Care for children affected by HIV/AIDS
Item
- Title
- Care for children affected by HIV/AIDS
- extracted text
-
Care for children affected by HIV/AIDS
What is in this guide?
This guide looks at ways of supporting children
affected by HIV/AIDS. It covers children whose
parents are ill or have died as well as children
living with HIV/AIDS.
4/
It has the following sections:
1.
2.
3.
4.
5.
6.
Introduction
Important principles
Community child care committees
Children whose parents are ill
Children who are orphaned
Children who are living with HIV/AIDS
This web site also contains the following guides
on HIV/AIDS
Important things to know about HIV/AIDS
Introduction to community projects on HIV/AIDS
How to run HIV/AIDS prevention and education
projects and campaigns
How to care for people living with HIV/AIDS and
their families
How to care for children affected by HIV/AIDS
How to coordinate local community projects on
HIV/AIDS
How to develop a municipal AIDS strategy
Introduction
The fact that there is a stigma around HIV/AIDS that prevents people from being
open increases the isolation of people in families affected by HIV/AIDS. Not only
do they have to deal with their own grief and emotional suffering but also this is
made worse by the way that the community treats them.
Vs
V\\
The greatest impact of HIV is on young people. The same generation whose
parents are ill now are likely to be the ones who will themselves be ill in later
years. In their childhood, they get little emotional and material support and they
often have to start playing roles that are usually expected from adults. In many
families, they play the adult role of maintaining the house and sometimes even
trying to provide an income. Most of them play some nursing role and directly
look after the parents who are ill. Older children also play the parent role to their
younger siblings.
When parents die, very small children are often taken in by relatives. The survival
of older children is often neglected and they are more vulnerable. In many cases,
older children drop out of school to look after younger siblings. When they are not
provided for by relatives, some end up living on the streets or barely surviving in
very impoverished homes.
There are three categories of children who need special care:
Children whose parents are ill
Children whose parents have died
Children with HIV/AIDS
Most of the affected children (and the people who care for them) do not get the
grants they have a right to get. See page 24 for foster, care dependency and
child support grants. The main reason for this is ignorance, lack of access and
lack of the right documents.
2. Important principles
Target all children in need
There are many different models of community childcare projects. The main
principle should be that all children in need should be identified and supported in
some way. A project that deals with children affected by HIV/AIDS should be
integrated in other efforts to help children in need.
This will also help to deal with the stigma and secrecy surrounding HIV/AIDS. If
all children who have ill parents are supported, it will be easier for children to ask
for help than if a project only helps children whose parents are ill with AIDS.
Keep children in their communities
Children should be supported in ways that help them to stay part of their
community and family. For example, the common old-fashioned idea that
children who are orphaned should be put in institutions like orphanages is no
longer popular.
Orphanages are expensive and are not very healthy places for children to grow
up. It is much better to keep the children in the communities they come from and
to make sure that they get adult supervision and support in a familiar
environment.
Adoption is also not easy to organise, especially for older children. It is even
difficult to find adoptive parents for babies if there is a chance that they may be
HIV positive.
It is not good to separate children from their siblings when they have lost their
parents. It is much better to keep them as close to their natural support groups as
possible. If there are other members of the family who can take in children this is
often better than fostering them out to different families or letting different families
adopt different children.
Coordinate services and use volunteers
Support must be well coordinated and reach down to the ground. This means
that all services and organisations should work together to identify children in
need and to make sure they get the right help. Welfare and health workers
should work with churches and schools to identify children whose parents are ill
or have died.
At a local community level, volunteers should be used to visit families, help child
headed families and monitor foster care and other projects.
2. Community childcare committees
Community childcare committees are an option that has been used very
successfully in different countries. A group of adults work together to take
responsibility for organising support for vulnerable children in an area. Childcare
committees can be set up by social workers, the community can elect volunteers
or they can be appointed by various organisations. It is important that they have
community support and some official status so that they can be effective.
The volunteers usually come from different organisations and religious groups.
They find out children, in need and try to ensure that they are either linked to
welfare services or that members of their family look after their needs.
The community childcare committees can also take responsibility for helping all
children in need to get access to social workers and to child support or foster
grants. They should also take responsibility that all births and deaths are
registered so that children can get IDs and therefore access to social grants
when they need them.
Community childcare committees can also help to screen foster parents and to
monitor them to make sure that they treat children properly. Children in need are
very vulnerable to exploitation and abuse. Some people take in foster children
just to get the foster grants.
Community childcare committees should be linked to social workers from the
government Welfare Department or the Child Welfare Society. They should get
some training and report regularly to professional supervisors to ensure that they
are doing their work properly.
3. Children whose parents are ill
In many families, children become the main caregivers for people who are ill with
AIDS. Older children also often play the parenting role for younger ones. Home-
based care and childcare volunteers should target these children for training and
support. Here are some of the things that should be done:
Educate children about HIV/AIDS and teach them basic methods
for washing and looking after patients.
Make sure they are in school and are able to survive - get food
parcels and clothes to them.Help them to get access to grants
and to things like parent’s bank accounts.Talk to them about
their fears and answer their questions.
Make sure they are registered with Home Affairs and apply for ID
books.
Invite older children to family support group meetings
Make sure the ill parents make memory boxes and have all their
documents in order.
Talk about the future and help make arrangements to look after
the children after their parents death - most children are terrified
by the uncertainty of what will happen to them when their parents
die.
4. Children who are orphaned
Children who have lost one or both parents need a lot of support. They have to
deal with grief as well as survival. Most orphaned children are supported by
relatives. They are usually older women and are often unemployed or on
pension. The family will become poorer and will need food and financial support.
A large number of orphans stay on alone in the family home when their parents
die. Older children look after young ones and try to find ways to survive.
Thousands of children are living in desperate poverty in these child-headed
homes. Many of them drop out of school and some turn to sex work or crime to
survive.
Some children are taken in as foster children whilst others go to orphanages or
other institutions. In this section, we look at the different options and the role child
care committees can play.
Child-headed homes and care by relatives
We must find ways to support children who are looked after by relatives or by
older siblings in child-headed homes. Community child-care committees are best
to reach and support these children. Here are some of the things that community
child care volunteers should do:
Make sure that they get the government grants they are entitled
to receive and help them get access
Make sure they get food parcels and benefit from poverty relief
programmes
Try to keep children in school as long as possible and work with
schools to organise support for children who cannot afford
books, fees or clothing.
A volunteer should visit the family at least once a week to check
that children are coping, going to school and eating.
Check that children are healthy and help them get healthcare,
vaccinations and medicine when needed.
Support children who are HIV positive and get them into medical
and other support programmes.
Work with churches and welfare organisations to collect clothes,
bedding and building materials
Help children get documents like death certificates and IDs
Counsel children to help them deal with their feelings of loss and
grief.
Be an adult they can trust and come to with their problems
Foster care
Foster care is provided by a family that takes in orphaned and other vulnerable
children and looks after them. They do not adopt them and the state remains
responsible for the welfare of the children. A court has to officially appoint foster
parents - this is usually organised by social workers. Foster care parents receive
a grant for doing the work and should use it to provide material and emotional
support for the children and to ensure that they attend school, (see page 23/4 on
grants)
If foster parents do not fulfill these obligations, the children will be moved to
another family. Foster care is better than orphanages because it provides a
family life for children. It is still not always an ideal situation and many children in
foster care can be neglected or even abused and exploited.
It is important for foster parents to be trained and monitored by social workers.
Childcare committees should also visit foster families and talk to the children to
check that they are receiving proper care.
Group housing
In some communities group housing has been provided for children. This means
that a number of different children who are orphaned will live in a house or
homestead with one adult to look after them. These adults are often older women
who no longer have their own children to look after. This option has been tried on
farms and in rural villages where orphans have become a big problem and the
traditional leader or farmer has taken responsibility for setting aside a house for
this purpose.
Adoption
When you adopt a child it is a formal legal process and the child becomes yours.
You have full responsibility for the child and the law treats the child as it would
treat your own biological child. There are no special grants for adopted children
and they family will only qualify to get the child support grant if they are poor.
Orphanages
There are very few orphanages available for the thousands of orphans who need
care. Orphanages are a very expensive way of looking after children since the
building, staff and services are costly. Orphanages are also not very good for
children since they are impersonal and often there is too little contact with adults.
Many children are abused by older children in orphanages. Families are the best
place for children to grow up. When that is impossible it is better to get one adult
to look after a small group of children than to put a children in an institution.
Some orphanages use a house parent system and instead of one large
orphanage, they have a number of smaller houses in one place. Each house will
have 5-10 children with one adult to act as their "parent".
5. Children living with HIV/AIDS
Children living with HIV/AIDS will have special needs that are different from those
of adults. They are not able to get access and help themselves in the same way.
Usually they depend on their mother or another caregiver. If they are very young,
they will not understand the disease and the steps they have to take to stay
healthy and to protect other people.
Most children with HIV/AIDS get the disease from their parents who can become
ill or die when the child is very young. Home-based care and childcare volunteers
should make sure that children with HIV/AIDS are properly supported.
It is best for children to be looked after by those they know and make them feel
safe. If possible, children with HIV/AIDS should be left in the care of their families
and relatives. In some areas, there are hospices or homes for children who are ill
or dying. Social workers should work with clinics, home-based care and
childcare volunteers to identify children who would be better off in hospices.Most
ill children are too small to care for themselves in any way. The caregiver has to
be the main target for support and training to make sure the child receives proper
care.
Index
HIV/AIDS Prevention | Care for Childrei | Care for People with
HIV | HIV/AIDS and Municipalities | Community Action | How to
coordinate work around HIV/AIDS |
This material may not be used for profit without permission from ETU
Global Estimates of the HIV/AIDS epidemic, as of end 2002.
Total
5 Million
Adults
4.2
Million
Women
2 Million
Children 15
years
800.000
Total
42 Million
Adults
38.6
Million
Women
19.2
Million
Children <15
years
3.2
Million
Total
3.1
Million
Adults
2.5
Million
Women
1.2
Million
Children <15
years
610.000
Total
21.8
Million
Adults
17.5
Million
Women
9 Million
Children <15
years
4.3
Million
People newly infected with HIV in 2002
Number of people living with HIV/AIDS in 2002
AIDS deaths in 2002
Total no. of AIDS deaths since the beginning of the
epidemic until the end of 2001
Total no. of AIDS orphans* since the beginning of the Tota*
epidemic until the end of 2001
14 Million
I
I
I
*
The number of adults* and children infected with HIV during 2002
Total of newly infected Adults & Children with
Region
HIV
Sub Saharan Africa
3.5 Million
Asia and the Pacific
970 000
Eastern Europe & Central Asia
250. 000
Latin America and the
210. 000
Carribean
The Middle East and North
83. 000
Africa
75. 500
High-income countries
Regional HIV/AIDS statistics, December 2002.
