Children Affected by HIV and AIDS Access to Prevention, Treatment and Care

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Children Affected by HIV and AIDS - Access to
Prevention, Treatment and Care Global Situation
and Response
Peter McDermott Chief, HIV/AIDS
Section UNICEF 7 February 2006
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Overview
1,

• Global Situation
• Key Challenges
• Emerging practice
• What needs to be done

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While There Has Been a Paradigm Shift. . .
Children are missing from the global response

• Paradigm shift in the Global Response
• Political
• Advocacy
• Resources
• Treatment
• Treatment costs
• ..But children missing out

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Estimated deaths in children (lt15 years) from
AIDS during 2005
Eastern Europe Central Asia 2,100
Industrialized Countries 200
East Asia Pacific 7,700
North Africa Middle East 10,000
South Asia 25,000
Latin America Caribbean 7,000
Western Central Africa 170,000
Eastern Southern Africa 340,000
Total 570,000 (510,000 670,000)
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Estimated number of children (lt15 years) newly
infected with HIV during 2005
Eastern Europe Central Asia 3,700
Industrialized Countries 700
East Asia Pacific 11,000
North Africa Middle East 10,000
South Asia 36,000
Latin America Caribbean 12,000
Western Central Africa 220,000
Eastern Southern Africa 410,000
Total 700,000 (630,000 820,000)
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Children (lt15 years) estimated to be living with
HIV as of end 2005
Eastern Europe Central Asia 7,700
Industrialized Countries 14,000
East Asia Pacific 31,000
North Africa Middle East 38,000
South Asia 100,000
Latin America Caribbean 68,000
Western Central Africa 680,000
Eastern Southern Africa 1.4 million
Total 2.3 (2.1 2.8) million
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Impact of HIV/AIDS epidemic on children

• Child deaths due to AIDS in 2005 570,000
• New HIV infections among children in
  2005 700,000
• Children living with HIV 2.3 million
• Children orphaned by AIDS 15 million
• Children made vulnerable by AIDS ???

Source UNAIDS. AIDS Epidemic Update 2005.
UNICEF, USAID, UNAIDS Children on the Brink 2004
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The worst is yet to comeThe number of orphans
will rise even after the number of adults
infected stagnates or declines
Epidemic curves for Sub-Saharan Africa
2004
25,000,000
20,000,000
Adult mortality - AIDS
Adults living with HIV
15,000,000
Millions
18 million orphans due to AIDS in 2010
10,000,000
Orphans - AIDS
5,000,000
0
1985
1990
1995
2000
2005
2010
1980
Mortality is cumulated over 17 years to
represent parents that have died. Based on
projections of the AIDS epidemic 2004 by
UNAIDS/WHO working group on HIV/AIDS/STI
surveillance
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In Sub-Saharan Africa 5.2 million children
experienced the death of a parent in 2003 alone
Estimated number of children ages 0-17 who will
experience the death of a parent during the year
Source Children on the Brink, 2004
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The number of orphans is decreasing in all
regions except sub-Saharan Africa.
143 million orphans in 2003
Asia
Sub-Saharan Africa
Latin America and the Caribbean
Source UNICEF/UNAIDS/USAID Children on the Brink
2004
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In 11 countries in sub-Saharan Africa, more than
15 of all children were orphans in 2003
Percent of children ages 0-17 who are orphans
Source Children on the Brink, 2004
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Impact of AIDS on child mortality Estimated
impact of AIDS on under-five mortality rates
20022005, selected countries in sub-Saharan
Africa
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Orphaning only one category of children affected
Children are affected by HIV/AIDS for many
reasons, but the majority of children affected by
AIDS are made vulnerable because the adults
around them are sick, dying or have recently
died. Orphans represent only one category of
children affected and are not always the most
vulnerable.
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Complexity of Problems among Children and
Families Affected by HIV/AIDS
HIV infection
Children may become caregivers
Increasingly serious illness
Psychosocial distress
Economic problems
Deaths of parents young children
Problems with inheritance
Children withdraw from school
Children without adequate adult care
Inadequate food
Discrimination
Problems with shelter material needs
Exploitative child labour
Sexual exploitation
Reduced access to health services
Life on the street
Increased vulnerability to HIV infection
Source Williamson 2000
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Orphans and vulnerable children are at higher
risk of becoming infected themselves
HIV infection and reproductive health outcomes by
OVC status, Manicaland, Zimbabwe 2004
Source Gregson and others. 2005. HIV infection
and reproductive health in teenage women orphaned
and made vulnerable by AIDS in Zimbabwe. AIDS
Care 17(7)796-794.
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Orphans are less likely to be at the proper
education level
Probability of being at appropriate education
level
6 to 10
11 to 14
Source Bicego, G. S. Rutstein and K. Johnson.
2003. Dimension of the emerging orphan crisis in
sub-Saharan Africa. Social Science and Medicine
56(6)1235-47.
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Almost half of orphans in sub-Saharan Africa are
adolescents
Percentage of children ages 0-17 who are orphaned
by age group
Source Data produced for Children on the Brink,
2004
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The proportion of orphans in rural settings
versus urban settings varies by country
Surplus percentage of children ages 0-14 who are
orphaned in urban setting versus rural setting
Additional percentage in urban setting
Additional percentage in rural setting
Ratio of urban to rural orphans
Source UNICEF MICS, Measure DHS 1999-2004
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Vulnerable children are less likely to have
basic material needs than non-orphaned or
orphaned children
Percentage of children with basic material needs
(blanket, shoes, two sets of clothing), Blantyre,
Malawi 2004
Vulnerable child whose parent is chronically
ill, or who lives in a household where an adult
has recently died or an adult is chronically
ill. Street a child who slept on the street
the night before the survey. Source
UNICEF/USAID, 2004, OVC Pilot Survey, Blantyre
Malawi.
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Global commitments exist UNGASS Declaration of
Commitment, 2001

