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Edited draft Asia Guide 1
HEALTH AND NUTRITION
INTRODUCTION
HIV/AIDS affects children’s health and nutrition directly. Children living with
HIV have special health and nutritional needs.
Children can be infected with HIV in Several ways:
•
Mother-to-child transmission from an HIV-positive mother during pregnancy,
birth or breastfeeding is responsible for most HIV infection in children.
Without intervention, one in three positive mothers will pass on the virus to
their children. The risk of transmission can be significantly reduced by a
combination of antiretroviral drugs and replacing breast milk with a suitable
formula, soy or animal milk. Evidence about the role of caesarian Section and
exclusive breastfeeding (feeding with breast milk only) in reducing the risk
of transmission from mother to child is more controversial.
•
HIV can be transmitted to children through transfusion with infected blood
or injections using equipment contaminated with infected blood. The risk of
transmission can be reduced by using sterile or disposable instruments,
needles and syringes, and screening blood for transfusion services.
•' Spxual abuse or exploitation of children may expose them to HIV infection.
HIV/AIDS also affects children’s health and nutrition indirectly. Children who
do not have HIV but who are living with sick parents or without parents often
live in poverty. They have poor health because of inadequate environmental
and sanitary living conditions, lack of access to health care, lack of food, and
neglect. They are more likely to be malnourished because poor households
cannot afford enough good food; sickness is reducing food production; and
when less food is produced families have less income and threrefore less
food to eat.
This Guide is divided into two sections:
Issues - considers how HIV/AIDS affects children’s health and nutrition
and explains why programmes should pay attention to the health and
nutritional needs of children affected by HIV/AIDS.
•
Principles and strategies — outlines principles of programming to
improve children’s health and nutrition, and describes possible ways of
taking action to address the health and nutritional needs of children
affected by HIV/AIDS.
I
ISSUES
Children affected by HIV/AIDS are at increased risk of poor health because of:
•
Poor living conditions - Children without parents or with families
affected by HIV/AIDS often live in poor housing, without access to clean
water and adequate sanitation. Poor living conditions, together with poor
domestic, personal and food hygiene, increase the risk of common
childhood diseases such as diarrhoea and pneumonia. Children with HIV
are especially vulnerable to common childhood diseases, and those who
live in poor conditions may suffer frequent and severe infections. Young
children living in overcrowded conditions with adults who have infectious
tuberculosis (TB) are at increased risk of TB.
•
Poor nutrition - Children who do not get enough to eat or who do not eat
good food are at increased risk of infections. Infections are often more
severe in malnourished children.
•
Lack of knowledge - Older carers and children living without parents may
lack basic knowledge about health and hygiene or when to seek care from
a health worker. For example, they may not know about the importance of
immunisation or about the need for prompt treatment for common
infections. They may opt to use traditional healers who are unaware about
HIV/AIDS or who provide inappropriate treatment for childhood diseases
such as diarrhoea, pneumonia or malaria. Lack of awareness means that
children and their carers cannot tell the difference between genuine and
counterfeit medicines, which are widely available in some places. Parents
and grandparents may lack information about how to care for children with
HIV when they are ill. Children may not know how to care for sick or dying
parents.
•
Poverty - Poverty affects access to health products and services.
Affected families, grandparents and children living without parents may not
be able to pay for preventive interventions, such as mosquito nets, or for
medical consultations, drugs or transport to health facilities. Poor families
may delay seeking care until a child is seriously ill, which can be fatal if the
child has pneumonia or malaria. Some poor families may decide that
spending money on health care for children with HIV is not worthwhile.
•
Discrimination - Judgmental attitudes of health workers towards families
affected by HIV/AIDS may deter children and their carers from seeking
treatment from health services. Adolescents and child-headed households
may not use health services because of lack of confidence and fears about
negative attitudes. Children and their carers may also be reluctant to use
health services if they think that health workers will not maintain
confidentiality about their HIV status or that the community will suspect
they have HIV. In some cases, children being cared for by relatives or
foster parents are less likely to be taken to a health centre than the
family’s own children.
2
Lack of adult care - Parents with HIV are often too sick to take their
children for health care. Children without an adult carer may have no one
to take them to a health centre for immunisations or treatment. Children
who are caring for sick parents or who are living without parents may
neglect their own health. Orphans may have no one to care for them when
they are sick and to help them recover from illness by making sure they
take their medicines or eat properly.
Poor health care - Health workers may not have the training, skills or
drugs to manage children with HIV. For example, they may be unaware of
the specific immunisation needs of children with HIV or of how to manage
opportunistic infections. Paediatric formulations of drugs to treat
opportunistic infections and antiretrovirals are not widely available. In
many poor countries, children do not have access to antiretroviral therapy
through public health services. Health workers may feel it is better to use
limited resources to treat healthy children rather than children with HIV
who will only live for a few months or years. Health workers may also be
unaware of the health needs of children from families affected by
HIV/AIDS but who are not themselves HIV-positive.
Work-related risks - Children often have to work to contribute to
household income or to support themselves and their siblings. Their health
is at risk if they work in hazardous or dangerous conditions with little or no
protection. For example, some jobs expose children to toxic substances,
such as chemicals or pesticides, or to the risk of burns or injuries. Working
long hours is also harmful to children’s health and development.
Children affected by HIV/AIDS are at increased risk of malnutrition because
of:
•
Parental illness - Children in families affected by HIV/AIDS may not get
enough to eat, because their parents are too sick to earn money to buy
food, to farm their land or to sell their produce. Parents may not have the
time or energy to prepare meals or to make sure that children eat properly.
•
Sale of assets - Families may sell land or livestock to cope with reduced
income or increased expenditure because of HIV-related illness. After the
death of their parents, children may be forced to sell assets to pay debts or
funeral expenses. Households without land or livestock cannot produce
food or earn money to buy food, and have nothing to fall back on in times
of food shortage.
•
Physical and psychological problems - Frequent infections, such as
diarrhoea, cause malnutrition. Emotional distress because parents are sick
or have died can cause children to lose their appetite. They may not get
the help they need to make sure that they eat properly.
•
Poor knowledge about nutrition - Grandparents and children who are
caring for younger siblings may not know about good childhood nutrition,
because most nutrition education programmes are targeted at mothers.
3
Grandparents sometimes have traditional ideas about feeding children,
including taboos about children eating certain types of foods. Older carers
and children living without parents may not have the skills, energy, time or
fuel to prepare nutritious meals.
•
Lack of money, land or skills - Children living without parents or with
grandparents may not get enough to eat because of poverty, especially if
there are many children in the household. Many children and older people
do not have the land, skills or tools required for food production, or the
money to buy seeds, fertiliser or pesticides. Relatives may take land and
livestock that belongs to children after the death of the parents. Parents
may die before passing on agricultural skills, so even if children manage to
keep the family land, they may not be able to produce enough food for
themselves and their siblings.
4
PRINCIPLES AND STRATEGIES
Principle 1: PROTECT CHILDREN’S RIGHTS TO HEALTH AND
DEVELOPMENT
Programmes should be based on the principle of children’s rights to health
and development, and non-discriminatory access to health care.
The Convention on the Rights of the Child states that:
•
•
All children should have access to adequate healthcare services and
programmes. These should include adequate preventive education and
treatment for HIV/AIDS when necessary.
Orphans and vulnerable children should receive special protection from
economic exploitation and from performing any work that is likely to be
hazardous or harmful to their health, or physical, mental, moral and social
development.
Strategies for action
•
Educate communities about the rights of all children to health and
development, and the importance to society of healthy children.
•
Promote collaboration between different sectors and organisations,
including health, education and agriculture, community, women’s, youth
and PLHA organisations, and community, traditional and religious leaders.
•
Consider carefully before HIV testing. Younger children should only be
tested if appropriate counselling is available for the child and the caregiver
and if knowing the HIV status will result in the child receiving better care
and support. Older children should only be tested if the same conditions
apply and they have understood the issues and given informed consent.
•
Take steps to prevent discrimination. Possible approaches actions include:
Inform communities that children with HIV can stay healthy and
live for many years if they receive good preventive care and
treatment and good nutrition.
Make sure that health services have and implement protocols
that protect the confidentiality of families and children.
Sensitise health workers to the needs of children with HIV,
children living in affected families and orphans.
Educate health workers about HIV/AIDS and universal
precautions, to reduce their fears about occupational
transmission.
Advocate for health authorities to implement policies that protect
against discrimination
Encourage community leaders and committees to protect
children’s rights to health care and to address discrimination in
5
healthcare provision for infected or affected children and their
families.