Percent
Main
of HIVmode(s) of
Adult
Adults and children
positive transmission#
living infected with prevalence
adults
for adults
rate*
HIV/AIDS
who are
living with
women
HIV/AIDS
Region
Epidemic
started
Sub Saharan
Africa
Late ’70's Early 80's
29.4 Million
8.8%
58%
Heterosexual
sex
North Africa
and the Middle
east
Late ’80’s
550.000
0.3%
55%
Heterosexual.
IDU
South and
South East Asia
Late '80's
6.0 Million
0.6%
36%
Heterosexual,
IDU
East Asia and
Pacific
Late '80’s
1.2 Million
0.1%
24%
IDU. Hetero,
MSM
Late ’70's
early 80's
LateVO's- I
i Early 80's
1.5 Million
0.6%
30%
MSM. IDU, |
Hetero
440,000
2.4%
50%
Hetero, MSM
Latin America
Caribbean
Eastern Europe
Early '90's
& Central Asia
Western
Late '70's I Early’80's
Europe
Late 70's North America
Early 80’s
Australia and
New Zealand
Total
Late 70's -
1.2 Million
0.6%
27%
IDU
570,000
0.3%
25%
MSM. IDU
980.000
0.6%
20%
15,000
0.1%
7%
1.2%
50%
MSM, IDU
Hetero
MSM
Early ’80’s
42 Million
... ................ .... ..
Notes
* The proportion of adults (15 to 49 years of age) living with HIV/AIDS
in 2001, using 2001 population numbers.
# MSM (sexual transmission among men who have sex with men), IDU
(transmission through injecting drug use), Hetero (Heterosexual
transmission).
$ Defined as children who lost one or both parents to AIDS when they
where under the age of 15 .
These figures are estimates at the end of 2002, published by UNAIDS
in the 'AIDS Epidemic Update', Decemeber 2002 and UNAIDS ' Report
on the global HIV/AIDS Epidemic', July 2002.
These estimates include all people with HIV infection,whether or not
they have developed symptoms of AIDS, alive at the end of 2002.
For each of these countries, the 1999 prevalence rate published by
UNAIDS was applied to the country's 2001 adult population to produce
estimates given in the table. The estimates are given in rounded
numbers. However, unrounded numbers were used in the calculation
of rates and regional totals, so there may be minor discrepancies
between the regional/global totals and the sum of country figures.
Adults in this report are defined as men and women aged 15-49. This
age range captures those in their most sexually active years. While the
risk of HIV infection continues beyond the age of 50, the fast majority
of people with substantial risk behaviour are likely to have become
I
I
infected by this age. Since population structures differ greatly from
one country to another, especially for children and the upper adult
ages, the restriction of 'adults' to 15-49 has the advantage of making
different populations more comparable.
For further information, see our web pages
•
•
•
•
Global HIV and AIDS epidemic
AIDS around the world
AIDS in Africa
AIDS in India, China, AIDS in Thailand
f Ba^loR£ B
INDIA AND HIV/AIDS - STATISTICS
India has a population of one billion, around half of whom are adults in the
sexually active age group, with a large number below this age group. The first
AIDS case in India was detected in 1986, and since then, HIV infection has been
reported in all States and Union Territories.
The spread of HIV in India has been diverse, with much of India having a low rate
of infection and the epidemic being most extreme in the southern States. 96% of
the total number of nationally reported AIDS cases were found in 10 of the 28
States and 7 Union Territories, the worst being Maharashtra in the west, Tamil
Nadu and Pondicherry in the south, and Manipur in the north-east.
In Maharashtra and Tamil Nadu the infections are mostly due to heterosexual
contact, while infections are mainly found amongst injecting drug users (IDU) and
their sexual partners in Manipur
Estimated numbers of adults and children living with HIV/AIDS, end 2001
Adults
3970000
Women
1500000
Children
170000
Adult HIV prevalence estimate
0.7%
These estimates above are based on previously published estimates for 1997
and 1999 and on recent trends in HIV/AIDS surveillance in various populations.
Adults are defined as men and women aged 15 to 49. These estimates include
all those with HIV infection, whether or not they have developed symptoms of
AIDS.
AIDS data on December, 2002
AIDS cases in India Cumulative
Males
32161
Females
10786
Total
42947
-
I
I
J
The statistics for AIDS cases may be a poor guide to the severity of the
epidemic, as in many situations a patient will die without HIV having been
diagnosed, and the cause of death attributed to an opportunistic infection, such
as tuberculosis or PCP.
Transmission Categories Number of cases
%
Sexual
36201
84.29
Perinatal
1 119
2.61
Blood and blood products
1282
2.99
Injecting drug users
1232
2.87 *
Not known
3113
7.25 I
Total
42947
100
_»
.---- ------------
Age group Male Female Total
0- 14
1018
624
1642
15-29
10427
501 I
15438
30-44
18132
4507
22639
=>45
2584
644
3228
Total
32161
10786 42947
J
State/Union Territory AIDS cases
Andhra Pradesh
2350
Assam
149
Arunachal Pradesh
0
A & N Islands
24
Bihar
146
Chandigarh (UT)
650
Delhi
720
Daman & Diu
1
Dadra & Nagar Haveli
0
Goa
124
Gujarat
2029
Haryana
247
Himachal & Kashmir
2
Karnataka
1575
Kerala
267
Lakshadweep
0
Madhya Pradesh
941
Maharashtra
9106
Orissa
82
Nagaland
298
Manipur
1238
Mizoram
34
Meghalaya
8
Pondicherry
157
Punjab
227
Rajasthan
616
Sikkim
6
Tamil Nadu
18276
Tripura
5
Uttar Pradesh
804
West Bengal
930
I
‘
I
Ahemdabad M C
267
Mumbai MC
1563
HIV estimates, 2001
The prevalence rates below are taken from data collected during screening of
women attending antenatal clinics, meaning that these prevalence rates are only
relevant to sexually active women.
State/Union Territory HIV Prevalence (%)
Andhra Pardesh
1.50
Assam
0
Arunachal Pradesh
0
A & N Islands
0.16
Bihar
0.13
Chandigarh (UT)
0
Delhi
0.13
Daman & Diu
0.25
Dadra & Nagar Haveli
0.25
Goa
0.50
Gujarat
0.50
Haryana
0.51
Himachal Pradesh
0.13
Jammu & Kashmir
0.25
Jharkhand
0.08
Karnataka
1.13
Kerala
0.08
Lakshadweep
Madhya Pardesh
0.25
Maharashtra & Mumbai
1.75
Orissa
0.25
Nagaland
1.25
Is
Manipur
1.75
Mizoram
0.33
Meghalaya
0
Pondicherry
0.25
Punjab
0.40
Rajasthan
0
Sikkim
0
Tamil nadu
1.13
Tripura
0.25
Uttar Pradesh
0
Uttranchal
0
West Bengal
0.13
1
Some areas report an HIV prevalence rate of 0 in antenatal clinics. This does not
necessarily mean that there is no HIV in the area, as some of them report the
presence of the virus at STD clinics and amongst injecting drug users.
Sources:
UNAIDS Epidemiological factsheet, 2002 Update.
NACO HIV and AIDS Surveillance in India, 31/12/2002
s
HIV/AIDS great threat to child rights
Cape Town 27 May 2003 Sapa
One of the greatest threats to the realisation of child rights in South Africa and in sub-Saharan
Africa is the HIV/Aids pandemic, the University of Cape Town's Children's Institute said on
Tuesday.
"The illness and death of adults as a result of HIV/Aids has a profound impact on the survival,
development and protection of children in South Africa," the institute said.
According to a report released by the university's Centre for Actuarial Research, about 6,5
million South Africans are estimated to be HIV-positive, including 3,2 million women of
childbearing age (15 to 49).
For each man between the ages of 15 and 24 who is infected with HIV, 4 young women are
infected.
It says that about 75 percent of HIV-infected people in South Africa are in stages one and two
of the disease's progression, therefore they have not yet developed symptoms and many do
not know their status.
Between January and December last year 89,000 children were infected with the virus as a
result of being born to an HIV-positive mother. This figure is around 7,5 percent of the total
number of babies born during this period.
The institute warned that without access to health care services that could prevent the
transmission of HIV/Aids from mother to child, the cumulative number of HIV-infected children
in South Africa would continue to grow.
"Without access to the necessary basic health care services and support, most of these
children will require repeated and prolonged hospital admissions - placing a massive burden
on health facilities - and will die before their Sth birthday.
"Improved health service delivery to HIV-positive children is urgently needed as part of a
comprehensive national treatment plan," it said.
Last year alone, about 150,000 children lost a mother to Aids.
The institute said that without any major new health interventions, close to two million
children would lose a mother by 2010, and this would mainly be due to Aids.
Children in South Africa faced many vulnerabilities before their caregiver died. These included
children having to look after the sick adult, not being able to attend school, and a loss of
earnings as the adult was not able to work.
"The Children's Institute therefore supports the call for urgently improved and accessible
poverty alleviation mechanisms as part of a comprehensive package of care and support for all
children in South Africa."
The institute said that in heavily HIV-affected communities - the majority of which were poor the impact of HIV/Aids was felt collectively, placing an enormous strain on community
structures and formal and informal support systems.
\* i
/o f
Households that previously supported one another, through the sharing of resources and
responsibility for care, were now unable to do so as household members fell ill or died as a
result of HIV/Aids.
"As increasing numbers of households are affected by illness and death, it is inevitable that
informal networks of inter-household support -often referred to as the "social safety net" - will
be weakened," it said.
"This has an impact on all children, not just those directly affected by HIV/Aids."
The institute said the provision of antiretrovirals in the public sector was a crucial step towards
decreasing the number of children who would be made vulnerable as a result of HIV/Aids.
