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Programs |
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Care for Orphans, Children Affected by HIV/AIDS, and Other Vulnerable Children |
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One measure of the massive social change yet to come as a result of the global HIV/AIDS pandemic is the number of orphans, children affected by HIV/AIDS, and other vulnerable children. According to revised 2000 estimates, there are 34.7 million children under age 15 in 34 countries who have lost their mother, father, or both parents to HIV/AIDS and other causes of death. By 2010 that number will rise to 44 million. Without AIDS, the total number of children orphaned would have declined by 2010 to fewer than 15 million. In 2010, 20 percent to 30 percent of all children under age 15 will be orphaned in 11 sub-Saharan African countries–even if all new infections are prevented and some form of treatment is provided to slow the onset of AIDS in those infected with HIV. The impact of HIV/AIDS on children and their families is not a simple problem with an easy solution. The current situation is complex, interrelated on all levels of life, and cuts across all sectors of development. State-of-the-art components for the care and support of orphans and other vulnerable children have evolved from lessons learned in various countries and experiences from development, child survival, children of war, and other HIV/AIDS-related programs. These lessons include: Policy and Law: Appropriate government policies are essential to protect orphans and other vulnerable children and their families. These policies must contain clauses to prohibit discrimination in access to medical services, education, employment, and housing, and protect the inheritance rights of widows and orphans. Medical care: For the maximum well-being of orphans and other vulnerable children, they and their guardians need to have access to complete, relevant information and appropriate health care including clinical and preventive health care services, nutritional support, palliative and home-based care. Socioeconomic support: Orphans and other vulnerable children and their families are confronted with severe threats to their well-being including isolation, loss of income, educational access, shelter, nutrition, and other essentials. When families and children are forced to focus on basic daily needs to decrease their suffering, attention is diverted from factors that contribute to long-term health and well-being. Psychological support: The psychological needs of children continue to be one of the most neglected areas of support. But the AIDS pandemic has increased the urgency to address the psychological problems of children on a par with other interventions. Education: Education plays a vital role in the well-being of children. It offers them a chance for their future as well as developmental stimuli. The impact of HIV/AIDS on the educational system has resulted in a decreasing number of teachers due to mortality, a growing number of children who are not able to attend or stay in school, and rising numbers of pupils whose ability to take advantage of schooling is undermined by other factors including poor nutrition and psychological stress. Human rights: Human rights-based approaches have been increasingly recognized as essential to the success of HIV prevention and care programs, including those working with children and adolescents. Especially important are those tenets outlined in the convention of the rights of the child. Community-based programs: There is agreement on the components of community-based programs for orphans and other vulnerable children. Prioritizing program activities will depend upon community needs, abilities, and preferences, as well as on the nature of sponsoring or partner organizations. The community is best able to identify target groups for interventions, although the government may wish to select target regions or communities for program implementation. The 1997 and 2000 editions of Children on the Brink consolidate existing knowledge from a wide range of sources. According to both versions, interventions must include five basic strategies: (1) strengthen the capacity of families to cope with their problems; (2) mobilize and strengthen community-based responses; (3) increase the capacity of children and young people to meet their own needs through access to quality education, protection from exploitation and excessive labor, and building the capacity to care for themselves; (4) create an enabling environment for children and families through such activities as ensuring basic legal protection through laws and policies to protect women and children, decreasing stigma, and behavior change interventions; and (5) ensure that governments protect the most vulnerable and provide essential services. The following should also be considered in designing such programs: Emphasizing community care rather than institutional care: Long-term institutionalization of children in orphanages and other facilities is not a desirable solution to the impacts of HIV/AIDS. Resources expended to fund institutional care for a single child can assist scores of children if used effectively to support a community-based initiative. The institutionalization of children separates them from families and communities and often delays healthy childhood development. Strengthening the care and coping capacities of families and communities: The first line of response to the needs of children affected by HIV/AIDS comes from extended families. Strengthening the capacity of communities to fill the widening gaps in the safety net traditionally provided by the extended family may be the most efficient, cost-effective, and sustainable way of assisting orphans and other vulnerable children. Families and communities also play a crucial role in identifying children who are most in need, both those affected by HIV/AIDS and other vulnerable children. Involving children and youth as part of the solution, not part of the problem: Children are not simply a passive, powerless target group to be aided, but capable actors and important resources to engage in a community response to HIV/AIDS. Actively involving children in care initiatives can build their sense of self-esteem and efficacy and cultivate skills they can use in the future. Building broad collaboration among key stakeholders in all sectors: To meet the needs of children affected by HIV/AIDS, there have to be broad networks and targeted advocacy to involve government, civil society, and nongovernmental organizations in shared initiatives of community action for orphans and other vulnerable children. Application of long-term perspective: Children will continue to be affected by AIDS for decades to come. Due to the scope and scale of the pandemic, program design requires sustainable and replicable approaches. Although material assistance is important, it is also important to ensure that community projects are not driven by material support alone but by ownership and responsibility. Integration with other services: Since the problems experienced by orphans and other vulnerable children begin well before the death of their parents, care for children affected by HIV/AIDS should start at the earliest possible point. Services for orphans and other vulnerable children should be integrated with the elements of comprehensive care such a voluntary counseling and testing for HIV, prevention of mother-to-child-transmission of HIV, and others. Linking care and prevention: Orphans and other vulnerable children are themselves at high risk of HIV infection due to economic hardship and loss of parental care and protection. For this reason alone, care programs should include a strong prevention component targeting children and youth. Resources
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