Principle 2: ENSURE ACCESS TO QUALITY HEALTH CARE FOR
FAMILIES AS WELL AS CHILDREN AFFECTED BY HIV/AIDS
The health and nutrition of children depends on the health of those who care
for them. A sick caregiver cannot prepare meals, take a child to the clinic, or
care for a child who is ill. Good-quality health care for parents, grandparents
and other carers helps to prolong their lives and increase their capacity to look
after children’s health and nutrition. Programmes should provide health care
for the whole family, as well as for affected or infected children. However, it is
important to provide care for all poor and vulnerable families. Targeting
affected households or children causes resentment and can increase
stigmatisation and discrimination.
Strategies for action
•
Ensure that caregivers, especially grandparents and older children, know
how to access health services.
•
Work with local leaders and community groups to identify ways to increase
access to health care for the most poor vulnerable children and
households. Possible actions include:
Exempt orphans, caregivers who are sick and households
caring for many children from charges for medical consultations
and drugs.
Promote links between schools and clinics, and increasing the
awareness of teachers of the health needs of affected children.
•
Ensure that health services and health workers are responsive to the
needs of children and families affected by HIV/AIDS. Possible actions
include:
Encourage health authorities and NGOs to train heath workers
in counselling skills and clinical management of children with
HIV and children from affected families.
Make sure that health facilities have basic drugs and supplies to
treat common childhood and adult infections and opportunistic
infections.
Advocate for access to treatment with antiretroviral drugs for
children and adults with HIV.
Ensure that health workers have clear guidelines on referral of
children who do not respond to treatment for common infections.
Establish “one stop” family services that provide information,
counselling, diagnosis and treatment.
Establish youth-friendly and child-friendly health services with
specially trained staff and flexible opening hours.
6
Promote links with TB programmes to ensure that adults with
infectious disease receive anti-TB treatment.
Provide home-based services for children or carers who are too
sick or poor to come to the clinic.
In Cambodia, Save the Children UK worked with the Women's Organisation for
Modern Economy and Nursing and the Solidarity for Urban Poor Federation in
Phnom Penh, to improve provision of youth-friendly and child-friendly health
services in slum areas.
5a ve the Children UK, 2001. Young people and HIV/AID5: responding to the new
Asian crisis
•
Encourage communities to solve problems that stop people from
accessing health care. Possible actions include:
Establish community funds to pay for healthcare costs for the
poorest children and families, and children living without parents
or with elderly carers.
Organise transport to health or referral centres.
Provide practical help with childcare or domestic tasks to give
carers time to take children to the clinic.
In Cambodia, World Vision has provided ambulances to referral hospitals, to
assist in referral of patients from the community to hospital, as well as from
the referral hospitals to the national hospital. Villagers have to make a
commitment to contribute the fuel costs for transportation from their
community.
Member of Asia Guides development group
•
Promote a continuum of care for children, with links between communities,
home-based care programmes, health centres and referral services.
•
Include children in home-based care and treatment services provided by
outreach teams, community health workers or community volunteers.
IDA in Cambodia supports home-based care through teams of community
volunteers, PLHA, NGO and health centre staff. The teams provide care and
referrals for children and child carers. IDA also pays costs related to health
care, such as transport, tests and food, for families that cannot afford to.
Member of Asia Guides developmentgroup
•
1-
Take steps to control counterfeit medicines and drugs. Possible
approaches include:
Advocate for laws to prohibit the supply and sale of counterfeit
medicines and drugs.
Encourage community committees to monitor the sale of
counterfeit products.
7
Educate communities about counterfeit products.
Principle 3: STRENGTHEN COMMUNITY AND FAMILY CAPACITY TO
KEEP CHILDREN HEALTHY
Communities and families need to know how to keep children healthy. Carers
need basic information about prevention and treatment of common childhood
infections, including what they can do at home and when they need to take a
child to the clinic. Those caring for children with HIV need to know how to look
after children when they are sick and how to protect themselves from
infection.
Strategies for action
•
Educate communities and families about child health, and train older
people as educators, especially in communities where the old are widely
respected and are traditionally seen as a source of advice.
•
Provide parents and caregivers with practical information about basic
hygiene, good nutrition, immunisation, preventive care, treatment of mild
illnesses and when to seek help from a health worker.
•
Provide practical information, training and support for those caring for
children with HIV. Possible actions include:
'4
Organise educational sessions about the symptoms of HIV in
children and how to care for children with HIV.
Provide information about how to prevent HIV transmission, for
example, by minimising contact with blood and body fluids,
covering open cuts and wounds and being careful with sharp
instruments, and practical materials such as soap, disinfectants,
and latex gloves.
Use home-based care programmes and home visits to offer
training and support.
Promote links with healthcare services.
Implement training in palliative care for the dying, especially pain
control.
•
Give carers practical and emotional support. Possible actions include:
Encourage religious organisations, traditional healers, women’s
groups, youth groups, and self-help groups of people living with
HIV/AIDS to provide psychosocial support to carers.
Establish peer support groups for older carers.
Organise day care to give carers a rest from looking after
children.
Make referals to counselling services.
Duringhotne visits^n^ambodia, IDA teams provide education, counselling for
people living with HIV/AIDS and their carers, health kits including basic
8
f
medicines to treat problems such as diarrhoea and skin infections, and practical
training for carers in basic hygiene and nursing care.
Member of Asia Guides developmentgroup
•
Mobilise communities to improve the conditions that can increase the risk
of infectious disease in children, for example poor housing and sanitation.
In Cambodia, the NGO NAPA works with local commune committees to help
improve housing of affected families and child-headed households.
Member of Asia Guides development group
HEALTH CARE
• Look out for symptoms of illness, especially cough, fever, fast or difficult
breathing, loss of appetite, poor weight gain, diarrhoea and vomiting treat or seek treatment as soon as possible.
• Make sure a child is immunised. Note: Children with HIV disease or AIDS
should not be given BCG or yellow fever vaccine.
• Keep children away from people with TB, pneumonia and measles — if
possible children should not sleep in the same room as a person with TB.
• If possible children should sleep under a mosquito net, preferably a net
that has been treated with a suitable insecticide, to protect them from
malaria.
• Give plenty of fluids to child with fever. Give paracetamol to reduce high
fever. Take a child to a health centre if fever continues for more than 3
days, sooner if the child also has convulsions, diarrhoea, stiff neck, cough,
or there is malaria in the area.
• Give a child with diarrhoea more fluids to drink than usual - water, soup,
yoghurt drinks, coconut water, unsweetened tea, rice water - keep feeding
the child, seek care if diarrhoea continues for more than 3 days, or there is
blood in the stool, the child vomits often, eats or drinks poorly, or has
fever.
Caring with Confidence: Healthlink Worldwide (1997)
Principle 4: STRENGTHEN COMMUNITY AND FAMILY CAPACITY TO
PROVIDE GOOD NUTRITION
Immediate efforts to improve nutrition - for example by providing food should be complemented by efforts to improve community and family selfsufficiency, for example, by increasing agricultural production. Nutrition
education programmes should promote use of locally available, low-cost
foods.
Carefully assess the nutritional needs of children from affected households
before designing programme interventions. It is especially important to
consider the implications of introducing school meal programmes. Providing a
midday meal or breakfast can act as an incentive for school attendance and
9
improve children’s ability to learn, and well designed programmes can help to
improve children’s nutrition. However, these programmes need to be
designed to make sure that families do not see a school meal as a substitute
for a meal at home and to make sure that children receive high-quality food.
Programmes need to provide meals for all children, to avoid stigmatising
children affected by HIV/AIDS.
Strategies for action
•
Improve community and family knowledge about good nutrition and
appropriate foods for children. Possible actions include:
Work to increase community and family awareness of the
importance of good nutrition for children’s health and
development.
Provide nutrition counselling and education about locally
available, low-cost nutritious foods and recipes through cookery
and nutrition classes for parents, grandparents, older children
and other carers.
Teach simple ways to prepare food that increases the nutritional
value of meals and reduces fuel consumption, for example,
adding oil to porridge and avoiding over-cooking.
In India, the YMCA runs nutrition education programmes for mothers and
adolescents, which involve discussion of children’s nutritional requirements and
low-cost, locally available foods, and practical preparation of recipes.
Member of Asia Guides development group
An NGO in India found that orphaned children being cared for by relatives were
sometimes given less food than the families' own children. At the same time as
providing nutritional Support for these children, the NGO is working with
families to encourage them to change their attitudes.
Member of Asia Guides development group
•
Make sure enough food is available. Possible actions include:
-
-
Mobilise support from government agricultural departments, for
example, to advise families about animal raising, crop
diversification or crops that require less labour, and to provide
seeds, fertilisers and pesticides.
Establish community, school and home fruit and vegetable
gardens, which can also be used to teach children agricultural
skills:
•
Pfdyi^p financial and practical support for households or
Communities to start growing,crops for sale or animal
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Proniote small-scale community-based food processing to
improve access tofood and income.