It warned that the stage of the pandemic in South Africa this year was such that the country
was 12 years away from experiencing the peak in the number of orphans.
"We currently face an equally large and more immediate service need that is often neglected:
supporting the large numbers of children currently living with, and often caring for, terminally
ill adults and other children.
"Well-grounded strategies and interventions put in place now will lay the foundation for a
response that can grow with the size of the orphan population and should strive to
appropriately address the needs of children currently living with sick adults," it said.
Child Protection Week, which aims among other things to highlight the plight of abused
children, is currently being observed in South Africa.
i r^f
Volume 5, Number 1, Fall/Winter 1999
HIV/AIDS and Children's
Rights
Today, the majority of all new HIV infections
occur among children and young people under
25 years of age, the people who were born and
who have grown up during the AIDS epidemic.
The epidemic is straining resources in already
impoverished communities and creating new
obstacles to the realization of children's rights
to survival, development, and protection. The
failure to ensure children's rights creates
opportunities for HIV infection; at the same
time, HIV/AIDS creates opportunities for the
violation of children's rights. Advances in the
realization of children's rights, including the
implementation of the United Nations
Convention on the Rights of the Child (UNCRC),
are necessary to stem the growth of the AIDS
epidemic.
We reproduce a fact sheet produced by the
Interagency Coalition on AIDS and Development
(ICAD) that summarizes available information
on HIV/AIDS and children, and discusses the
effect of HIV/AIDS on children's rights. The fact
sheet also provides information about other,
essential resources on HIV/AIDS and children.
A Universal Framework for Children's Rights
The United Nations Convention on the Rights of the Child (UNCRC)
was unanimously adopted by the General Assembly of the United
Nations on 20 November 1989. The Convention has since been ratified
by 191 member states of the United Nations and has entered into force
as an international treaty. Only the United States and Somalia have not
yet ratified it. This near- universal ratification establishes the UNCRC
as the global standard for children's rights. The UNCRC covers the
cultural, social, economic, and political rights of children and is guided
in interpretation and implementation by four principles: non
discrimination: the best interest of the child; the maximum survival and
development of the child; and consideration of children's opinions and
views in matters that affect them. The rights defined in the Convention
are indivisible and form a comprehensive framework for use in
\b \
determining children's best interests.
The United Nations
Convention on the Rights of
the Child has been ratified by
191 member states of the
United Nations. Only the
United States and Somalia
have not yet ratified it.
Defining Children in the Context of Their
Rights
The UNCRC defines children "as every human being below the age of
18 years unless, under the law applicable to the child, majority is
obtained earlier." Unfortunately, most epidemiological data collection
for HIV uses 14 as the cut-off age for children and labels all people
above this age as adults. To avoid discriminating against any portion of
the global population of children, all persons under the age of 18
should be counted and referred to as children. This means that until allinclusive data on children becomes available, references and statistics
that count children between the ages of 15 and 18 together with adults
should be clearly identified as being inclusive of children.
Children Infected with HIV
According to the Joint United Nations Programme on HIV/AIDS
(UNAIDS) and the World Health Organization (WHO), children and
young adults (ie, persons under 25 years of age) accounted for over
one-third of the 33 million people living with HIV in 1998. As well, the
majority of all new HIV infections in that year came from this
population. Four million children under the age of 15 contracted HIV
since the epidemic began, most of whom (about 90 percent) became
infected from their mothers during pregnancy, labour, birth, or breast
feeding. In 1998 alone, it is estimated that there were 590,000 new
infections among children under the age of 15. and 2.5 million new
infections among children and youth in the 15-24 age group.
Combined, this translates into 8500 new infections among children and
young people every day.
Children Orphaned Due to AIDS
Children who became orphans due to the death of one or both parents
from HIV/AIDS are a rapidly growing population in urgent need of
attention. By the year 2010. the number of orphaned children is
expected to reach 40 million. Current estimates from UNAIDS reveal
that by 1997 a total of 8.2 million children under age 15 had lost their
mothers since the beginning of the epidemic, and that in 1997 there
were 6.2 million children alive who had been orphaned by HIV/AIDS.
Ninety percent of these children were in sub-Saharan Africa. The need
for homes and guardians for large numbers of orphans is impacting
entire communities and regions of the world. A study by the Zambian
Ministry of Health indicated that 40 percent of all households have one
or more orphans. In Zimbabwe, eight percent of all children under the
age of 15 have lost their mothers to AIDS.
Children Affected by HIV/AIDS
Children are affected by HIV/AIDS not only through infection or the
loss of a parent. For example, many children experience a premature
end to their childhood as they are required to become heads of
households, drop out of school, work, raise younger siblings, and care
for parents and other family members sick from AIDS. Furthermore,
children experience greater poverty as a result of the loss due to AIDS
of adult wage earners, farmers, and other skilled and contributing
household members. These losses affect all of the children in a
household and. where infection rates are high, entire communities.
Without adequate care and support, children experience losses in
health, nutrition, education, affection, security, and protection. They
suffer emotionally from rejection, discrimination, fear, loneliness, and
depression.
The Effect of HIV/AIDS on Children's Rights
The realization of the survival and developmental rights of children, as
defined in the UNCRC, are affected in obvious ways as family and
community resources become strained and overburdened by
HIV/AIDS. Accomplishments in child survival that were made over the
past two decades are endangered. If the AIDS epidemic is not
contained, the mortality rates of infants in some countries could
increase by 75 percent, and those of children under five years of age by
100 percent (UNAIDS). In the absence of caring adults to protect them,
and as they struggle to survive, children who experience increased
poverty, abandonment, rejection or discrimination, or an added burden
of responsibility for themselves and other family members, are at
increased risk for abuse and exploitation. Children's rights are ignored
as family property is taken, siblings are separated, the children suffer
physical and sexual abuse, or the children become homeless. Girls
marry at very young ages in order to have a home. Children join the
100 million children estimated to be living and working on the streets
of the world (UNAIDS) or the more than one million children annually
who are sexually exploited for the first time (1996 World Congress
Against Sexual Exploitation of Children).
The Effect of Implementing the UNCRC on
the AIDS Epidemic
Actions that support the protection of children's rights and the
implementation of the UNCRC are synonymous with those that reduce
the likelihood of infection with HIV. When their rights to survival,
development, protection, and participation are realized, children are
less likely to find themselves in situations involving a high risk of HIV
infection. Protecting children from situations where they are known to
be at risk of sexual abuse and exploitation, and where intravenous drug
use is common, directly reduces their risk of infection. Healthy
physical and emotional growth and development, access to information
about their rights and about sexual health, and a voice in making
decisions that affect them - all among the rights of children - are vital
steps that, if begun in childhood, enable people throughout their lives to
protect themselves from HIV. Lasting solutions for the next generation
must address both protection from HIV and protection of children's
rights.
The Impact of HIV and AIDS on Children, Families and
Communities:
Risks and Realities of Childhood during the HIV Epidemic
Miriam Lyons
INS4
TABLE OF CONTENTS
Introduction
T'ne First Generation
Social and Economic Contexts. Vulnerability to HIV I
Children Treated Like Children For Better or Worse
Solutions that Address Reality
Defining a Common Goal
/•$/
fer
IM
%
Introduction
While recent scientific efforts have resulted in a series of discoveries and advances in
understanding and controlling the virus that causes AIDS, this progress has had limited impact on
the majority of HIV infected people and populations living in developing countries. The social and
economic conditions that nurture the spread of the virus have to be confronted as essential
elements in local and global efforts to stem its spread and create effective solutions to halt the
epidemic. The current demographics of the epidemic illustrate that this is particularly true of the
conditions of human life during childhood.
HIV has found a wealth of opportunities to thrive among tragic human conditions fueled by
poverty, abuse, violence, prejudice and ignorance. Social and economic circumstances contribute
to vulnerability to HIV infection and intensify its impact, while HIV/AIDS generates and amplifies
the very conditions that enable the epidemic to thrive. Just as the virus depletes the human body
of its natural defenses, it can also deplete families and communities of the assets and social
structures necessary for successful prevention and provision of care and treatment for persons
living with HIV/AIDS. This is demonstrated by the estimated 30 million people living with
HIV/AIDS, mostly in developing countries. Over 2 million people are expected to die from HIV
related illnesses this year adding to nearly 12 million deaths attributed so far to the epidemic. The
impact of HIV/AIDS extends beyond those living with the virus, as each infection produces
consequences which affect the lives of the family, friends and communities surrounding an
infected person. The overall impact of the epidemic encompasses effects on the lives of multiples
of the millions of people living with HIV/AIDS or of those who have died. Those most affected by
HIV/AIDS are children.
The First Generation
Growing up with the HIV Epidemic
Children and young adults currently between the ages of 15 and 24 were born and grew up as
the first generation to experience childhood during the HIV/AIDS epidemic. Today it is among this
same population of 15 - 24 year olds that new HIV infections are concentrated. According to
recent United Nations estimates, more than 50% of the 16,000 new HIV infections which occur
daily are within this age group. An additional 10% of new infections occur among children under
age 15. Since the virus was first identified in 1981, more than 3 million children have been born
HIV positive and the mothers of over 8 million children have died from AIDS. By the year 2010 it
is predicted that as many as 40 million children in developing countries will have lost one or both
parents to HIV/AIDS. In some countries this is equivalent to one in every 4 to 6 children. The
effects of HIV and AIDS on children who are orphaned, or in families where parents are living with
the virus, not only include these calculable loses, but also the immeasurable effects of altered
roles and relationships within families. Clearly HIV infection has its greatest impact on the young.
Childhood: Rights and Goals
Although "childhood" might differ for every human being and numerous interpretations of the
concept exist, common to all is a period in the early years of human life marked by rapid growth
and development. During the years of physical growth in which a child matures towards
adulthood, the child is also developing psychologically and in ways that define intellectual, social,
spiritual and emotional characteristics. The circumstances or conditions in which this growth
takes place can limit or enhance development. Physical and emotional well being and social and
intellectual development can be permanently limited for a person deprived of the opportunities
and time to grow and develop successfully during their childhood.
