1. Children and HIV/AIDS Children in Developing Countries Renata Serra – March 6 th 2007

2. HIV/AIDS affected children Children may be disadvantaged or subject to discrimination when they are: HIV/AIDS Orphans: children who have lost one or both parents to AIDS Children infected by HIV Children living in HHs where one member is HIV/AIDS Children living in HHs which have taken up a HIV/AIDS orphan

3. Exposure to HIV/AIDS Vertical transmission: mother-child Poverty: malnutrition makes the body weak and the skin thin increasing vulnerability to HIV Lack of family support and protection may expose children to sexual exploitation

4. Issues at stake General Emotional, material, psychological and physiological losses Disruption of existing living arrangements Discrimination by both children and adults Specific Loss of mother may mean a child is double orphan Local ways to deal with pain and death vary Needs differ according to child’s age/development Adults may be differently affected and some bear disproportionate costs

5. Targeting HIV/AIDS adds to other problems: poverty, lack of nutrition, exploitation, etc. Q: Should HIV/AIDS orphans be specifically targeted? Yes, their situation is most critical AIDS orphans are likely to be discriminated against The adults caring for them are already poor No, vulnerability or poverty should be addressed instead Some orphans do better than non-orphans, it all depends on where and with whom they live Targeting may lead to stigmatization

6. Highest rates of orphaning in the world

7. Complex children’s needs Material, emotional, psychological, relational, etc. Young children are perceived as the most vulnerable but older children have a huge burden and need to be helped Given individuality of needs and conditions, standardized solutions are inappropriate – hence required solutions are costly Need to look at sibling groups rather than children individually

8. Community vs. institutional care Institutional care: Insufficient: too few resources/staff for children in needs Segregation and dependency may result Family and community based care Building on own community resources Proximity to people the child knows and loves Extended families may not suffice, hence whole communities step in

9. Broadening interventions Avoid specific targeting, involve whole communities Devise local-specific, acceptable solutions Make children participate What are the best way to involve children and discuss issues with them? See “True Friends” video Involve all community members: especially men in taking financial and other responsibilities

10. UN-sponsored framework for action 1. Strengthen the capacity of families to protect and care for OVCs 2. Mobilize and support community-based responses 3. Ensure access to essential services 4. Promote improved policy and legislation 5. Raise awareness at all levels and create a supportive environment

11. Current initiatives? Comparatively little is devoted to OVCs nationally or internationally Governments have little funds and priority are others See example of government of Zambia PEPFAR 2005: $274m (out of $2.3b total budget, of which $1370m to focus countries) for care of orphans and other people affected by HIV/AIDS Global Fund to fight AIDS, Tuberculosis and Malaria 57% of $2b disbursed in 2005 goes to HIV/AIDS Much less for care initiatives Need to readdress priorities