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Mobilising community labour to assist households headed by
children or the elderly with planting and harvesting.
Establish community grain or rice banks to make sure orphans
and vulnerable children have enough food.
Improve crop preservation and storage methods.
In Cambodia, the NGO Khin Care provides elderly and child carers with seeds
and small amounts of funding for raising pigs and chickens. This helps to improve
childrens nutrition directly as well as indirectly through improved income from
sale of products.
Member of Asia Guides developmentgroup
Also in Cambodia, the NGO NAPA has trained communities to run home gardens,
and surplus vegetables are given to orphaned children.
Member of Asia Guides development group
•
Mobilise support for affected families and children from communities,
NGOs, religious organisations and the private sector. Possible actions
include:
-
Introduce community meal schemes for younger children.
Provide meals to pre-school children at daycare centres.
Target nutritional supplements, such as high-energy foods and
vitamins, to the most vulnerable children.
Use religious venues to coordinate food collection and
distribution.
Encourage local businesses and food suppliers to donate food.
A volunteer network led by a Buddhist monk collects and distributes donated
food to families in need in one district of Cambodia. In Vietnam, pagodas receive
food and other material offerings. They often receive more than they need, and
distribute the excess to poor families. A Buddhist temple in Thailand has set up
a milk bank to improve children's nutrition.
Member of Asia Guides developmentgroup
The Women's Action Group is providing nutritional support to over 250 HIVinfected and affected children and their families in a poor slum area of Delhi in
India. Families are given weekly rations, which the NGO buys from shops in the
community, to Support the local economy. The initiative is partly funded by the
NGO and partly funded by the community. Provision of food is accompanied by
cooking demonstrations for parents and children. NGO staff make periodic home
visits to check that the rations are given to the children and are not resold in
the market. In addition, when the children come to collect their rations, a
doctor checks their weight and height and follows up any child that is losing
weight.
Member of Asia Guides development group
11
In India, the Rotary Club provides a daily breakfast for adults and children
receiving treatment for TB through a DOTS (directly observed therapy - short
course) programme.
Member of Asia Guides development group
Principle 5: PROVIDE CHILDREN WITH APPROPRIATE KNOWLEDGE,
SKILLS AND SUPPORT
Children affected by HIV/AIDS often take on responsibity for caring for their
sick parents or for younger siblings. They can play an active role in promoting
their own health and nutrition and that of their families, if they are given the
knowledge, skills and support to do so. Programmes should encourage
children's participation and identify ways to give children a voice in their own
health and development, and in decisions about their treatment and care.
Strategies for action
•
Educate children about how to prevent common infectious illness,
including the basic principles of good sanitation and hygiene; the
importance of immunisation; how to prepare a nutritious low-cost diet; and
the prevention of transmission of HIV.
•
Encourage educational authorities and schools to teach children about
health, hygiene and nutrition.
In India, Nutrition Week celebrations are used to improve children's knowledge
of health and nutrition. Children are encouraged to undertake activities at
school and in the community, such as making posters and writing songs.
Member of Asia Guides development group.
•
Ensure that children know how to access information, counselling and
treatment services.
•
Identify community volunteers to accompany children without parents, or
whose carers are sick, to health facilities.
•
Develop child-friendly information and strategies to help them take their
medicines.
•
Provide practical information, training and support for children who are
caring for parents with HIV, including information about how to prevent HIV
transmission, and practical materials such as soap, disinfectants, and latex
gloves.
•
Use home-based care and home-visit programmes to provide practical
and emotional support for children caring for sick family members.
12
Edited draft Asia Guide 2
LIVELIHOODS AND ECONOMICS
INTRODUCTION
HIV/AIDS has a major impact on economics and livelihoods, increasing
poverty and reducing economic opportunities.
Many children affected by HIV/AIDS live in great poverty. Poor households
are struggling to meet children’s needs for food, clothing, health care and
education. HIV/AIDS-related illness and death increase expenditure and
decrease income, reducing household economic resources. Taking
responsibility for additional children increases the burden on families who are
already suffering economic hardship.
Living in poverty also reduces children’s opportunities for training and
education. With few qualifications and skills, children’s future employment
prospects are limited to informal and low-paid work. This reduces their ability
to improve their economic situation. They are likely to grow up into the poor
adults and parents of tomorrow. Many orphans and affected children also lose
their rights to family land, property and livestock. Without assets, it is difficult
for them to generate income or obtain credit.
This Guide is divided into two sections:
•
Issues - considers the economic impact of HIV/AIDS on children and
explains why programmes need to strengthen the livelihood and economic
skills and resources of children, families and communities.
•
Principles and strategies - outlines the key principles of programming to
improve the economic situation of children affected by HIV/AIDS, and
describes possible ways of taking action to strengthen the livelihood and
economic skills and resources of children, families and communities.
1
ISSUES
HIV/AIDS creates or worsens poverty because of:
•
Decreased income - Family income decreases when parents become too
sick to work their land or to earn an income. Sometimes a parent may lose
their job because of their HIV infection or frequent illness. Often the
household has no income at all after the parents die. In places where
HIV/AIDS is highly stigmatised, the family may lose income because other
people in the community refuse to buy their crops or goods.
An appraisal of the situation of children affected by HIV/AIDS in Cambodia
found that in some cases children are reduced to begging. As one child said: ‘T
want not to have to beg".
Children affected by HIV/AID5; appraisal of needs and resources in Cambodia.
KHANA, 2000.
•
Increased expenditure - Households with a family member with HIVrelated illness often spend much of their income on medical treatment,
leaving less money for food, health care and education.
Reduced resources - To cope with economic hardship, affected families
commonly sell assets or use up their savings, reducing their capacity to
generate income or to borrow.
•
Family debt - Borrowing money to pay for food, medical treatment or
funeral costs is often the only option for poor families. If parents die
leaving unsettled debts, children may have to take responsibility for
repayment. In some cases, they may be subjected to violence from
moneylenders or be forced into bonded labour to pay off the debt.
•
Increased pressure on poor households - Caring for orphans increases
the economic burden on families who are already caring for their own
children. Elderly carers with no source of income or welfare safety net find
it particularly difficult to cope with the costs of raising orphaned
grandchildren.
•
Lack of welfare support - Children and older people may not know about
their entitlement to welfare benefits or may lack the knowledge and skills
to obtain benefits.
HIV/AIDS reduces children’s economic opportunities and future life chances
because of:
Loss of inheritance - Selling off family assets, such as property, land or
livestock, reduces the capacity of children to generate income or obtain
credit. If parents do not make a will, children may lose their inheritance to
relatives, especially when they have no legal rights or title deeds. These
children may not have access to legal support to help them claim their
2
rights. Grandparents may lack the resources or capacity to pursue a legal
case on behalf of orphaned grandchildren.
A study in Thailand found that many families of people living with HIV/AIDS
used family savings, often intended to pay for children's future education, or
sold land to pay for medical treatment.
W Im-Em and 5 Phuangsaachai, 1999. Household resources allocation and
responses toward AID5-related illnesses. Mahido! University and CARE, Bangkok
•
Lack of economic support and skills - Without a regular income or
assets, or with existing debts, it is difficult for poor and HIV-affected
families, the elderly or children to obtain credit or loans. Households
headed by children or the elderly also commonly lack skills and access to
training to help them start income-generating initiatives or to market their
goods. Children may be unaware of or denied their parents’ share of
community savings and credit schemes.
Missed education - Children in affected households or who have lost
their parents often have to earn money to contribute to family income or to
support themselves. Even if the family can afford to educate them, children
from poor homes may feel too ashamed to go to school if they do not have
clothes or shoes. These children start work earlier than their peers,
reducing their chances of achieving basic literacy or gaining qualifications.
Children in affected households may also drop out of or miss school to
help with caring for the sick, domestic tasks, farming or the family
business.
Reduced life chances - Children without education or formal
qualifications are less likely to have access to vocational training and have
limited employment opportunities. These children may end up working for
low wages in the informal economy, with little chance of improving their
situation. Girls who drop out of school or miss school may have little
alternative but to sell sex in order to support themselves and their families,
increasing their risk of HIV infection.
3
PRINCIPLES AND STRATEGIES
Principle 1: PROTECT CHILDREN’S RIGHTS
Children have the right to enjoy adequate standards of living and to have
access to welfare benefits, including social security and social insurance. It is
essential to protect children’s rights to their inheritance.
Protecting the rights of widows as well as of children is also important, as
children’s wellbeing often depends on the economic resources available to
their mother.
Strategies for action
•
Ensure that affected households and children have access to welfare
entitlements. Possible actions include:
Provide affected families with information about how to access
scholarships, free health care and other benefits.
Give households headed by children or elderly carers practical help
with application forms and procedures.
Identify community advocates who can ensure that orphaned
children receive the social welfare benefits they are entitled to.