The most universally accepted statements with regard to children and childhood can be found in
the U.N. Convention on the Rights of the Child (UNCRC). Having been ratified by all but two
member nations of the United Nations, this international covenant can rightfully be utilised as a
guide for ensuring universally accepted goals for childhood. The individual articles of the UN
Convention on the Rights of the Child address rights related to survival, protection, development
and participation that enable a child, a person under age 18, to achieve the goals of childhood
successfully. It confirms, as did the Universal Declaration of Human Rights, "that childhood is
entitled to special care and assistance.": this care and assistance being designed to promote and
provide for, among other things, the "full and harmonious development of his or her personality"
and "that the child be fully prepared to live an individual life in society." To this end the UNCRC
declares that "The family, as the fundamental group of society and the natural environment for
growth and well-being of all its members and particularly children, should be afforded the
necessary protection and assistance so that it can fully assume its responsibilities in the
community."
Social and Economic Contexts: Vulnerability to HIV Infection
and AIDS
Children are affected by HIV/AIDS in ways that can diminish their childhoods and as a result limit
choices and opportunities for successful survival throughout their lives. Circumstances of an
individual's life and their social context in family and community during childhood can increase the
probability they will one day be exposed to, and infected by, HIV. In order to develop appropriate
means of enabling and protecting people, either as children or as adults, against infection and the
effects of HIV/AIDS, adequate and judicious attention needs to be given to the rights and realities
of childhood.
Children First
HIV and AIDS are brutal escalators of other cruelties which children endure. In today's world the
majority of people living in poverty are women and children. Three quarters of the 24,000 daily
deaths (more than 8 million every year) related to hunger are among those under the age of five
(The Hunger Project). One hundred and twenty million children between the ages of 5 and 14
work in conditions that are hazardous to healthy growth and development (ILO). Estimates
suggest that as many as 100 million children worldwide are homeless or spend most of their time
surviving on the streets (UNICEF). Massive populations of families with children are displaced
and often separated because of conflict and natural disasters. According to the United Nations
Expert Report on the Impact of Armed Conflict on Children, prepared by Grapa Machel, more
than half of the near 60 million people displaced by war are children with millions separated from
their families. Millions more have been injured, disabled, orphaned and died in armed conflict.
Children are used as soldiers and forced to kill; raped by soldiers or made to watch their mothers
and sisters raped and their families murdered. Added to these, children are victimised and
trafficked as commodities for sale in local and global sexual prostitution and pornography
industries. Estimates are that at any time, as many as one million children are involved in the
commercial sexual exploitation arena every day. (ECPAT, World Congress Against Commercial
Sexual Exploitation of Children). Countless others are physically, sexually and psychologically
abused in what should be the secure confines of their homes and neighborhoods.
The roles that children fill as poor, hungry, exploited and abused human beings increase their
vulnerability to HIV infection. This can occur directly through those activities known to be
associated with transmission, or indirectly as occurs when earlier harm turns children into
vulnerable adults. For example those with have a history of childhood physical or sexual abuse
have also been found in adolescence or adulthood to be more likely than non-abused peers to
engage in behaviors that place them at high risk of HIV infection..
Poverty, a Leading Promoter of HIV and AIDS
Poverty is clearly a factor in the spread and impact of HIV/AIDS. The struggle to survive everyday
overshadows attention and concern about a virus that does not demonstrate any immediate
harm. HIV/AIDS is a distant threat until it has a visible presence manifested by illness and death.
Poverty, in depriving people of access to health facilities, schools and media also limits their
access to information and education on HIV/AIDS. Poverty pushes families, often unaware of the
risks, to send children into the work force or to hand them over to recruiters promising jobs in a
distant place where, unprotected, they might be forced into a childhood of harsh labor or sexual
abuse. When HIV/AIDS appears in an already impoverished household there are limited means
for response, the mortality rate is high, the impact is severe and the pressures and pain of
poverty increase. As increasing numbers of infected young adults are unable to contribute to their
communities through their work as parents, teachers, laborers, drivers, farmers, etc., entire
economic and social structures of communities suffer and demands for services increase with
fewer able people to provide them.
The vast majority, over 90%, of all people infected with HIV since the beginning of the epidemic
are from the developing world. In sub-Saharan Africa where two-thirds of the world's infections
have occurred, more than 7.4% of the population between the ages of 15 and 49 is estimated to
be infected with HIV. In Zimbabwe infection rates are estimated to be in the region of 20% while
in Botswana adult infections are thought to be approaching 25 - 30% of the population. In India
although the overall infection rate is still less than 1% of the population, this amounts to between
3 and 5 million people, most of whom are untested and unaware of their infection status. Ante
natal testing among those with access to health facilities provides some staggering statistics: in
Haiti the national rate is over 8%, while in some areas of Southern Africa local HIV infection rates
among pregnant women of 30 - 60% have been reported.
Losses for Children that Last a Lifetime
While the majority of the 2.3 million predicted HIV/AIDS related deaths this year will occur in
developing countries, this is also where 87% of the world's 2 billion children will be trying to grow
up. Although life-saving drug regimens have dramatically decreased mother-to-child transmission
of HIV and have kept mothers well and alive longer in the industrialised world, poverty and the
lack of necessary social and medical infrastructure and services make them inaccessible in those
places where they are most needed. Many women who know that they have tested positive for
HIV may have no choice but to breast feed their babies when clean water and formula are
unobtainable, even though they risk transmitting infection to their babies. Without access to
health care or a nutritious diet, infected infants often die before they are two or three years old.
For children who survive longer, for uninfected children whose parents or guardians are
incapacitated by HIV/AIDS, and for those who are orphaned, childhood can be dramatically
shortened in other ways.
The illness or death of parents or guardians because of HIV/AIDS can rob a child of the emotional
and physical support that defines and sustains childhood. It leaves a void where parents and
guardians once provided love, protection, care and support. Since HIV is often (but by no means
always) transmitted to sexual partners, children are more likely to lose both parents to HIV/AIDS.
Someone is needed to step into parental roles so that children can survive and develop into
healthy and productive adults. Grandparents, aunts, uncles or other caring adults frequently
assume responsibilities that enable children to remain in their homes or take them into their own
families and households. However, where the infection rate is high or harsh social or economic
conditions exist, adults may be unable to assume the additional responsibilities of these families
and children affected by HIV/AIDS. Other barriers grow out of ignorance and social attitudes.
Fear of discrimination leads to families keeping secret the knowledge of HIV infection and AIDS
within the household rather than seeking help. Others seek help but are rejected or abandoned,
even by family members, when they reveal the nature of the illness. Fear, discrimination,
ignorance, and social stigma associated with HIV/AIDS, in addition to overwhelming demands on
caring adults, leave children isolated with their grief and suffering while they watch parents and
other loved ones die and their families languish.
Children in Adult Roles: Working to Maintain Home and Family
In the absence of capable adult caretakers, children themselves take on responsibilities for the
survival of the family and home. Undeniably children in most families share duties even when
parents are healthy. In economically disadvantaged communities, a child's contribution is often
necessary for the survival of the household. But in numerous HIV/AIDS affected households
children have not simply increased the amount of work that they do but have also assumed
decision-making and responsibilities that transform roles within families and households. Children
assume adult roles as heads of household because there are no alternatives. They care for
parents and younger siblings who are sick and dying from HIV/AIDS. They take charge of the
care and running of the home for themselves and their siblings. They work long hours doing
household tasks, supervising younger children and engaging in income-generating work in order
to support the family. Many quit school and jeopardise their own health and developmental needs
to take on roles as parent, nurse and provider.
Failing to Meet the Goals of Childhood
In many families and communities the environment for healthy growth and well-being has been
devastated by HIV/AIDS. Instead of receiving special care and assistance, childhood is spent
providing care and assistance. Children become decision-makers, responsible for the social and
economic future of the family, and fill these roles without the physical and emotional protection,
guidance and support that, as children, they deserve. They may act like adults, but it cannot be
forgotten that these "heads of households" are children, but children whose childhood has been
impoverished by HIV/AIDS. In such households, all children are affected. The care that older
siblings can provide for younger children is likely to be inadequate because of the increased
poverty of the household and the lack of maturity and experience of the caretaker, leading to poor
health, hygiene and nutrition; absence from school, and developmental delays. The loss of
material, emotional and developmental support from an adult exposes children to the distress
which results from lack of affection, insecurity, fear, loneliness, grief or despair. It limits the
possibility of a successful childhood which, in turn, affects the future as adults.
Children Treated Like Children: For Better or Worse
In this world where some children are fortunate enough to be loved and nurtured in ways that
respect their rights as children and are supported in ways that enable them to become
independent, competent, adults while others are treated as little more than property or tools to be
used for the benefit and satisfaction of adults, the idea of "treating a child like a child" has
contradictory meanings.
Vulnerabilities of Childhood
Even when adults intervene and take responsibility for children who are left without parents or
guardians because of HIV/AIDS, it cannot always be assumed that children benefit. The
limitations that adult society places on them because of their assumed immaturity (while often to
their advantage) can also leave children powerless and defenseless. Precisely because they are
children, in most societies, children have no direct right to own or control property, nor to take
responsibility for important decisions concerning their own future. While the right to participate in
such decisions is confirmed in the UN Convention on the Rights of the Child this is often ignored.
As a result of the sickness or death of parents or guardians, children are often made to leave the
place that they have always known as "home" and sometimes are separated from their closest
remaining family members, their siblings. They are dependent on the abilities and attitudes of
adults who are given ownership or control over their property and decision making about their
future life. Separated from close family members, without a secure home, the vulnerabilities of
childhood can take on new dimensions.
Since the need for caretakers of infants and very young children is obvious and immediate as a
matter of basic survival, they are taken into the homes of family members, placed with foster
parents or guardians or in group homes or larger institutions. However, the needs of older
children (approximately 8 to 18 years of age) can be more easily under-served, overlooked or
underestimated, since the risks to their survival are less apparent. Even under good conditions,
where resources and caring adults are available, it is not easy for a child who has lost everything
to recover and adjust. Some are offered a home with caring adults but nonetheless resist being
absorbed into new families and homes because of fear and distress. For the majority, counseling
and psychological support services are unavailable. Some react with behavior which provokes
rejection. Others run away. Where infection rates are high within a family or community, even the
most loving guardians must focus their energy on the survival of those households where large
numbers of children have been taken in and need care and support. Although these guardians or
foster parents work hard to furnish a caring substitute home and family for children, there are
often limits to how much care and support they are actually able to provide. Children may be
unable to go to school because there is no money to pay for books and fees or because they
experience rejection or discrimination. Some must leave school to help care for younger children
or to earn an income to help support the household. Fear and frustration lead children to run
away in search of a better life often only to join the growing numbers of homeless and exploited
children.
