The USAID Response to the Global HIVAIDS Pandemic

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The USAID Response to the Global HIV/AIDS Pandemic

• US Agency for International Development
• Bureau of Global Health, Office of HIV/AIDS
• May, 2004

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Presentation Outline

• DATA
• IMPLICATIONS
• RESPONSES
• USAID/USG SUPPORTED ACTIVITIES
• INTERNATIONAL COMMITMENTS
• AND CONSENSUS

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DATA
4

• An estimated 20 million adult and child deaths
  due to AIDS have occurred since the beginning of
  the epidemic

5
Projected population structure with and without
the AIDS epidemic, Botswana, 2020  
Source US Census Bureau, World Population
Profile 2000
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Children on the Brink 2002Joint report USAID,
UNAIDS, UNICEF

• Three regionsAfrica, LAC, Asia
• 88 countries
• Paternal, maternal, double orphans
• Due to AIDS and due to all causes
• Children under the age of 15
• (COB2004Children under the age of 18)

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Not Just Orphans

• Parent(s) dead
• Parent(s) ill
• Over 15 years old, as well as under 15
• Living in families caring for orphans
• Living in communities severely affected

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Sub-Saharan Africa34 Million
East, South Southeast Asia65 Million
Latin AmericaCaribbean8.2 Million
At the end of 2001 there were more than 100
million orphans under the age of 15.
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Children Affected by HIV/AIDS

• 200113.4 million orphans as a result of AIDS
• 201025 million orphans as a result of AIDS
• Children under age 15 and living in most
  severely affected regions of the world.

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Percent of children under age 15 who are orphans
by region, year, and cause
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Number of orphans by region, year, and cause
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By 2010, orphans will account for 15 to over 25
of all children in 12 sub-Saharan African
countries
13
Number of double orphans in sub-Saharan Africa is
increasing due to HIV/AIDS
14
All orphans and orphans due to AIDS by HIV
prevalence for Uganda, by year
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IMPLICATIONS
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• The pandemic is undermining two decades of
  hard-won gains in child health and survival.It
  will also have other, far-reaching consequences
  on social structure, economic development, and
  human productivity.

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Multi-faceted Vulnerability

• Morbidity and mortality
• Psychological distress
• Poverty
• School drop-out
• Malnutrition and food insecurity
• Loss of inheritance
• Fear, isolation and stigma
• Abuse and neglect
• Risk of HIV/AIDS.

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The Situation of Care Takers Is Also Worsening

• Increased Burden of Care

• Increased Discrimination

• Little Access to Resources, Few Supports
•  

• Denial of Rights Inheritance, Property,
  Decision Making

• Lost Opportunities for Paid Employment and
  Education

• Care giving Pushes Women Back Into the
• Spiral of Poverty and HIV/AIDS Infection
•  

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RESPONSES
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Responses must address  

• Urgency
• Scale
• Duration
• Complexity

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• The large majority of adults and
• children in ALL high prevalence
• countries are HIV negative or
• continue to be in good health
• while HIV-positive

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Families are Responding

• Adopting and fostering children
• Shifting children to equalize extra burdens
• Changing member roles and responsibilities
• Expanding childrens participation
• Working harder and more productively.

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Communities are Responding

• Forming orphans assistance committees
• Targeting assistance to the most needy
• Counseling guardians and providing material
  assistance
• Protecting widows and orphans land and property
  rights
• Raising funds and starting income-generating
  projects
• Pooling labor and resources.

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Young People Are Responding

• Responsible for their own survival
• Caring for the sick
• Becoming household heads
• Supporting younger children
• Participating in community
• orphan committees
• Supporting other vulnerable
• children in their communities
•  

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Governments Are Responding

• Creating national orphan policies
• Reviewing and codifying laws
• Expanding social services
• Providing public assistance
• Tightening sexual abuse laws
• Changing adoption and fostering laws
• Creating public awareness and providing
  public education

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International Community is Responding

• Increased funds
• Coordination and consensus
• National policies and strategies
• Research
• Documents, reports, tools
• Training and technical assistance
• Monitoring and evaluation

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USAID/USG SUPPORTED ACTIVITIES
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President Bushs Emergency Plan for AIDS Relief

• Treat 2 million HIV-infected people
• Prevent 7 million new infections
• Care for 10 million HIV-infected individuals and
  orphans and other children affected by HIV/AIDS

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Countries in the Initiative

• Botswana
• Cote d'Ivoire
• Ethiopia
• Kenya
• Mozambique
• Namibia
• Nigeria
• Rwanda

• South Africa
• Tanzania
• Uganda
• Zambia
• Guyana
• Haiti

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ANNUAL PROGRAM STATEMENT (APS)

• Objectives
• To provide comprehensive and compassionate care
  to improve the quality of life for OVC.
• To strengthen and improve the quality of OVC
  programs through the implementation, evaluation
  and replication of best practices in the area of
  OVC programming.
• 2 review periods 11/03 4/04
• Total 20 million FY04 funds