•
Encourage families to protect their children’s rights to property, land and
other assets. Possible actions include:
Help families to make a legally binding will.
Encourage parents to pass on birth certificates and title deeds to
their children.
Promote birth registration in places where children need a birth
certificate to inherit property or to obtain social welfare benefits.
Make sure that children and their carers are aware of laws that exist
to protect inheritance rights.
Provide access to legal advice, aid and support for children and
caregivers to help them claim what they are legally entitled to.
In India, the Lawyers’ Collective provides advice to help ensure that children’s
inheritance rights are protected. One man who had taken on responsibility for
caring for his nieces and nephews was very concerned that they would lose their
share of their deceased father’s property to unscrupulous relatives. The
Collective helped him to file a guardianship petition to look after the children
and their property and to file an injunction to restrain paternal relatives from
selling or transferring the property. In another case, lawyers and social workers
helped orphaned siblings to get the family home transferred into their name.
Member of Asia Guides developmentgroup
•
Mobilise the community to protect the rights of widows and children.
Possible actions include:
4
Promote awareness of the inheritance rights of women and
children.
Enlist community leaders to protect the inheritance rights of widows
and children and to solve family disputes.
Encourage village committees to take responsibility for promoting
the interests of orphans and vulnerable children, including
protecting them from unscrupulous relatives.
Principle 2: PROMOTE COMMUNITY SELF-RELIANCE
Strengthen the capacity of communities and families to improve their situation.
Schemes that rely on donor funds to provide financial and material support
are not sustainable and encourage dependence on welfare and external
support.
Strategies for action
•
Promote integration with existing community structures to ensure
sustainability. Possible actions include:
Strengthen existing community organisations rather than
establishing new structures to address the needs of children
affected by HIV/AIDS.
Encourage village development committees to organise the
provision of practical support for affected families.
•
Mobilise communities to provide economic and material support. Possible
actions include:
Establish community welfare funds to pay for education and health
care for orphans and vulnerable children, to cover the costs of
funerals, or to provide short-term relief to families in crisis.
Promote community food and clothing donation schemes.
Involving religious organisations.
The Sangha Metta Project, which works in Thailand, Cambodia, Laos, Bhutan and
Vietnam, encourages Buddhist monks and nuns to get involved in HIV/AIDS care
and support. Communities traditionally make donations to the temple, and the
monks are using this mechanism to generate resources, which they distribute to
affected families and children during home visits. Some temples are conducting
fundraising activities on special days such as World AIDS Day and Children's
Day, as well as motivating community volunteers to provide practical support to
affected families.
Member of Asia Guides development group
In Cambodia, the NGO NAPA is encouraging communities to help grandparents
caring for their orphaned grandchildren by giving clothes and school materials.
Member of Asia Guides development group
5
•
Encourage communities to provide labour when parents are too sick to
work and for households headed by children or grandparents. Possible
actions include:
Identify community volunteers to help with tasks such as harvesting
or house repairs.
Establish “labour banks”.
Establish caregiver groups to provide mutual practical support.
•
Encourage communities and families to contribute towards the cost of
providing services.
The Orchid Clinic in Thailand, which provides daycare services for infected and
affected children, expects parents in return to make a regular contribution to a
bank account for their child.
Member of Asia Guides development group
Principle 3: STRENGTHEN THE ECONOMIC COPING CAPACITY OF
FAMILIES AND COMMUNITIES
Families and communities are the main safety net for children. Their capacity
to provide for children depends on their economic resources and ability to
maintain livelihoods.
When they are in economic difficulties, families rely on relatives, neighbours
and others in the community and on, for example, community-based child
care, repair of deteriorating houses, apprenticeships and training, agricultural
support, labour sharing, credit and savings schemes. Efforts to build the
capacity of households must be complemented by efforts to strengthen
community safety nets. Strategies to address poverty and improve the
situation of affected children should therefore focus on strengthening the
economic coping capacity of communities and families rather than providing
direct economic support to children.
Strategies for action
•
Promote coordinated approaches to avoid provision of piecemeal support
from different sources. Affected children and families require a range of
support, which requires different programmes and projects to work
together. Possible actions include:
Promote links between programmes intended to support affected
children and other community development programmes, for
example, community development, rural livelihoods, agriculture,
non-formal education, micro-finance and credit.
Coordinate activities with health and education services.
6
•
Help families to maintain economic independence. Possible actions
include:
Provide legal support to parents with HIV who experience
discrimination at work or are dismissed from their jobs.
Introduce practical measures that enable parents to continue to
earn income or work their land, for example, community pre-school
and daycare centres for children.
Involve the elderly and affected children in identifying solutions to
their economic problems and developing income-generating
activities.
Provide agricultural advice to help affected families grow crops that
require less labour.
In Cambodia, the organisation IDA supports the employment rights of people
living with HIV/AIDS. In one case, an HIV-positive woman was dismissed from
her job because she was sometimes sick. IDA helped her to get her job back by
talking to her boss about HIV/AIDS.
Member of Asia Guides development group
The Orchid Clinic daycare centre for children allows people living with
HIV/AIDS, to continue to work without worrying about leaving their children
alone all day.
Member of Asia Guides development group
•
Strengthen capacity to generate income. Possible actions include:
Target income-generating schemes to affected families, in particular
grandparents, widows and children.
Explore how older people can generate income using traditional
skills.
Identify local employment needs and providing relevant vocational
training for affected families.
Provide training in business, financial and marketing skills.
Support cottage industries, small-scale community and family
initiatives, cooperatives and self-help groups.
Promote links with the private and business sector, including
helping communities to market their products.
Establish small-scale animal husbandry enterprises.
Provide grants to buy equipment and tools for affected families who
are setting up small-scale enterprises, or establishing a community
“tools bank”.
In India, Project CHILD targets support for income-generating activities to
grandparents caring for orphaned children, as older people find it difficult to
get a job or to obtain credit, and often have no savings to fall back on. Project
CHILD also provides direct material and financial assistance to the poorest
7
grandparents to help them continue to raise their grandchildren in order to
avoid the institutionalisation of these children.
Member of Asia Guides development group
The rural NGO, Homeland, in Cambodia recognises that supporting women to
earn an income after their husbands have died is essential to keeping families
together. Homeland supports groups of HIV-positive and negative widows to
make and sell cloth and mats. This helps them economically, promotes integration
and understanding between women with and without HIV, and gives children
from affected families the opportunity to play with other children.
Member of Asia Guides development group
In Thailand, Buddhist temples are providing practical support for income
generation. For example, the community is using land donated by one temple to
grow vegetables and to farm fish, and uses profits from the sale of produce to
help affected families. Another temple is providing training in income-generating
skills such as tailoring and traditional silver crafting.
Member of Asia Guides developmentgroup
Lessons learned about income-generating activities
> Target the whole community - This helps more people, increases
contributions, shares the work, is more likely to succeed and less likely to cause
resentment than targeting specific households.
> Involve households and children in identifying potential projects - This
develops ownership and a sense of self-worth, as well as making sure that
children can take over if adults become sick or die.
> Have clear objectives - Decide whether the activities are intended to be a
sustainable business or to provide mutual support with some material benefits.
> Plan carefully - Analyse the feasibility of any planned activity, and make sure
people understand the time and resources required.
> Avoid too narrow a focus - Many projects focus on cottage industry crafts
instead of producing goods that are appropriate to the local situation and that
people actually want to buy, such as soap, clothes and food products. Diversify
income sources so income is not badly affected when returns from one source
are poor.
> Ensure activities can be managed and maintained by the community Avoid activities that need ongoing external support or equipment that is difficult or
expensive to repair.
> Provide adequate support - This includes training in business and production
skills, funds to secure premises, materials and equipment, and technical
assistance with processing and marketing.
> Plan how to deal with problems — Establish clear rules about leadership,
ownership and profit sharing. Plan how to deal with conflict, interference from
local leaders, and hostility from others in the community who chose not to or
cannot be involved.
8
•
Improve access to micro-finance - savings, loans and credit - to help
households to maintain income flow in times of crisis and acquire savings.
Possible actions include:
Target start-up grants and low-interest loans to families without
security and to the poorest affected families.
Provide affected families with information and support to help them
obtain loans.
In Cambodia, the organisation NAPA provides small loans to affected families
who do not have capital or access to credit to enable them to start small
businesses. This support has enabled the children in these families to continue
to go to school. Another Cambodian NCO, Friends, also provides affected
families with credit to start income-generating activities.
Member of Asia Guides development group
Help Age International is working with NGOs in Thailand to strengthen older
people’s associations and support income-generating activities by older people.
Using funds from NGOs, government grants and their own fundraising activities,
the associations offer loans at low interest rates to older carers. One 79-yearold woman used the loan to expand her business, which enabled her to pay her
granddaughter’s school fees and reduced her constant worry about making ends
meet.