The Value of a Child
The experience of older children who have lost their homes or families to HIV/AIDS related illness
and death is insufficiently documented. However, in a world where millions of children are
neglected, exploited and abused everyday it is reasonable to assume that these children can
become easy prey to adults who are unconcerned with the child's best interest. Some adults
might take children into their households to serve an ulterior purpose. Children are easy to
intimidate and control. Children can provide extra income or free labor and can be treated like
property or servants, kept from school and given inferior food and care. Millions of children suffer
neglect and physical and sexual abuse. In the absence of alternatives, more and younger girls
marry early. Boys and girls trade abusive situations for the streets where life and survival are
even more difficult. The risk of HIV infection rapidly increases as children are exposed to drug
use and engage in unprotected sex (willingly or coerced), exacerbated by the increased
susceptibility to infection of bodies which are still in the process of physical development and
maturation.
Balancing Empowerment and Protection
The empowerment of children, essential in reversing pervasive inequality between adults and
children, needs to be balanced with the necessary protection and guidance to which children
have a right as part of safe and healthy development. However, adult authority can result in
decisions which are misguided or unrealistic.
Judgements about children based upon adult wishes rather than reality can lead to decisions that
do not serve a child's best interest. For instance, in many societies, prevailing attitudes support
the idea that children should be "protected" from information pertaining to sex in order to preserve
"childhood innocence". Such attitudes are inconsistent with the realities of life for millions of
vulnerable children and therefore deprive them of opportunities to understand the risks and
dangers they may face. One result of this is that children are inadequately taught about sexuality
and STD's(including HIV/AIDS) before sexual experiences begin. The factors which make it
necessary to provide such education is a problem many adults prefer to ignore. Children left
powerless through the denial of sex education are also rendered powerless to protect themselves
from infection in those situations which they are able to control.
WOMEN, THE GIRL CHILD AND HIV/AIDS
Sheila Dinotshe Tlou
Introduction
I feel it is appropriate that a woman from Sub-Saharan Africa, where millions of people
are infected with and affected by HIV/AIDS. should critically examine some of the socio
cultural dimensions of the epidemic.
It is even appropriate because I come from the Southern African Development
Community (SADC), the region where more than three quarters of the member countries
have the highest number of HIV and AIDS cases in the world per capita. SADC has only
1% of the world’s population, but nearly 40% of the world's HIV infections are in the
region, and the majority of them are young women.
Talking was good: the time for Action is Now
The Platform for Action, resulting from the Fourth World Conference on Women and the
Programme of Action.adopted at the International Conference on Population and
Development, call for a holistic life cycle approach to women's health care with
emphasis on increased allocation of resources for the provision of affordable health care,
health promotion and disease prevention, and prevention and treatment of sexually
transmitted diseases and HIV/AIDS.
The call was again made at the 43rd Session of the Commission on the Status of Women
when member states resolved to ensure greater protection of women from HIV infection,
including access to female controlled methods, access to affordable antiretroviral therapy
for people living with HIV and AIDS, eradication of gender based violence and harmful
practices such as female genital mutilation. Southern African Development Community
(SADC) sponsored a resolution on women, the girl child and HIV/AIDS which called
upon Governments, NGOs, civil society and the international community to speed up
efforts to prevent and reduce the horrible impact of HIV/AIDS on women and girl
children in developing countries.
The twenty-third Special Session of the General Assembly entitled "Women 2000:
gender equality development and peace for the twenty first century" noted some positive,
but very slow, signs in the fight against HIV/AIDS and member states further resolved to
intensify efforts to protect women of all ages from HIV infection and other sexually
transmitted infections, including access to female controlled methods, voluntary and
confidential HIV testing and counselling, and development of vaccines.
In short, the ‘talk and talk and talk’ about the gender aspects of HIV/AIDS has been with
us for a considerable length of time. The question one needs to ask is: why is there so
little or inadequate action when it comes to implementing these gender sensitive
resolutions?
In my paper I attempt to answer this question by looking at some of the factors behind the
non-implementation of these noble resolutions.
Youth: our window of hope
The special vulnerability of girls and young women to HIV/AIDS has been documented
in many studies and discussed at the various United Nations fora. While most states agree
that young people have the right to develop their capacities, to access a range of services
and opportunities, to live, learn and earn a safe and supportive environment, and to
participate in decisions and actions that affect them, one finds that social institutions such
as schools, NGO's, the media, the private sector, and the governments are doing very
little to support these rights. For example, access to information relating to sexual health
is still a controversial issue despite extensive research showing that school-based life
skills education empowers youth and does not increase their sexual activity (Kirby et al..
1994).
From my observations, backed by 10 years of experience teenagers who are "kept in the
dark" about matters of sexuality are at a much greater risk than those who are provided
with information because when they do decide to engage in sex, it is likely to be unsafe
sex which immediately results in a pregnancy and/or a sexually transmitted disease. Their
ignorance and lack of planning guarantees that they cannot negotiate safer sex let alone
carry a condom or even know how to use it.
Girls, women and poverty
In most countries, the legal systems and cultural norms reinforce gender inequality by
giving men control over productive resources such as land, through marriage laws that
subordinate wives to their husbands, and inheritance customs that make males the
principal beneficiaries of family property. This is still happening despite the fact that
most of these countries have ratified the Convention on the Elimination of all forms of
Discrimination Against Women (CEDAW). Such resolutions have far reaching
consequences for the rights of women, the achievement of national development, and the
transmission of HIV. Furthermore, Structural Adjustment policies seem to have worsened
the levels of poverty in many countries rather than improving their economic situations.
As usual, women and girls have been the most affected by some of the strategies
employed. The continuing retrenchments and lack of employment opportunities have
resulted in women and girls resorting to both direct and indirect commercial sex work for
survival, placing them at risk for HIV infection. The appropriate question to ask is: To
what extent do governments have linkages between programmes targeting HIV/AIDS at
community level to those targeting economic empowerment of women? Poverty
eradication among women requires gendered dimensions by dismantling the institutions
and ideologies that maintain women's subordination in all spheres of their lives.
Economic empowerment and poverty reduction cannot be accomplished through anti-
poverty programmes alone, but through a democratic environment and changes in
economic structures giving access for all to resources and opportunities that enhance their
quality of life.
For women living with HIV and AIDS, a gendered approach ensures that they have
access to food, sanitation, education, housing and health care, including the provision of
antiretroviral drugs. Our governments seem to hide under the cloak of "drugs are too
expensive" to the point where very little is being done to procure them, but these are the
same governments that spend millions of dollars on military equipment and on armed
conflicts. In my own continent, Africa, about one eighth of the military budget of most
countries would be enough to provide free antiretroviral drugs to all citizens living with
HIV and AIDS, yet it is the drug companies that seem to be getting an unequal share of
the blame for exploiting the situation. Whatever happened to state accountability to its
citizens?
Political will and commitment
There is still a wide gap between the acknowledgement of HIV/AIDS as a problem and
what any one political leader does about it, and the resources to be allocated for such
programmes and activities. What we need are leaders who can:
(a) create supportive socio-political and legal frameworks for gender equality.
(b) ensure gender-sensitive programming which educates for use of and provides both
male and female-controlled methods of HIV prevention.
(c) transform their societies into ‘noble societies' which have programmes for the life
long empowerment of women and girl children against HIV/AIDS. One such
‘noble society' is Botswana which can serve as an example of good governance,
political will and commitment to a human rights approach to HIV/AIDS. Some of
the national programmes in place include:
o
o
o
o
o
Free schooling with meals provided
Free health care for Tuberculosis and STI clients, persons under 18
and those over 60; the rest pay P2-00 or US 40 cents
Universal National Old Age (over 65) pension of Pl 10-00 a month
Social welfare programme for the destitute
Community home based care programme which includes:
(a) food basket for nutrition supplementation
(b) supplies and equipment such as gloves, adult diapers,
detergent, bedpans, wheel chairs, etc.
o
o
A transportation allowance of PI 00-00 for volunteer caregivers
An orphan programme with supplies and allowances for caregivers
o
An MTCT of HIV programme (AZT and infant formula) for HIV
positive pregnant women.
Working with men
Until recently, men have been the almost invisible part of the solution to the HIV/AIDS
epidemic even though it was obvious that their socialisation and subsequent behaviours
determine how and to whom the virus is transmitted (Panos. 1998). Men. especially
African men, tended to be all tarnished with one long brush that painted them as being
irresponsible, violent, predatory and fast transmitting the virus. Such labels are very
stereotypical, do not facilitate male involvement, and ignore the fact that there are a lot of
good, caring, responsible, loving, and very gender-sensitive men in Africa, and they are
in the majority. It is only now, after last year's (2000) World AIDS Day theme, that many
stakeholders realise that the qualities of these good men can be tapped and used to role
model appropriate behaviours for the "not so good" ones who have wrong perceptions of
masculinity.
Civil Society needs to be involved not just as actors but as researchers, decision makers,
planners, and designers of programmes on HIV/AIDS prevention and reduction of its
impact. Most government programmes fail because they lack community-based
experience and expertise, for example: programmes on prevention of mother to child
transmission of HIV in Botswana initially had serious problems because they failed to
recognise the important role of the community in women's decisions to go for HIV
testing, to take antiretroviral drugs, and to exclusively breastfeed or use infant formula
(Tlou, S.D., 2000).
Older persons are important stakeholders because they are increasingly taking on
unrecognised, unappreciated, and unremunerated social and economic responsibilities of
caring for the sick and for children orphaned by HIV/AIDS at the expense of their own
health (Tlou, S.D., 1999). Therefore, HIV/AIDS interventions, including information,
education and support, should also target them.
What other steps do we need to take?
Based on the above observations, I would like to reiterate the following recommendations
for a global response:
1. We need to emphasise a human rights approach to the HIV/AIDS epidemic
which entrenches the principle that governments should be accountable to their
people. Each time a woman is unable to negotiate safer sex, it is a violation of her
civil rights because it indicates her lack of autonomy to decide on matters relating
to her sexual and reproductive health and such a situation cannot continue.
2. There has to be political commitment at the highest level to reform socio
cultural and legal systems to empower women and girls for HIV/AIDS prevention
and alleviation of its impact. Heads of state should not just talk about HIV and
AIDS, they should rely less on donors and actually allocate at least 10 percent of
their budgets for HIV/AIDS programmes.