• 65. By 2003, develop and by 2005 implement
  national policies and strategies to build and
  strengthen governmental, family and community
  capacities to provide a supportive environment
  for orphans and girls and boys infected and
  affected by HIV/AIDS including by providing
• appropriate counselling and psycho-social
  support
• ensuring their enrolment in school and
• access to shelter,
• good nutrition, health and social services on an
  equal basis with other children
• to protect orphans and vulnerable children from
  all forms of abuse, violence, exploitation,
  discrimination, trafficking and loss of
  inheritance

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• After more than 20 years
• Less than 10 per cent of pregnant women are being
  offered services to prevent transmission of HIV
  to their infants.
• Less than 10 per cent of the children who have
  been orphaned or made vulnerable by AIDS receive
  public support or services.
• Less than one third of young women aged 1524 in
  sub-Saharan Africa fully understand how to avoid
  the disease.

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Unite for Children Unite Against AIDS Global
Campaign

• Provide a child-focused framework for nationally
  owned programmes around the Four Ps urgent
  imperatives that will make a real difference in
  the lives and life chances of children affected
  by AIDS
• Prevention mother-to-child transmission of HIV
• Provide paediatric treatment
• Prevent infection among adolescents and young
  people
• Protect and support children affected by
  HIV/AIDS

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Public support for orphaned and vulnerable
children globally is estimated to be very low
(3)
Excluding Eastern European Region Source Policy
Project Coverage Survey, 2004
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Coverage of prevention of mother-to-child
transmission of HIV
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Increasing primary prevention will reduce the
number of new infections among young people (aged
1524)
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Global agreement on broad strategies

• Strengthen capacity of families
• Mobilize and support community-based responses
• Ensure access to essential services
• Ensure that governments protect the most
  vulnerable children
• Raise awareness through advocacy and social
  mobilization.
• From the Framework for the Protection, Care and
  Support of Orphans and
• Vulnerable Children Living in a World with
  HIV/AIDS

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Key Challenges to a Global Response 1

• Reconceptualisation Definition terminology
• Need for differential analysis response
• Coherence
• Stronger data and evidence
• Scale project to programme to National

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Key Challenges to a Global Response 2

• National coordination multisectoral response
• Limited programme level indicators/quality
• Limited life cycle approaches
• Lack of state and civil society capacity
• Targeting challenges

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Key Challenges to a Global Response 3

• Public service infrastructure manpower
• Getting resources to the base
• Non utilization key assets, FBO, schools, clinics
• Voices and participation children
• Primary Prevention

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Emerging Practices

• National Plans and strategies
• Strengthening capacity Govt. and Civil Society
• Community Care points
• Cash grants elderly care givers/households
• Abolition school fees and other barriers
• Minimum care package concepts
• Linking OVC responses with Home Based Care
• Psychosocial support responses
• Social / legal protection responses
• Stronger documentation, research and M E
• Paediatric treatment

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The Global Response Requires Regional Adaptation

• Differential analysis
• Epidemiological analysis
• State capacity
• Contextual situation of children affected
• Need to adapt
• Framework
• Strategies
• Programme interventions

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What needs to be done?

• National Programmes (scale responses)
• Identify , overcome key obstacles/barriers
• National social protection responses S.Africa
  Botswana, Namibia
• Scale up NGO/community responses Zambia, Uganda
  increasingly Malawi and Zimbabwe
• Align, Integrate and Mainstream responses
• PRSPs, development instruments
• Three ones, GTT, Universal access
• Sector-wide plans education, health and social
  welfare systems
• National Development and AIDS plans

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What does need to be done. 2

• 3.Strengthen role and capacity of governments
• Policy and legislation
• National Coordination
• Infrastructure and human resources
• Standards, monitoring, evaluation and
  supervision
• 4. Improve monitoring, data and measurable
  outcomes for children
• Strengthen monitoring and evidence base
• Increase operational research
• Document experiences
• Focus on results and measurable outcomes

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What needs to be done. 3

• 5. Make the money work for children
• Mobilize and effectively utilize resources
• Count and measure
• 10 Floor for children
• 6. Partnerships
• Coordinating the contributions of all actors is
  essential to avoid isolated interventions that
  are not linked to wider and longer-term
  programmatic, sectoral or national interventions.
• The number of international contributions to the
  fight against HIV/AIDS often strains the capacity
  of national coordinating bodies, leaves gaps in
  national responses and increases the risk of
  duplication.

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What needs to be done. 47. Endorse, adapt and
operationalise
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Thank you!