Help Age International, December 2002. HIV/AIDS and older people. Ageways,
issue 61
Principle 4: HELP CHILDREN TO DEVELOP PRACTICAL ECONOMIC
AND LIVELIHOOD SKILLS
Given the skills and opportunities, children are capable of caring for
themselves and their siblings, and of making responsible economic choices.
Children need relevant education and training to enable them to earn a living
in the community. Children themselves have identified vocational training and
household and business management skills as a priority.
Strategies for action
•
Identify adults in the community who are willing to share their skills with
children without parents or whose parents are very sick.
•
Provide children with vocational skills so that they can, if necessary,
generate income to enable them to stay at school and can earn a living
after they leave school. Possible actions include:
Develop vocational training schemes that are relevant to local
livelihoods and employment needs.
Integratie vocational and skills training into schools.
Establish links with institutions that provide vocational training.
9
Establish apprenticeship programmes with local companies or small
community businesses.
Encourage local businesses to fund youth skills development.
Set up revolving fund or loan schemes to support apprenticeships,
attendance at vocational training schools, and help young people
set up small businesses.
Some NGOs in Cambodia are linking vulnerable children to government vocational
training schemes. One girl from an family affected by AIDS living in severe
poverty attended a six-month hairdressing course through the provincial
women's organisation and now has a job and is able to help support her family.
Other NGOs are providing vocational training directly. For example. Friends runs
a training centre for children living on the streets of Phnom Penh, and CARE
trains orphans and children who are heads of households in skills such as
tailoring, also providing them with sewing machines and materials.
Member of Asia Guides development group
In Thailand, some primary schools are teaching livelihood skills, both to motivate
children to remain in school and to enable them to earn a living while they are in
school and after they leave.
Member of Asia Guides development group
•
Develop children’s household budgeting and financial management skills.
In Thailand, several NGOs are helping older children to learn how to manage
money.
Member of Asia Guides development group
Principle 5: SUPPORT FUTURE PLANNING FOR CHILDREN
Families and communities need to plan for the future of children whose
parents are sick or who may die. This should be done while the parents are
still alive and well and with the involvement of children themselves.
Strategies for action
•
Help families to plan for their children’s future. Possible actions include:
Encourage parents and grandparents to pass on skills and
knowledge before they become too ill to do so.
- Help parents to establish a bank account or savings for their
children.
In India, the NGO Committed Communities Development Trust encourages HIV
positive parents to start putting aside some of their earnings for their children
and to ensure that funds from sale of assets such as land go into an account for
their children.
Member of Asia Guides development group
-
10
I
•
Review savings and credit schemes. Possible actions include:
Allow orphans and child-headed households to participate in
community savings schemes and revolving funds.
Ensure that children receive parental shares.
•
Establish insurance and other financial security schemes for widows and
orphans, including providing for sickness or death insurance in micro
finance services.
11
1
Edited draft Asia Guide 3
EDUCATION AND TRAINING
INTRODUCTION
Children affected by HIV/AIDS are less likely to be enrolled in school or to
attend regularly. They may perform less well than their potential because of
grief and anxiety, isolation and withdrawal, or stigma and discrimination.
Poverty means that many children come to school hungry, tired, sick and
unable to concentrate, and therefore do less well. Some affected children
drop out of school early because they need to earn an income to support
themselves or their families or perform domestic chores, and because they
lack adult support and guidance. This is particularly the case for girls. If
children do not remain in school long enough to achieve basic literacy or
qualifications, this affects their opportunities for future training and
employment.
However, it is vital for children that they attend school and take full advantage
of their education. School is also important for their psychological
development. Schools can provide children with a safe, structured
environment, emotional support and supervision of adults, and the opportunity
to learn how to interact with other children and to develop social networks.
Education, in and out of school, can also reduce children’s risk of HIV
infection by increasing their knowledge, skills and opportunities.
Children also need vocational training, especially those who have to earn
money. Providing children with vocational skills strengthens families’
economic coping capacity, and improves their life chances and future
employment prospects.
This Guide is divided into two sections:
Issues - considers how HIV/AIDS affects children’s education and
explains why programmes need to pay attention to the education and
training of children affected by HIV/AIDS, including their need for
information about HIV/AIDS.
•
Principles and strategies - outlines principles of programming to
improve children’s education and training, and describes possible ways of
taking action to address the educational needs of children affected by
HIV/AIDS.
I
ISSUES
HIV/AIDS reduces children’s access to education and to training opportunities
because of:
Poverty - Families living in poverty because of HIV/AIDS may not be able
to pay school fees. Food or medicines may take priority over education.
Even when schooling is free, families may be unable to afford the other
costs of education, such as uniforms, books and travel to and from school.
Sometimes poor children feel too ashamed to go to school because they
do not have shoes or nice clothes. Many affected children and children
living without parents attend school irregularly or drop out of school
altogether, because they have to earn money to contribute to household
income or to support themselves and their younger bothers and sisters.
•
As one child in Cambodia said: "I want a school bag so that I can look like other
children”. Another boy said: "After my parents died the burden of responsibility
for the family fell on my shoulders and I no longer have the opportunity to go to
school”.
KHANA, 2000. Children affected by HIV/AIOS: appraisal of needs and
resources in Cambodia
•
Family responsibilities - Children from affected families may miss school
or drop out of school because they have to perform domestic tasks, help
with farming or the family business, and care for sick parents or younger
siblings. Children with many responsibilities may not have the time or
energy to study. Girls are often more likely to stop going to school to help
at home, affecting their future life chances.
•
Poor health and malnutrition - Children from affected families and
children with HIV may have frequent illness because of inadequate living
conditions, poor nutrition, lack of parental care and access to health
services. Children who are sick or malnourished are less likely to attend
school. If they do go to school, they find it more difficult to concentrate and
learn.
•
Psychological problems - The illness or death of a parent causes
children severe emotional distress. They may experience anxiety,
depression, low self-esteem, and become isolated and withdrawn. These
difficulties can prevent a child from attending school or performing well at
school.
•
Stigma and discrimination - Children from affected families and children
with HIV may miss or drop out of school because of teasing or rejection by
other children or the discriminatory attitudes of teachers. Sometimes they
are denied access to education by school principals or teachers or are
forced to leave school because of the negative attitudes of parents of other
children. In places where the education of girls is considered to be less
2
important, girls are discriminated against when poor families have to
decide which of their children can go to school.
A study in Thailand found that in 20% of affected families, children were
ostracised by other children and in several cases they were forced to leave
school.
Yoktri M, 1999. AIDS ...Impact on children in Thailand
In Cambodia, there have been cases of children denied access to school because
of discrimination. In one case, a boy whose parents were infected with HIV was
denied access to school by the school principal. In another case, three children
whose parents had died of AIDS were discriminated against by schoolteachers,
who scolded and beat them in class. Because of this treatment, in addition to
their financial difficulties, these children decided to stop going to school.
Member of Asia Guides developmentgroup
Similar cases have been reported from India. In one case, two orphaned children
were living with their grandparents. When news that their parents had died of
AIDS spread through the community, they were thrown out of school. These
children changed schools several times, but each time were denied education.
Finally, a school agreed to admit them, but the parents of other pupils removed
their children from school, so the authorities asked the children not to go to
school and a teacher now tutors them at home. These children are denied the
right to the same education as other children, to play and interact with other
children of their own age.
Johari l< 2002. Silent cries and hidden tears. Lawyers' Collective
•
Lack of adult support - Children without parents may lack adult support
to make sure they go to school, encourage them, and help with their
schoolwork. Children whose parents have died may not have a birth
record, which may be required to enrol at school, or an adult who can
register them. Elderly carers and other relatives may be unable or
unwilling to send orphaned children to school, expecting them to help at
home or to work. In some places, children drop out of school because they
do not have parents to protect them from beatings or abuse by teachers.
•
Quality and relevance of education - HIV/AIDS affects the quality of
education if teachers are ill or have to care for family members who are
sick. Poor-quality education discourages school attendance. Sometimes
children do not go to school because the curriculum is not relevant to their
daily lives or future employment prospects, or because school hours are
not convenient for working children. If children miss school, there is often
no help available to enable them to catch up. Children who find it difficult
to keep up may lose their motivation to learn and drop out of school
altogether. In addition, many children lack basic knowledge about
HIV/AIDS, because the subject is not taught in schools.
3
PRINCIPLES AND STRATEGIES
Principle 1: PROTECT CHILDREN’S RIGHTS TO EDUCATION
Children have the right to education. Programmes for children affected by
HIV/AID8 should promote children’s right to education and advocate for
policies that support equal educational opportunities for all children.
The Convention on the Rights of the Child states that:
•
Access to primary education is a basic need and the right of every child.
