack regular income support (incl. food insecure, forced to sell their assets, including land, to meet the basic needs of children under their care); Time given to caring reduces older carer’s ability to earn income; Older carers find it difficult to maintain good health for themselves and the children under their care;

11. Findings continued Older carers find it challenging to assume the role of a parent and impart the relevant and appropriate life skills and psychosocial support; Children living in households headed by older people often have more and physically heavier household duties than other children. They also often have the burden of earning incomes, and many of them care for their ageing grandparents in addition to this work; Children carry a heavy burden of emotional stress derived from their grief for dead parents, combined with fear about their future; Likewise, older carers also need psychosocial support stemming from the grief felt as resulting from the loss of their adult children and the stress of providing adequate care for their grandchildren.

12. Recommendations 1.As the relationship between children and older people is largely reciprocal, every effort should be made to support intergenerational households as a positive alternative form of care for children who are orphaned. 2.This is also recommended as a preferable arrangement for the older people themselves. 3.The approach should be in family centered and integrated in terms of its response to HIV and AIDS.

13. Recommendations continued 4.Focus on the rights of older caregivers and the children in their households at national, regional and local level. This includes: - building in rights based indicators which directly address the rights of older-headed households into UNGASS indicators, M&E frameworks; - Review regional and national policies, strategies and programmes across the sectors (HIV and AIDS, Children, Social development, Education and Agriculture); - Address inheritance, discrimination, access to education, child labour.

14. Recommendations continued 5.Programmatic support for older-headed households: -CSOs need to review programming, more family centred; -Programmes to support the agricultural capacity and livelihoods of older-headed households; -Social protection measures including social transfers need to be put in place to support households headed by older people; -Psychosocial support targeted at older carers needs to be put into place. Local support groups are an important way of doing this; -Psychosocial support targeted specifically at the emotional needs of children living in these households; -Older carers need education and support in parenting and communication skills.

15. Recommendations continued 6. Participation of older people and children - Older carers and children should be involved in designing, implementing and monitoring programmes that concern them. Formal structures and systems should be created for meaningful older caregiver and child participation at national, district and community levels.

17. www.riatt-esa.org