3. HIV/AIDS is a complex epidemic which requires multipronged solutions. No
"single fix" can ever be effective, therefore, I call upon the international
community and the relevant United Nations agencies to intensify their support of
national efforts against HIV/AIDS prevention for women and girls, especially in
the worst hit regions of Africa. Africa needs a sustained, substantial support from
the global community or it will be unable to keep pace with the epidemic.
4. Research on gender and HIV/AIDS issues should inform and drive policy,
therefore, there should be fora for interaction between researchers, policy makers,
and implementers of programmes. The value of policy oriented research and
evidence-based practice on HIV/AIDS cannot be overemphasised.
5. Men are not the problem but part of the solution, they are also vulnerable to
HIV/AIDS and should be involved in all national and international activities
relating to prevention, impact alleviation, and care of people living with HIV and
AIDS.
6. Lastly, allow me to speak as an African woman who has lived most of her life
in Africa: My fellow Africans, HIV/AIDS challenges us to take responsibility for
our own destiny. No one can do it for us. We can solicit and gain the support of
the international community, but in the ultimate we have to be the movers and
shakers to rid our continent of this scourge. Let us all make efforts to fulfil the
obligations of the Universal Declaration on Human Rights and the Africa Charter
of Human Rights for "the other half' of our populations, namely the girls and the
women.
Street Children - Whose Challenge?
- Ezekiel Kevin Annan
- -
Page 1/1
A new millennium has dawned for another look to be taken on the subject of street children. An
encyclopedia has not been written about this all important subject but only little have been done in practice
to curb this menace. Street children's vulnerability is rapidly becoming targeted and expanding the web of
social cankers. The onus now lies on all child-workers, governments, NGO's and other stakeholders and
opinion leaders to consolidate a cohesive force to combat the much talked about subject. For the purpose of
an approach to solve the problem, this piece of writing is intended to assess the situation to enable an indepth understanding and to strategically find a way out.
A child, according to the UN convention for the rights of the child, is anybody below the age of 18 years.
This suggests that any single individual below 18 years is a child and should be dependent in his/her
parents for development. However, this has not been so in a lot of countries for generation. Definitions of
street children have varied from person to person, and from country to country depending on the kind of
the perceptual lenses in which street children are see in their new environment. From my own view, the
street child is any single individual below the age of 18 years, who is living independently on the street at
his home to make ends meet, due to lack of parental care and societal neglect.
It is a choice of necessity. Streetism, could be a predominant source to breed and ignite a heterogeneous
whole of social cankers in our world, if society does not go beyond paying lip-services to this threatening
predicament. The children on the street are vulnerable to numerous risks including HIV/AIDS due to their
nearly universal involvement in "survival sex" (prostitution). The danger has been disclosed in studies that
show that frequency of sexual relations within the group of street children also implies that one HIV positive
street child could pass the disease to a larger proportion of street children.
Streetism is a danger that undermines the potentials and developments of children. Certain negative values,
behaviors and attitudinal changes from the already positive living priority formed at their tender age under
the supervision of their parents. It is a liability to society in this era, when they are found without a true
home for warmth, and without love and care for a sense of belonging. They are spotted at street corners,
both during the day and the night struggling for survival by whatever means possible. Drug addiction, child
labour and violence are other key products of streetism which adds to the crime wave and disturbs the
peace of the globe.
Children do not deserve the right to be abandoned on the street. The street is void of parental care,
protection, love warmth and safety and cannot be a home. "Street children" have become stigmatized by
society; ironically their name suggests they were begotten by streets. Truthfully, we forget that these
children on the streets are victims of circumstances. These children do not desire to leave their homes and
live on the streets where their lives are constantly in danger. They are yearning for the help of all and to get
back into sound and secure society.
It is the society that has neglected them and left them to their fate. Their desire is that, they also have that
right to complete with equals of the schools but not to compete with equals of similar fate on the streets.
They desire to get back home where Daddies and Mummies shout to them for breakfast, lunch and dinner
but not where the order of the day is "the survival of the fittest." They are not strong enough of this task.
Some young girls are sexually abused and others are also enticed into nasty relationships in exchange for
meals, little presents and shelter. If society fails to act promptly to save these kids, there will follow serious
results ranging from HIV infections to other perilous circumstances soon in this hopeful century. Every single
individual owes a service to the street child. If we dare make a mistake in handling their issues, if we allow
them to "swim their own swim", if we dare say "each one for himself and God for us all" in their case, we
will be found digging graves for ourselves. There are indications that, the future of the world, especially the
developing countries, is black when pragmatic and drastic measures are not taken to rectify this social
diversity of our ways. The unseen will be seen.
Written by: Ezekiel Kevin-Annam
Reader Comments
not_neo
All childrens
are the concerns and responsibility of all the earths peoples.
Mans greatest act of menace, seperate and conquer.
Even children with legal addresses and parents or guardians are sometimes still "street children".
Where there is no love given or found where it should come from then the "streets" are just
outside the doors. The places where "twisted minds" or adults lurk.
Nourishment from the heart is not always as readily available as they pretend it to be, where
parents have no time or do not know how to spend time with the children.
Pre-pre-school..
Ivy
Inspiring....
Your article has made me think why I'm in this cosy house while someone like my age, is out in
the cold out alone being abused by others?? It's not fair. The parents or the guardian has
responsibilities and they shouldn't let their children out in the cold out alone. Parents lack of
responsibilities is causing problems for the child and the child have to suffer even though she/he
didn't do anything to deserve any of it. Sometimes the child might run away and end up as a
street boy/girl. The government should be helping people living on the street. I will never survive
on the street for days. Those street children eat restaurant's leftovers from the garbage. This has
nothing to do with survival with the fittest, like you said. No children under 18 yrs.old will survive
out in the streets. Street Children might no even go to school, because they're either afraid other
children will make fun of them, or they don't have money to go to school,it just makes it harder
for them to find proper jobs, sometimes leading them to prostitution. They're flushing their future
down the toilet. People always say "children is our future" but how can they be the future if
they're living in the streets?? It doesn't make sense. If children is our future, we got to take
ACTION!! lol, I just want to say that you wrote a great article on street childrens and well, keep
up the good work!
nadinea
I agree 100%with what you have said. "Street kids"are like all the other children around the
world. They are not different from you and me. they should be respected and have equal rights
and be HELPED!
There are loads of children around the world ,found in each and every country, which do not
have shelter, food nor proper education. The is only a limit to when a child(under the age of 18)
could live without food water or shelter, streetism is danger fr all youths. Many kids die around
the world because of streetism.
Children living on streets die became of sickness, poor health , AIDS/HIV. Without proper shelter
adolescents are exposed to the harsh weather .With no way to see a doctor you get sicker and
sicker until your body can't take it no more. Drugs are one of the main reasons a tot is on the
street. Drugs are worse than not having food and water to eat and drink. Once there is addiction
to a drug and you have no way of getting more then you have no chance of living.
People that are to blame is their parents . 11 is their fault that they are not sheltered , getting
everything they want (spoiled...ex. going every where the may chose)not caring what they do
with their lives. If they could not take responsibility why then did they have sex an be a father or
mother. They had a choice and so all that happens to their children, they are the ones to that
should take responsibility, and the blame.
Some teens that are living on the streets and probably have a meal a week probably by pit
pocketing or prostitution or eating out of the garbage. They have sex for money to able to have
something in their stomachs. Can you feel the pain they go through every day, week , month! I
can since I fast all day for 30 days (one month) to feel how they feel and to see what they go
through.
I wish that there could be a way to get all off of the "street kids"and find them a place where
they can be loved ,cared for, have good education, health and where they can get three meals a
day and extra snacks and to top it off ,to be HAPPY!! As Ivy said we HAVE TO TAKE ACTION!!
This is a very important topic and I really enjoy reading this. Keep it up. I hope I read another
article that you have made. :) :P
Nadine
z '•
VA
HIV/AIDS and the Forgotten Children
What happens to children when they lose one or both parents to complications associated
with HIV/AIDS? How does losing a parent to AIDS affect a child's mental health? How
can the public sector safeguard the well-being of HIV-affected children and help ensure that
these kids grow healthy and strong?
These are just some of the questions HRSA and two of its sister agencies in HHS are trying
to answer.
Over the past 3 years. HRSA has supported the HIV/AIDS Mental Health Services
Demonstration Program in partnership with the Substance Abuse and Mental Health
Services Administration (SAMHSA) and the National Institutes of Health. Funded at more
than $4 million per year, the program supports 11 diverse projects across the Nation.
Prior to the development of this demonstration, which was the first to earmark federal
dollars to meet the mental health needs of people living with or affected by HIV/AIDS,
policymakers and program planners knew very little about the mental health needs of
children and adolescents who lose one or both parents to HIV/AIDS.
However, two of the sites—the Special Needs Clinic at Columbia Presbyterian Medical
Center in New York City and Kinship Connection at the Elizabeth General Medical Center
in New Jersey—serve large numbers of children, many of whom have lost one or both
parents to HIV/AIDS or are facing the death of a parent. Both projects serve a
predominantly urban African American and Latino population that has been hard hit by the
AIDS epidemic.
"Every day in our work, we are forced to confront the harsh reality that HIV is a family
disease that disproportionately affects communities of color." says Martha Saldarriaga, who
heads up the Kinship Connection project. "One-quarter to one-half of our clients are dealing
with end stage HIV illness, and one of our biggest challenges is getting parents to face the
fact that someone will need to take care of their children after they die. Far too often,
parents put off making these decisions until it's too late or until their ability to make
decisions is compromised by AIDS-related dementia."
The typical Kinship client is a socially isolated single mother diagnosed with AIDS who has
a T-cell count below 200 and two to four minor children. The New Jersey project also has
found that the children and teenagers they serve are at increased risk for substance abuse
and early sexual activity, which may lead to teenage pregnancy and HIV infection.
"We have found that developing an individualized treatment plan tailored to the unique
needs of each family is the most effective way to serve our clients," Saldarriaga says,
adding that it can take as many as a dozen visits to the family's home before they will agree
to accept services. "We match client or family needs with the skills and cultural
understanding of the family therapists on our staff. The assigned staff person is responsible
for coordinating services for the client and family to ensure they get the full range of
services and support they need." She adds that treatment plans are reviewed and updated
every 12 weeks.