Strategies for action
•
Promote community awareness of the importance of education and
encourage communities, families and guardians to take responsibility for
educating the children in their care. Possible actions include:
Support adult literacy programmes, so that communities see the
benefits of education.
Make families aware of children’s rights to education and their legal
responsibilities.
•
Advocate for the right of all children to receive an education, including
HIV/AIDS affected and HIV-infected children, working children, street
children, and children from the poorest families.
•
Highlight gender discrimination and the importance of girls’ access to
education and vocational training. Possible actions include:
Advocate for changes in laws and policies that exclude girls who
become pregnant from school.
Target support for school fees to girls’ education.
Provide separate sanitation facilities at school for girls and boys.
Encourage girls to learn subjects such as mathematics, science and
technology.
•
Make sure that children themselves are aware of their right to education.
•
Identify community advocates to enrol children at school.
In India, the YWCA provides education and counselling to children to promote
awareness of their right to education.
Member of Asia Guides development group
Principle 2: IMPROVE ACCESS TO EDUCATION AND TRAINING
Programmes should support strategies to increase children’s access to school
and to vocational training. This means addressing financial, practical and
4
other barriers to education, such as stigma and discrimination. Efforts to
increase access to education, such as paying school fees, should be
sustainable. They should focus on strengthening the capacity of communities
and families to support their children’s education.
Strategies for action
•
Strengthen the capacity of communities and families to support the
education of children. Possible actions include:
Establish pre-schools and nurseries to give children from poor
families a good start before they begin primary school, and to
enable their older siblings to attend school.
Support initiatives to increase income.
Provide practical support to grandparents who have to continue
working to pay for schooling for their orphaned grandchildren.
Encourage communities to work together to negotiate with schools
and teachers and to advocate on behalf of children without parents
Provide practical support with caring for sick adults, for example
through home-based care programmes or community volunteers,
so that children who care for their parents can attend school.
In some rural areas of Cambodia, schools are only open for a short time and
teachers demand private fees for afternoon teaching. If families cannot afford
this, their children are unable to access good education. Some communities have
decided to join together to negotiate with teachers over fees, as well as
advocating for exemptions on behalf of children with no adult or financial
support.
Member of Asia Guides developmentgroup
Educating orphaned children puts considerable pressure on grandparents, as one
70-year-old man in Thailand described. "My son and his wife died of AIDS six
years ago leaving a four-year-old child with me. My wife and I still have to work
in the field so we have enough money to send our grandchild to school."
Help Age International, Thailand. Voices of older people from Asia-Pacific.
The Khmer Buddhist Association helps children affected by HIV/AIDS to
continue their schooling, in addition to mobilising community resources to care
for children and helping families with succession planning. For example, the
Association has helped one widow to buy a small plot of land and to get
treatment for her opportunistic infections so that she can be economically
independent and in the meantime has provided support for her two older
children to return to school.
KHANA Annual Report, 2002
In Cambodia, CARE provides support to affected families to enable children to
continue their schooling. One 13-year-old girl whose father had died of
5
HIV/AIDS stopped going to school to core for her mother, who also has HIV
infection and is chronically ill. With support from the CARE home care team,
who help to look after her mother, she has been able to resume her studies.
Another Cambodian NGO runs a hospice to provide care for very sick and dying
i_ living
i:..: with
s+u HIV/AIDS.
uT\//ATr>«; This relieves the burden of care on children and
people
ensures that they can go to school.
Member of Asia Guides development group
Support the cost of educating children from very poor families and children
•
without parents. Possible actions include.
-
Advocate with local education authorities and schools to reduce or
-
waive school fees.
Access tuition fees provided by the government.
Accept labour or in-kind payments from households and
-
communities.
Encouragw communities to establish special funds to pay fees or
-
other costs of schooling.
,. .
Set up donation schemes for school materials and equipment.
Establish scholarship schemes and bursaries through religious or
private-sector organisations.
In Thailand, the NGO Northnet has established a community fund to raise
money to pay school fees. The fund supports any child who is unable to go to
school because of poverty, not just children affected by HIV/AIDS, to avoid
stigma and discrimination. The NGO supports income-generating activities at t e
same time, to ensure that funds are replenished and do not become dependent
on external funding.
Member of Asia Guides development group
Also in Thailand, the Sangha Metta project, which supports Buddhist monks and
nuns to conduct HIV/AIDS prevention and care, is encouraging temples to offer
scholarships to children of people living with HIV/AIDS to enable them to
continue to attend school. Temples also receive and distribute donations of
textbooks, pens, notebooks, and provide children with school uniforms.
Member of Asia Guides development group
•
Reduce stigma and discrimination. Possible actions include.
-
-
Advocate with local education authorities for policies to protect
children from discrimination by and in schools, and for the
introduction of universal precautions to prevent transmission and
reduce fear of infection.
lllIW,»mc
Educate school principals, teachers and parents about HIV/AIDb
and sensitising them to the situation of affected children and the
impact of stigma and discrimination on children’s education and
wellbeing.
6
Train teachers so that they have the skills to tackle stigma and
discrimination and can provide psychological and emotional support
to affected children.
Identify community volunteers to advocate with schools and parents
on behalf of affected children.
Educate schoolchildren about HIV/AIDS to reduce fears and
misconceptions, and working with children to develop educational
materials that promote positive attitudes towards people living with
and those affected by HIV/AIDS.
Provide counselling for children to help them talk about their
feelings and to cope with negative attitudes.
Save the Children reported that schools played an important role in combating
stigma in Thailand, changing attitudes towards people living with HIV/AIDS
which were previously characterised by fear and discrimination, and in raising
awareness in the community. Also in Thailand, the Centre for AIDS Rights, an
NGO focusing on human rights, is working to address the situation of children
who have been excluded from school because of the discriminatory attitudes of
other parents and teachers. NGO staff visit schools and communities to raise
awareness and change attitudes, and the NGO also provides legal advice and
support in cases where children's rights are denied.
Save the Children UK Bangkok, 2001. Thailand HIV/AIDS Research and Project
Proposal
•
Identify practical ways to make schooling more accessible to children.
Possible actions include:
Offer flexible school hours so that children who work or have
domestic responsibilities can attend.
Establish evening or open or community schools.
Develop distance-learning programmes.
In India, an NGO called CHELSEA organises remedial classes for children who
have been unable to attend formal school.
Member of Asia Guides development group
•
Provide children with psychological and emotional support to enable them
to access and benefit from education. Possible actions include:
Identify trusted members of the community to take an interest in the
education of children without parents and to provide them with
encouragement and support.
Identify individual teachers to take special responsibility for the
progress of children without adult support.
The YWCA in India highlights the importance of providing children with more
than just financial and practical support to enable them to take advantage of
educational opportunities, especially if they have missed out on early education
7
or come from poor or abusive families. One girl aged nine years, who was the
Sole breadwinner for her family, started attending the YWCA s non-formal
education and life skills classes. Although she was married off at the age of 11
to a man of 23 years, psychological and emotional support gave her the
confidence to leave her husband and to start attending a residential school.
Member of Asia Guides development group
Principle 3: STRENGTHEN THE ROLE OF SCHOOLS
Schools can play an important role in providing information about HIV/AIDS,
tackling stigma and discrimination, and supporting and referring children
affected by HIV/AIDS to other services. They can promote life skills that help
children to protect themselves and provide the foundation for future
employment. Programmes need to strengthen the role of schools in providing
support to affected children and to encourage schools to offer education that
is relevant to the daily lives of children and their families.
Strategies for action
Encourage schools to teach topics that are relevant. Possible actions
•
include:
Review the primary school curriculum.
Promote the role of the elderly and using local wisdom and
knowledge.
Integrate practical skills into teaching of subjects such as
mathematics.
Encourage schools to integrate community service into the
curriculum, for example providing labour for affected households
Involve communities in improving and evaluating education in
schools.
•
Train and sensitise teachers to provide counselling, emotional and
practical support, and establish teacher support networks.
.
Create a supportive and caring school environment, where children feel
safe and secure and where their rights are respected. Possible actions
include:
-
•
Encourage children to decorate classrooms with their own artwork.
Provide counselling space and areas for children who are sick.
Establish peer counselling and child-to-child programmes in schools
to promote good communication.
Encourage schools to develop strategies to continue the teaching of
children who miss or drop out of school because they are sick or have
domestic responsibilities. Possible actions include.
Offer catch-up lessons.
8
Organise community homework clubs.
Encourage peer support between children.
Mobilise retired or volunteer teachers to give children extra tuition.
•
Promote links between schools and health and welfare services, and
develop protocols to help teachers respond to the needs of affected
children and to refer them for support.
•
Use schools for a wider range of community activities, such as training and
support for caregivers, community clubs, non-formal education for adults
and children who have dropped out of school.