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USAID Project Profiles Children Affected by
HIV/AIDS-Third Edition
 

• 99 Projects
• 83 country-specific
• 16 global/regional
• 21 countries
•  

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USAID Projects Multisectoral Responses

• Support to CBOs
• Psychosocial support
• Education assistance
• Food security/ Nutritional
• Economic strengthening
• Access to Health
• Increased awareness
• HIV/AIDS prevention

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USAID Projects Global Activities

• Expanding the knowledge base
• Tools
• Research
• Information Dissemination and Exchange

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Expanding the Knowledge Base

• Tools
• Electronic Toolkit
• Monitoring and Evaluation Program Guide
• Costing Guide for Programs
• Building Blocks Community Resources (Africa and
  Asia)
• Situation analysis methodology (Zambia and
  Global)
• Gathering Information from Children and
  Adolescents An Ethical Guide

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Orphans and Other Vulnerable Children Electronic
Toolkit (Alliance and FHI)

• What is the OVC Toolkit?
• A library of electronic resources
• Guidance on different aspects of programming for
  OVC (about 70 themes)
• Website/CD-ROM/Hard copy summary

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Orphans and Other Vulnerable Children Electronic
Toolkit

• What types of resources?
• Tools
• (training manuals, monitoring forms,
  protocols, how-tos
• Information
• (situation analysis, assessments, key studies)
  
• Operational Examples
• (grant reporting forms, enumeration forms)

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A Guide to Monitoring and Evaluating
Program-level Activities for Children Affected by
HIV/AIDS
Gap in Program-Level ME guidance identified
IATT-OVC and Technical Consultation on
Indicators April, 2003 May 8, 2003 Request
from Washington-based OVC Task Force
identified Guide being developed by FHI/IMPACT
Project
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Objectives

• Increase the practice of ME in OVC programs
• Monitoring Increase effectiveness of programs
• Increase efficiency of programs
• Evaluation Determine effectiveness
• Build capacity to conduct ME
• Foster a consistent approach

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Considerations for the Guide

• Includes monitoring and evaluation
• -including impact evaluation
• Target audience sub-national programs
• Organized by cross-referenced modules (27)
• Includes tools and other materials
• Quantitative and Qualitative methods addressed
• Addresses linkage between
• program and national/global indicators

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Guidelines for Calculating Cost of Programs for
Children Affected by HIV/AIDS

• Target audience Implementing organizations
• Objectives
• Assist local NGOs to assess costs for
  programmatic needs and effective resource
  management

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Objectives (continued)

• To determine actual costs of OVC interventions to
  inform costing models, decisions on scaling up
  and reproducing OVC activities, etc
• To provide the international community with
  instruments to estimate costs of OVC programs
  that can be consistent across programs

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Considerations for the Costing Guide

• Easy-to-follow, clear instructions to calculate
  actual cost of interventions
• Examples of use of cost information for decisions
  on scaling-up and replicating activities
• Examples of use of cost information for
  monitoring program and increasing efficiency
• Guide being developed by
• Community REACH and FHI/IMPACT Projects

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BUILDING BLOCKS BRIEFING NOTES International
HIV/AIDS Alliance

• Africa- based
• Psychosocial support
• Health and nutrition
• Economic strengthening
• Education
• Social Inclusion
• Asia-based Currently under development

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Expanding the Knowledge Base

• Research
• Models of intervention - succession planning
  (Uganda)
• Interventions to address lt5 children affected by
  HIV/AIDS (Kenya)
• Methodology and evaluation of program
  effectiveness (Rwanda/Zambia)
• Overview of positive models of youth involvement
  
• Overview of national policy

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Expanding the Knowledge Base

• Research (cont)
• RFA on Studies to improve effectiveness of OVC
  interventions
• Older people as Carers
• Children on the Brink 2002/2004
• Distribution analysis from DHS and MICS
• Country Data Profiles

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Improving Support to OVC through Focused Study
and Research (Community REACH)

• Four Research Grants
• Local existing program research partner
• Vulnerability and protection related to migration
  of OVC Uganda
• Programming support to older, primary caregivers
  Tanzania
• The role of early child development (ECD)
  practitioners in support to OVC South Africa
• Programming support to foster families - India

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Involving young people in providing support to
OVC in Zambia(HORIZONS, CARE/Zambia, Family
Health Trust)
 

• Youth caregivers were trained to involve OVC in
  recreational activities to reduce their sense of
  isolation, to contact schools to make sure that
  their needs are recognized, and to make referrals
  to NGOs working with OVC in cases when necessary.
  