Once parents have identified someone to take care of their children after their death.
Kinship Connection staff involve caregivers in the delivery of services to the family. "One
of the most difficult things we deal with is helping children through the transition from the
family they have always known to an unfamiliar, reconfigured family. This transition is
particularly tough for adolescents who, over time, have assumed the role of primary
caregiver and may feel protective of their parents."
The Special Needs Clinic (SNC) in New York City, takes a different approach to meeting
the needs of HIV-affected children and adolescents. Using a multidisciplinary mental health
team, including child psychiatrists, psychologists, social workers, and case managers, the
SNC identifies and engages families receiving medical care at Presbyterian Hospital in
ongoing mental health services at the SNC. This comprehensive, family-based approach
allows for the treatment of both adults and children in one mental health site where mental
health care is closely coordinated with medical care and HIV treatment for adults and youth.
"In New York City, an estimated 30.000 children are projected to lose their mothers to
AIDS by the year 2001." says SNC Director Jennifer Havens. M.D. "The families who
come to us tend to have a long history of psychosocial and mental health problems. In many
cases, mental illness, substance abuse, violence, and trauma have affected multiple
generations within the family. Usually, these problems have not been addressed, and
multiple members of the family require coordinated care in order to stabilize the child's
environment so that interventions on behalf of the child can be effective."
To make matters worse. Havens says that 22 percent of the children referred to SNC are
infected themselves and that most of these youth have experienced abuse, neglect, and
family disruption. "To say that the children and families we serve have extraordinarily
complex needs would be an enormous understatement." Havens says. "These families
historically have been poorly served and tend to be invisible to our service systems. HIV
illness connects them with the medical system in real ways. We have to seize this
opportunity to also address the mental health needs of their children and adolescents."
Over the course of the demonstration, both programs have learned several important
lessons:
•
Mental health services for children and adolescents can play an important role in
breaking the cycle of substance abuse and untreated mental illness, and may help
keep these children from following in their parents' footsteps.
•
The vast majority of HIV-infected women are poor. Concrete service needs—such
as food, money, shelter, and child safety—must be addressed before mental health
services can be effective. This approach helps establish a spirit of trust, and clients
are more likely to accept mental health services.
•
Continuity of mental health services across the continuum of parental HIV illness,
death, and family reconfiguration is essential to meeting the mental health needs of
HIV-affected children and adolescents.
•
When parents put off deciding who will care for their children upon their death—
especially those who are unable to do so because they are struggling ineffectively
with mental illness and/or substance abuse—children and new caregivers are more
likely to have difficulty handling the psychosocial and economic stress that comes
with a parent’s death.
Mental health, medical, and substance abuse treatment for HIV-affected adults and
children must be closely linked, coordinated, and co-located.
•
The social and cultural stigmas associated with mental health, substance abuse, and
HIV/AIDS often prevent families from accessing services. Many parents strongly
desire secrecy and confidentiality because they want to protect their children from
ridicule and because they are afraid that child welfare programs may take their
children away from them.
•
Frequent staff outreach and flexible scheduling often is needed to keep HIV-affected
families engaged in services. It is often helpful to provide services in the home in
order to gain the family’s trust. Home-based services are especially important for
parents with end stage HIV disease.
•
Women caring for children face unique logistical barriers to accessing services.
These include the need for child care to attend appointments, the cost of transporting
the entire family, and managing appointments for multiple family members.
•
Frequently coordinated case-conferencing is necessary to address both the needs of
individual family members and the family as a unit.
’’For all of the devastation that has come with the HIV/AIDS epidemic over the past 2
decades, we are now learning that there is something we can do to help keep these children
on track and to help them live constructive, productive, and healthy lives,” Havens says.
"We now know how complex their needs are and the kinds of services that will be
successful. Our next step is to expand our service capacity on a national basis to meet the
needs of the growing number of children and adolescents who are living with, and losing,
parents with HIV/AIDS.”
For more information about the HIV/AIDS Mental Health Services Demonstration
Program, call 1-800-789-CMHS (2647) or go to www.mentalhealth.org.
###
Ayz
Some Facts
With each passing minute HIV/AIDS
takes the life of another child. In 2001
there were 5 million new infections 800,000 of them children. 13 million
children have been orphaned by AIDS,
a number that is expected to more
than triple by 2010.
More than 95 percent of the estimated
40 million people infected with the HIV
virus live in the developing world, in
poor countries with few resources for
health care. The impact of AIDS and
the prospect of future damage to
communities and economies in the
developing world is devastating. CORE
Group
PVOs
are
working
in
partnership with governments and
communities to save the lives of
children through educational and
health programs.
'a
(S-'^c7•'
’'
9
\
Issues
Support issues
The Child Infected With HIV
Relevant CRC articles {key words}
Child specific issues
Knowledge of
HIV status
Participation in
And exclusion
From research
And consent
Issues
Psychological
and social
support from
family and
services
18: Common responsibility of parents
19: Protection against all forms of abuse
including negligent treatment
20: Care if deprived of family environment
23: Disability
24: Highest attainable standard of health and
facilities for treatment
26. Social insurance
27: Standard of living
39: Reintegration after exploitation
Access to and
quality of care
24: Highest attainable standard of health and
facilities for treatment
25: Periodic review of treatment
26: Social insurance
24: Highest attainable standard of health and
facilities for treatment
25: Periodic review of treatment
Prevention and
Treatment of
Opportunistic
Infections
Access to
Prescription
Drugs
Immunization
Child growth
and develop
ment
13: Information
16: Privacy
17: Access to information sources
13: Information
16: Privacy
17: Access to information sources
19: Protection against all forms of abuse
including negligent treatment
24: Highest attainable standard of health and
Facilities for treatment
25: Periodic review of treatment
Access to
educational
vocational and
recreational
opportunities
24: Highest attainable standard of health and
facilities for treatment
26: Social insurance
24: Highest attainable standard of health and
Facilities for treatment
28: Education
29: Personality and abilities
31: Rest and leisure(engage in play)
32: Child labor and economic exploitation
The four general principals (Article 2, Article 3, Article 6, Article 12) should be considered for each issue
presented.
Source: HEALTH AND HUMAN RIGHTS Vol. 3 No, 2002
The Child Infected With HIV (cont.)
Issues in HIV/
AIDS preven
tion, care, and
research
Children in
difficult
circumstances
Specific issues
Immediately relevant CRC articles (by key
words)
relevant to this
population
Sexuality and
sexual health
and reproductive
health
13: Information
15: Freedom of association
16: Privacy
17: Access to information sources
19: Protection against all forms of abuse
including negligent treatment
24: Highest attainable standard of health and
facilities for treatment
29: Personality and abilities
39: Reintegration after exploitation
Nutrition
Including infant
Feeding
23: Disability
24: Highest attainable standard of health and
facilities for treatment
27: Standard of living
Adoption
9: No forced separation
11: Illicit transfer and non-retum of children
19: Protection against all forms of abuse
including negligent treatment
20: Care if deprived of family environment
21: Adoption
24: Highest attainable standard of health and facilities for
treatment
The Child Affected by HIV/AIDS
Impact on
Family and
Community
Children whose
parents or
siblings are
Living with HIV/
AIDS
9: No forced separation
18: Common responsibility of parents
20: Care if deprived of family environment
27: Standard of living
Children
Orphaned by
AIDS
19: Protection against all forms of abuse
including negligent treatment
20: Care if deprived of family environment
21: Adoption
18: Common responsibility of parents
19: Protection against all forms of abuse
including negligent treatment
26: Social insurance
27: Standard of living
32: Child labor and economic exploitation
36: Protection against all other forms of exploitation
39: Reintegration after exploitation
Exhaustion of
Extended
Family’s coping
Capacity'
The Child Affected by HIV/A1DS (cont.)
Immediately relevant CRC articles (by key
words)
Issues in HIV/
AIDS preven
tion,care and
research
specific issues
relevant to this
population
Impact on
Services
Loss of educa
tional and
Vocational
Opportunities
28: Education
32: Child labor and economic exploitation
39: Reintegration after exploitation
Diminished
Access to
Prevention, care
And social
Services
18: Common responsibility of parents
24: Highest attainable standard of health and
facilities for treatment
26: Social insurance
27: Standard of living
Greater likelyhood of family
Reliance on child
Labor
19: Protection against all forms of abuse
including negligent treatment
27: Standard of living
28: Education
31: Rest and leisure (engage in play)
32: Child labor and economic exploitation
36: Protection against all other forms of exploitation
39: Reintegration after exploitation
Greater risk of
Sexual exploita
tion
19: Protection against all forms of abuse
including negligent treatment
27: Standard of living
28: Education
29: Personality and abilities
31: Rest and leisure (engage in play)
34: Protection against sexual exploitation and sexual abuse
36: Protection against all other forms of exploitation
39: Reintegration after exploitation
Exploitation of
Children
The Child Affected by HIV/AIDS (cont.)
Immediately relevant CRC articles (by key
words)
Issues in HIV/
AIDS preven
tion,care and
research
specific issues
relevant to this
population
Impact on
Services
Loss of educa
tional and
Vocational
Opportunities
28. Education
32: Child labor and economic exploitation
39: Reintegration after exploitation
Diminished
Access to
Prevention, care
And social
Services
18: Common responsibility of parents
24: Highest attainable standard of health and
facilities for treatment
26: Social insurance
27: Standard of living
Greater likelyhood of family
Reliance on child
Labor
19: Protection against all forms of abuse
including negligent treatment
27: Standard of living
28: Education
31: Rest and leisure (engage in play)
32: Child labor and economic exploitation
36: Protection against all other forms of exploitation
39: Reintegration after exploitation
Greater risk of
Sexual exploita
tion
19: Protection against all forms of abuse
including negligent treatment
27: Standard of living
28: Education
29: Personality and abilities
31: Rest and leisure (engage in play)
34: Protection against sexual exploitation and sexual abuse
36: Protection against all other forms of exploitation
39: Reintegration after exploitation
Exploitation of
Children
The Child Vulnerable to HTV/AIDS (cont.)