Principle 4: SUPPORT VOCATIONAL TRAINING FOR CHILDREN
Programmes need to recognise that children affected by HIV/AIDS often need
to work, to support themselves or their families. Some children work and go to
school. Some children drop out of school to work. Providing children who are
in and out of school with practical and relevant vocational skills is critical to
help them become self-reliant and to improve their future employment
prospects.
Strategies for action
•
Support research to improve understanding of the needs of the job market,
to develop relevant training.
•
Promote vocational training for children in the community. Possible actions
include:
Link up with vocational training centres and developing training
networks.
Involve community craftspeople and artisans in teaching practical
skills.
Encourage religious organisations and the private sector to support
vocational training, for example, using temples or business
premises for training.
Use school infrastructure as vocational training centres for carers
and out-of-school youth in the evenings and weekends.
Establish local apprenticeship schemes.
In Thailand, temples offer vocational training to children who are unable to
complete school, developing skills in tailoring and traditional silver smithing.
Member of Asia Guides development group
•
Integrate vocational training for children into schools. Possible actions
include:
Promote collaboration between parents willing to share vocational
skills and teachers, through parent/teacher associations.
9
Provide vocational training together with basic literacy skills.
•
In Cambodia, the NGO Friends, which works with street children, runs a training
centre providing vocational training in 11 different trades. The centre also
offers basic literacy and remedial classes to enable children to reintegrate into
the school system or to run their own businesses, as well as operatmg a mobile
library to reach out to children on the streets.
Member of Asia Guides developmentgroup
Principle 5: EDUCATE CHILDREN ABOUT HIV/AIDS
Children need information and skills about HIV/AIDS to protect themselves
from the risk of HIV infection. Schools can play an important ro e in educating
children about HIV and AIDS and need support to do this effectively. Other
programmes need to target children who are not in school and who may be
particularly vulnerable, such as street children.
Strategies for action
Encourage school authorities to provide pupils with clear information about
HIV/AIDS, and to include sexual health and life skills education in the
•
school timetable.
The Thai Life Skills Development Foundation programme to promote child
friendly schools is encouraging schools to develop life skills for children in
difficult circumstances, including children with or affected by HIV.
e
Foundation helps schools to take a learner-centred approach and to use active
learning to develop self-esteem and communication skills, and to cope with
stress and bereavement.
Member of Asia Guides development group
India has developed "'Learning for Life", a family health and life skills education
module for schools, which covers adolescence and growing up, teenage
pregnancy, STDs (sexually transmitted diseases) and HIV/AIDS, resistmg peer
pressure, creating a supportive environment and removing discrimination.
NCERT/NACO/UNICEF/UNE5CO, 2000. Learning for Life: a guide to family
health and life skills education for teachers and students
•
Provide HIV/AIDS education to improve knowledge, promote positive
attitudes and develop skills, in schools. Possible actions include.
-
Tram teachers to teach about HIV/AIDS using participatory and
active learning methods that are sensitive to the situation of
affected and infected children.
.
Use NGOs groups of people living with HIV/AIDS and religious
organisations to run HIV/AIDS awareness sessions in schools.
10
\
In India, CHETNA is conducting a school AIDS education programme in 70 urban
and rural schools. The programme runs advocacy workshops to orient school
principals and parents and obtain their permission and support. It also provides
training to build the knowledge and skills of teachers and peer educators in
communication and the use of participatory methods. CHETNA uses simple tools
for education, for example, aprons with pictures of male and female
reproductive health systems are used to teach children, since many lack basic
understanding of reproductive physiology. CHETNA has also organised a
children's fair with the participation of all 70 schools, with stalls providing
information and an exhibition of children's art.
Member of Asia Guides developmentgroup
The Sangha Metta project in Thailand is training student monks to share
information about HIV/AIDS with Schoolchildren and to organise education
activities for children and adolescents.
Member of Asia Guides developmentgroup
In Cambodia, the NGO NAPA organises sessions in schools, for example on
World AIDS Day, where children affected by HIV/AIDS tell their life stories
to other children. Another NGO in Cambodia uses games and role-play to
educate schoolchildren about sexual behaviour and condom use.
Member of Asia Guides development group
•
Involve communities and parents in planning HIV/AIDS education
programmes for children and use methods that are culturally appropriate
and relevant to the daily lives of children and their families, to ensure their
support.
A centre in Laos promotes itself as a venue for traditional arts and recreation
activities, as well as providing counselling and information about sexual and
reproductive health. In this way, it is able to address the concerns of young
people without being threatening to adults in the community.
Gave the Children UK, 200L Young people and HIV/AIDS: responding to the new
Asian crisis
•
Support peer and youth educators to conduct HIV/AIDS and life skills
education with in and out-of-school youth.
The Thai "friends tell friends" programme selects and trains children to conduct
peer education in schools.
Member of Asia Guides development group
In Cambodia, CARE is supporting youth advocates to do outreach work by
providing them with bicycles.
Member of Asia Guides development group
11
In India, the Thoughtshop Foundation started a youth movement called Ignited
Minds. Young people aged 15-25 years come together for workshops on
HIV/AIDS, sexuality, life skills and peer support skills, and are trained to
conduct outreach programmes in slums, schools and colleges using innovative and
participatory methods. Thoughtshop also offers telephone and face-to-face
counselling for children and young people who need support.
Member of Asia Guides development group
•
Develop suitable approaches and materials for out-of-school youth and
children with low levels of literacy.
Thoughtshop worked with the Child in Need Institute to develop participatory
methods, including stories, games and models, to discuss sensitive reproductive
health and HIV/AIDS issues with non-school going rural and slum-based
adolescents.
•
Use the media to provide children and young people with accurate
information about HIV/AIDS.
In India, Thoughtshop collaborated with a local newspaper to include a regular
ASK (AIDS Sex Knowledge) column, answering young people's questions. The
newspaper provided free space for the feature, which was published every three
weeks and ran for over a year. Thousands of letters were received and
answered. Thoughtshop also developed a 12-episode radio series on HIV/AIDS
awareness for young people. The programmes had young people participating in a
quiz based on a drama about various aspects of HIV/AIDS, along with a call-in
facility for listeners to ask questions. Two years later, young people are still
calling in with queries.
Member of Asia Guides development group
12
k
Edited draft Asia Guide 4
CARE AND PSYCHOSOCIAL SUPPORT
INTRODUCTION
Children’s psychosocial and emotional needs are as important, if not more
important, than their physical needs. While many programmes focus on
providing material support, relatively few consider the psychological and
emotional effects on children of caring for a sick parent or living in a
household affected by HIV/AIDS or losing one or both parents. Programmes
for affected and infected children should pay as much attention to meeting
children’s needs for love, affection and understanding as they do to meeting
their needs for shelter, food and clothing.
Parental illness and death is traumatic and stressful for children. Children are
often encouraged to keep their emotions to themselves or find it difficult to
express their feelings, and approaches to counselling that are appropriate for
children have received little attention. Early intervention, to help them cope
and to express their feelings, is essential to prevent longer-term psychological
damage. Children who have lost their parents often also lose their home,
friends and schooling. Their emotional distress is often worsened by poverty,
stigma and discrimination, and increased responsibilities, which prevent them
from feeling that they are part of the community. Programmes need to
encourage communities to provide children with practical help and to promote
social integration of children affected by HIV/AIDS and children with HIV.
•
Trauma - is an emotional shock, producing long-lasting, harmful effects on
the individual.
Stress - is an emotional condition, experienced or felt when an individual has
to cope with unsettling, frustrating or harmful situations. It is a disturbing
sense of helplessness, which is uncomfortable and creates uncertainty and
self-doubt.
Caregivers also need psychosocial and emotional support, to help them cope
with their own grief, fears, stress and worries about the future, and to enable
them to give children the best possible care.
This Guide is divided into two sections:
Issues - considers how HIV/AIDS affects the care of children and their
psychosocial and emotional wellbeing, and explains why programmes
need to pay attention to the psychosocial and emotional needs of children
affected by HIV/AIDS.
•
Principles and strategies - outlines principles of programming to provide
care and psychosocial support, and describes possible ways of taking
action to address the needs of children affected by HIV/AIDS.
ISSUES
HIV/AIDS affects the care and psychosocial and emotional wellbeing of
children with sick parents, children who have lost their parents, and children
with HIV. The impact on children includes:
•
Family poverty and stress - Families affected by HIV/AIDS have to cope
with many problems. Many are living in poverty, which causes
psychological stress for adults and children. Parents in affected families
may be too busy or worried to give children proper care or to talk to them
about what is happening to the family. Sometimes HIV/AIDS causes
domestic violence or family breakdown. Parents may separate or divorce,
or in extreme cases, an HIV-positive woman may be thrown out of the
house. Family stress and separation has a serious impact on children’s
emotional health.