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RESULTS
 

• Young caregivers providing Care and Support
• Females 4 PLHA and 4 OVC
• Males 4 PLHA and 5 OVC

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Average Number of PLHA and OVC cared for in
previous 3 months
 

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Services Provided to OVC
 

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CONCLUSION
 

• Trained youth caregivers are able to meet a range
  of PLHA and OVC needs, to the satisfaction of
  their clients, and their efforts may lead to
  decreased isolation and stigmatization of
  AIDS-affected families.

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Information Exchange

• Regional workshops to support national action in
  Africa
• Town hall technical information exchange (India,
  Economic Support, Education)
• Global Network on Better Care - children without
  family care
• OVC NGO task force
• OVC Technical Consultation 11/03
• (Meeting Report
• CABA Listserve

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Multi-Country Regional Workshops UNICEF USAID
UNAIDS, STC, FHI

• November, 2000 Lusaka, Zambia
• 14 countries - East and Southern Africa
• April, 2002 Yamoussoukro, CI
• 21 countries - West and Central Africa
• November, 2003 Maseru, Lesotho
• 10 countries - Southern Africa

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WORKSHOPS on STRENGTHENING NATIONAL RESPONSES to
OVC USAID, UNICEF, FHI

• November, 2003 Maseru, Lesotho
• THEMES
• Collaborative situation analysis
• National Consultations and coordinating
  structures
• Costed Strategic National Action Plans
• Monitoring and Evaluation
• Policy and Legislative Framework

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Children Affected by HIV/AIDS (CABA) Listserve

• Participants 750
• countries represented 40
• Types of Information Exchanged
• Discussion about technical issues
• Information about new documents, tools,
  workshops, jobs, etc
• Queries for resources and opinions

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INTERNATIONAL COMMITMENTS AND CONSENSUS
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UNGASS

• At the United Nations General Assembly Special
  Session (UNGASS) on HIV/AIDS, in June 2001,
  governments from 189 countries committed
  themselves to a comprehensive programme of
  international and national action to fight the
  HIV/AIDS pandemic. The Declaration established a
  number of goals, including
• reductions in HIV infection among infants and
  young adults
• improvements in HIV/AIDS education,
  health care and treatment
• improvements in orphan support.

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United Nations Special Session on HIV/AIDS
Declaration of Commitment
By 2003, develop, and, by 2005, implement
national policies and strategies that create
supportive environments for girls and boys
infected and affected by HIV/AIDS by providing
counselling and psycho-social support enrolment
in school access to shelter, good nutrition,
health and social services and protection from
abuse violence, exploitation, discrimination,
trafficking, and loss of inheritance.
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United Nations Special Session on HIV/AIDS
Declaration of Commitment
Ensuring non-discrimination and protection of
human rights of children orphaned and made
vulnerable by HIV/AIDS, through the promotion of
an active and visible policy of
de-stigmatisation. Urge donor countries, civil
society, and the private sector, to complement
national programmes to support children orphaned
by or made vulnerable to HIV/AIDS.
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International Consensus on Programming

• Framework for Protection, Care and Support of OVC
  Living in a World of HIV/AIDS
• Five strategies
• Principles of Implementation

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Strategies for Interventions

• Strengthen and support the capacity of families
  to protect and care for their children
• Mobilize and strengthen community-based
  responses
• Strengthen the capacity of children and young
  people to meet their own needs

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Strategies for Interventions

• Ensure that governments develop policies and
  provide essential services for the most
  vulnerable children
• Raise awareness to create an environment that
  enables support for children affected by HIV/AIDS.

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Principles for Implementation

• Strengthen the capacities of families
• Support economic strengthening
• Enhance responses to psycho-social needs of
  children and their caregivers

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Principles for Implementation

• 4. Foster linkages among HIV/AIDS prevention
  activities, home-based care, and efforts to
  support orphans and other vulnerable children.
• 5. Target the most vulnerable children and
  communities, not children orphaned by AIDS.
• 6. Give particular attention to gender roles.

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Guiding Principles for Interventions

• 7. Involve children and adolescents as part of
  the solution.
• 8. Strengthen role of schools and education
  systems.
• 9. Reduce stigma and discrimination

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Principles for Implementation

• 10. Accelerate learning and information exchange.
• 11.Strengthen partnerships at all levels and
  build coalitions among key stakeholders.
• 12. Ensure external support does not undermine
  community initiative and motivation.

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The impact of AIDS on children and youth and on
their families is so vast that only a unified
effort can truly begin to mitigate its impact
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Website addresses

• Http//sara.aed.org/ovc-tc
• www.aidsalliance.org...
• www.synergyaids.com...
• Children on the Brink 2002 (http//www.usaid.gov/p
  op_health/aids/Publications/docs/childrenbrink.pdf
  )
• USAID Project Profiles Children Affected by
  HIV/AIDS 3rd edition (http//www.usaid.gov/pop
  _health/aids/Publications/docs/cabaprojectprofiles
  .pdf)