Issues in HIV/ Specific issues
Immediately relevant CRC articles (by key
AIDS prevenrelevant to this
words)
Tion,care, and population
Research
Awareness and
Skills
Ability to
modulate risk of
Acquiring HIV
Infection
(negotiation
sexual practices
condoms, other
preventive
behaviors
13: Information
17: Access to information sources
24: Highest attainable standard of health and
facilities for treatment
29: Personality and abilities
34: Protection against sexual exploitation and
sexual abuse
Livelihood
Exploitation of
Children
Child labor
19: Protection against all forms of abuse
including negligent treatment
27: Standard of living
28: Education
31: Rest and leisure (engage in play)
32: Child labor and economic exploitation
36: Protection against all other forms of exploitation
39: Reintegration after exploitation
Sexual exploitTion
19: Protection against all forms of abuse
including negligent treatment
27: Standard of living
28: Education
29: Personality and abilities
31: Rest and leisure (engage in play)
34: Protection against sexual exploitation and sexual
abuse
36: Protection against all other forms of exploitation
39: Reintegration after exploitation
Access to
education
13: Information
17: access to information sources
27: Standard of living
28: Education
29: Personality and abilities
Access to health
Services
(including sexual
health and
reproductive
health)
18: Common responsibility of parents
23: Disability
24: Highest attainable standard of health and
facilities for treatment
26: Social insurance
Services and
Programs
The Child Vulnerable to HTV/AIDS (cont.)
Issues in HIV/
AIDS prevenTion, care and
Research
Children
Difficult
Circumstances
Specific issues
relevant to this
population
Immediately relevant CRC articles (by key words)
Access to social
Services
18: Common responsibility of parents
23: Disability
24: Highest attainable standard of health and
facilities for treatment
26: Social insurance
27: Standard of living
In times of
conflict and
internally
Displaced
23: Disability
24: Highest attainable standard of health and
facilities for treatment
38: Protection and care
39: Reintegration after exploitation
InstitutionalizaTion(prison
Mental instituTions, etc.)
23: Disability
24: Highest attainable standard of health and
facilities for treatment
25: Periodic review of treatment
37: Appropriate assistance
40: Special concems/privacy
Homelessness
20: Care if deprived of family environment
23: Disability
24: Highest attainable standard of health and
facilities for treatment
26: Social insurance
27: Standard of living
Exposure to
Violence
18: Common responsibility of parents
19: Protection against all forms of abuse
Including negligent treatment
27: Standard of living
31: Rest and leisure (engage in play)
32: Child labor and economic exploitation
36: Protection against all other forms of exploitation
Injecting drug
Use by children
Asylum seekers
And refugees
33: Protection from illicit use of narcotic drugs
8: Preservation of identity
10: Family reunification
11: Illicit transfer and non-retum of children
20: Care if deprived of family environment
22: Refugee status
23: Disability
Yes, you're positive, but there's nothing we can do for you
By Sandhya Srinivasan
What can the National AIDS Control Programme achieve in the
absence of integration of HIV-related services into the health
system as a whole? The second in a series assessing the
HIV/AIDS situation in India
When the National AIDS Control Programme was first set up in
1992 its first priority was to make people aware of HIV.
HIV is transmitted through unprotected sex, infected blood and
blood products and from an HIV-positive pregnant woman to her
baby either during pregnancy or through breast-milk. The
programme publicised these facts.
In some ways the programme took a bold step by starting to talk
about sex - the main route of transmission of HIV - in a society
which didn't like to talk about such things. Public information
campaigns were launched which actually spoke of how HIV
infection was acquired - and how it wasn't, through casual
contact, for example. These continue to meet with resistance:
some feel that talking publicly about sex corrupts the young and
is antithetical to Indian culture. Doubts have also been expressed
about the quality of information provided: some messages seem to
confuse and create fear more than they educate.
The programme also sought to provide a bare minimum of
preventive services by protecting blood supply and setting up an
effective treatment programme for sexually transmitted
diseases (people who already have certain STDs are more
vulnerable to HIV if exposed to it through sexual contact, so
treating STDs would make people less likely to get infected with
HIV if exposed to the virus). Finally, the programme worked at
developing a system to monitor the prevalence of HIV in various
parts of the country by conducting unlinked anonymous tests on
STD clinic users, commercial sex workers, injecting drug users,
pregnant women attending antenatal clinics, and gay men.
Phase II: More of the same
The second phase of the National AIDS Control Programme (1999
to 2004) tries to take all these activities one step further and
build on them.
The primary focus of the second stage of the programme has
been 'targeted intervention' to increase awareness among those
believed to be at high risk of infection, and to change their
behaviour. This includes the promotion of condom use among
these groups.
Other activities include developing a safe blood supply through
the establishment of properly-equipped blood banks where all
blood is tested for HIV and other infections before use;
promoting blood donation and banning trade in blood; setting up
testing centres where people are encouraged to go for testing
which is preceded and followed by counselling; further
establishing STD treatment services, and setting up a programme
to provide a short course of anti-retroviral drugs to pregnant
women reporting to antenatal clinics who test positive for HIV
(called the PMTCT or prevent mother-to-child transmission
programme).
Phase II of the NACP also has, as stated objectives, the
provision of decentralised services and strengthening of the
system's long-term capacity to respond to HIV.
Finally, the number of sentinel surveillance sites, conducting HIV
tests for monitoring purposes, increased dramatically in the
second phase. These were in STD clinics and antenatal clinics and
among groups of sex workers. As a result, it is believed,
surveillance data collected in the last few years may present a
more accurate picture of the prevalence of HIV infection in
India. (Still, the programme continues to be plagued by queries
about the quality of its data and many limitations have been noted
by public health experts and activist groups.)
NACP II was implemented at the state level using state AIDS
control societies, autonomous bodies headed by a senior civil
servant, but with independent financial authority. These societies
funded voluntary organisations to carry out prevention.
The targeted approach
Overall, the targeted approach dominates the second phase of
the National AIDS Control Programme. The targeted approach is
touted as a success story in states like Manipur and Tamil Nadu
where HIV prevalence has reduced among target groups such as
injecting drug users (in Manipur), commercial sex workers and
clients of STD clinics (Tamil Nadu). Indeed, surveillance figures
for 2000 and 2001 show a drop in HIV prevalence in targeted
groups in a number of states. However, it is not clear if figures
for the two years can be compared. Interestingly, the NACO
website does not contain any HIV prevalence figures after 2001.
The programme quotes reports from successful AIOS control
efforts to argue that the best way to reduce HIV transmission is
to target interventions at groups most vulnerable to HIV. These
vulnerable 'core transmitter' groups are preferred for
interventions to groups that are more difficult to identify and
approach, such as clients of sex workers.
It is true that in the US and Australia, for example, wellorganised information programmes for gay men, by organisations
of gay men, are believed to have brought a sharp reduction in HIV
prevalence relatively soon after the appearance of HIV infection
in these groups.
What about those outside the target group?
A number of activists have complained that the targeted
approach misses people who are outside the target group. So, for
example, messages on the risk of unsafe sex between men are
presented only in situations where men congregate to have sex
with other men, or to groups self-identified as having sex with
other men. Since messages on the risks of gay sex are not
presented to the general population, those who do not identify
themselves as gay are excluded from important information.
Likewise, partners of injecting drug users risk acquiring HIV but
there are few efforts to speak to them as a group.
Targeting groups for interventions also stigmatises these groups.
Surveillance figures in recent years indicate that HIV infection is
not confined to the 'target groups' of people with high risk
behaviour. A number of women who are HIV positive report
having had sex with only one partner — their husband. However,
there is no effort to reach the 'low risk' woman and discuss how
she might protect herself from infection.
=
Need for quality counselling
The general call for people to get themselves tested for HIV is
not supported by counselling services before and after testing.
The voluntary counselling and testing centres (VCTCs) set up by
the programme are reportedly under-staffed and counsellors are
often poorly trained. There are too many reported incidents of
people being informed of their HIV status in front of other
patients, of little or no effort being made to educate those who
test negative of how to avoid risk behaviour.
Yes, you're positive, but there's nothing we can do for you
It must seem particularly unjust to those who are encouraged to
test themselves and find themselves HIV positive, that they have
nowhere to go.
A few voluntary organisations do provide treatment and support
but they can meet just a fraction of the demand for such care. In
general, both private and public health services are completely
unprepared to respond to the growing need to care for people
with HIV. Private services generally refuse treatment, or provide
it at exorbitant costs to those who can afford it. Very few public
health services are equipped to provide treatment of any kind,
drugs are in short supply, as are protective materials to be used
for all patients (following universal precautions). And few
personnel have been trained in standard procedures to prevent
transmission of HIV or other infections. The kind of resource
allocation, education and regulation needed to ensure treatment
to people with HIV-related health problems do not exist.
In such a situation, there is no scope for treatment with anti
retrovirals through the public health system, a demand made by
some groups working with people with HIV.
A weakened health system
There is much talk about integration of HIV prevention and
treatment into the system. However, not only are preventive
programmes patchy and integration poor, there is no integration
of HIV-related services into the health system as a whole.
Further, public health services in India have deteriorated
steadily over the last few decades. There is no evidence of
efforts being made to strengthen the health system and prepare
it for a growing burden of ill people. Barely 20% of all healthrelated expenditure is made by the government; the rest is within
the private sector, where payment is made by individuals spending
their own money since health insurance is available to a negligible
percentage of people in India. The increase in HIV-related
problems calls for increased government spending on health. As
more awareness is generated and more people test positive, this
demand is bound to grow.
This increase in government spending on health is a decades-old
demand. Instead, the amount spent on health has gone down, not
up. There are innumerable instances illustrating the collapse of
health care through the government, from the rural primary
health centre all the way up to the municipal hospital
representing the tertiary level of care. Equipment does not work,
drugs and other materials are not available, staff are absent, and
so on.
In fact this general deterioration of public health services
actually increases people's vulnerability to HIV as shortages
encourage the reuse of unsterilised equipment.
Further, the absence of treatment may in fact exacerbate the
stigma attached to HIV.
HIV is driven by inequities
HIV is intrinsically linked to poverty and to inequalities of all
kinds - social, economic and gender. However, awareness and
other preventive programmes do not address inequities that are
intrinsic to the problem. The married woman is unable to refuse
her husband unprotected sex. The commercial sex worker will not
insist on her client using a condom if he threatens to go
elsewhere. The national HIV programme fails to take into
inequities into account.
- Media
15777.pdf
Position: 921 (8 views)