•
Anxiety and worry - Children worry about whether or not sick parents will
die, and what will happen to them, where they will live and who will take
care of them afterwards. Sometimes they worry that they are infected with
HIV and will die themselves. If adults do not explain to children what is
happening or talk to them about who will care forthem in future, children
may become very anxious.
•
Stigma, discrimination and rejection - Children with HIV commonly
experience stigma and discrimination from neighbours, relatives or other
children. Children from affected families may also be stigmatised and
discriminated against, because people assume that they too are infected
with HIV. Hostility and rejection increase children’s psychological stress.
They may feel isolated and unable to talk about their problems outside the
home, because of the shame associated with HIV/AIDS. Sometimes HIV
positive parents physically distance themselves from their children,
because they are afraid of infecting them. This makes children feel
unloved and rejected, especially if they do not know that their parents have
HIV.
•
Feelings and behaviour - Children who have lost their parents or siblings
may experience feelings of sadness, anger and guilt. Children who are
distressed may show aggressive, difficult or disturbed behaviour. If they
are punished for their behaviour, this adds to their distress. Older children
may feel angry with their parents for dying or with whoever they think has
caused their parents to die, or lose their confidence or self-esteem.
Younger children may lose their appetite. Sometimes children think that
they are to blame when their parents are ill or die, or feel guilty because
there were unable to keep their parents alive.
•
Loss of home and identity - Children may lose their home if their
parents divorce or die. Sometimes when the father dies, the mother has to
return to her family home, taking the children with her. Children who have
lost both parents may move away from their home and community to live
with relatives in an unfamiliar environment. They may also be separated
2
from their siblings. Losing contacting with their brothers or sisters and
friends in addition to losing their parents is very traumatic for children.
•
Loss of childhood - Children caring for sick parents or who are living
without parents have to take on adult responsibilities, such as earning
money, preparing meals, and looking after younger siblings. They do not
have the time or energy for normal childhood activities that are important
for their psychological and emotional development, like going to school or
playing with friends.
•
Lack of adult care and support - Children caring for sick parents are
often left to cope alone without social and emotional support. After their
parents die, they are left to cope with younger siblings or elderly
grandparents. Orphaned children miss out on parental love, protection,
advice and encouragement, and may lack adult support to help them
develop social skills or a sense of self. Sometimes children sent to live
with relatives are neglected or treated badly. Sometimes relatives refuse to
care for children whose parents have died of HIV/AIDS or children with
HIV, and these children are abandoned or placed in institutions.
•
Long-term psychological problems - In some cultures, adults do not
discuss illness or death with young children or find it difficult to talk to
children about these subjects. They may not be aware of children’s
psychological and emotional needs or know how to help children grieve.
Without appropriate counselling and the chance to mourn their parents or
to talk about how they feel, children may experience psychological
problems later in life or try to cope in ways that are harmful, such as taking
drugs or drinking. However, in many settings, there is a lack of specialised
counselling and support services for children.
•
Coping with HIV - Children with HIV who are frequently ill may feel afraid
or worried. They need special help to cope with and come to terms with
their illness, to learn to live positively with HIV, to deal with stigma and
discrimination, and prepare for the future.
7
PRINCIPLES AND STRATEGIES
Principle 1: PROTECT THE RIGHTS OF CHILDREN
Programmes should centre on the best interests of the child. Addressing
children’s needs for psychosocial and emotional support is as important as
addressing their physical needs for food, shelter and clothes. Children with
HIV and children affected by HIV have the same rights to identity, love, leisure
and individual development as other children. All children, especially those
who are vulnerable, need to feel secure and valued.
The Convention on the Rights of the Child states:
•
•
•
•
Children have the right to a name, nationality and sense of identity.
Children have the right to affection, love and understanding.
Children have the right to opportunities for play and recreation.
Children have the right to be a useful member of society and to develop
individual abilities.
Strategies for action
•
Take a holistic approach and promote collaboration between health,
education and social welfare services and organisations providing
counselling and support services.
•
Raise community awareness about the importance of psychosocial and
emotional support for children.
•
Promote integration of affected and infected children in the community.
Possible actions include:
Avoid separating children with HIV from other children in schools or
health facilities.
Support efforts to tackle stigma and discrimination.
Establish children’s clubs and play groups for all children in the
community.
Involve children in community development projects to give them
opportunities to interact with adults and other children.
•
Encourage parents to register their children’s births, so that they have an
official name and identity.
•
Make sure that children are aware of their rights and promote the active
participation of children in decisions about their lives.
Principle 2: PROMOTE EARLY INTERVENTION
Early intervention can prevent adverse effects on children’s long-term
development. It is important to prepare children for parental death, and to
identify and help children with psychosocial and emotional needs before they
develop problems.
Strategies for action
Help parents to plan fortheir children’s future while they are still well, and
to include children in decisions. Possible actions include:
•
Assist parents to make a legally binding will that protects children’s
inheritance and states who will care for the children.
Involve community leaders in encouraging families to discuss the
future of children.
Document the wishes of parents and children about future care.
Ensure that contact information for relatives living away from the
community is recorded before parents die.
One NGO in Cambodia monitors children whose parents are sick and encourages
the parents to decide who will care for the children after they die. The
organisation also provides counselling to help children before and after their
parents die and intervenes when necessary to ensure that children are not
abandoned. In one case, relatives only wanted to take the youngest of two
orphaned children, suggesting that the older child could go to a home. The NGO
negotiated with the family, explaining the importance of keeping siblings
together.
Member of Asia Guides development group
•
Prepare children and parents for death. Possible actions include:
Encourage parents to be open and truthful and to talk about their
illness and possible death with children, to help prepare them to
cope with grief and loss.
Give parents advice about how to talk to their children about difficult
issues in a way that they can understand and that is appropriate to
the needs of the individual child.
Provide counselling services for children in and out of school and
for parents.
Put together a memory box for children that contains information
about the family and things that are relevant to the child’s history
and background or encouraging parents to write a memory book
with their children.
Encourage religious leaders to provide spiritual support that is
appropriate for children.
Give children practical information about what is going to happen to
them, where they will live, who will care for them and where they
will go to school.
In India, Project CHILD works with children in affected households where
parents are very sick, to prepare them to cope with parental death, if the
parents have disclosed their HIV status to the children. All children in affected
households ore given skills training in first aid., household budgeting., home
management, and dealing with crisis situations.
Member of Asia Guides development group
•
Train carers, teachers and health workers to recognise the early signs of
developmental, psychological and emotional problems in children.
Principle 3: STRENGTHEN THE CAPACITY OF FAMILIES AND
COMMUNITIES
Families and communities are the most important resource for providing
children with psychosocial and emotional support. Programmes should focus
on strengthening the capacity of families and communities to care for children,
rather than targeting affected children directly. Support for families can help to
avoid children being abandoned or placed in institutions. It is also important to
provide psychosocial and emotional support for carers such as grandparents,
to help them cope with their own grief, stress and social isolation and with
looking after children with psychological and emotional problems.
Strategies for action
•
Educate communities about HIV/AIDS to reduce fear and encourage them
to take responsibility for caring for orphans.
In some rural areas of Cambodia, relatives were reluctant to take responsibility
for orphans, wanting to send them to orphanages or Buddhist temples. The main
reason was lack of understanding about HIV/AIDS and fear that they would
become infected with HIV through looking after these children. Volunteer
members of the Kien Kes Health Education Network have helped grandparents
and other relatives to understand that HIV cannot be transmitted through
normal daily contact, and people are now agreeing to take care of orphaned
children in the family.
Member of Asia Guides development group
•
Provide families with practical support so that they can continue to take
care of their children. Possible actions include:
Give practical advice about caring for children with HIV, including
preventing HIV transmission, and materials such as latex gloves
and soap.
Establish daycare centres or nurseries for pre-school children.
Organe respite care and intervention during times of family crisis to
prevent children being abandoned or left in institutions.
In Thailand, the Orchid Clinic found that most affected parents and parents
living with HIV want to keep their children, but sometimes find it hard to cope.
The Clinic established a daycare centre, supported by the government, and this
has prevented parents from abandoning their children or placing them in
6
institutions. Day care is less expensive than institutional care and enables
children to stay with their families. The centre takes a comprehensive approach,
encompassing nutrition, emotional care and child development, and referrals for
medical care. It also follows up children after they go on to school, to encourage
teachers to be supportive.
Member of Asia Guides development group
The Indian NGO, Committed Communities Development Trust, runs a crisis
intervention centre, which provides short-term residential care and support for
HIV-positive women and their children, including promoting mother-child
bonding and coping skills, while they look for longer-term alternatives in the
community. There is also a drop-in centre where women can obtain psychosocial
support.
Member of Asia Guides development group
•
Ensure that carers receive psychological and emotional support. Possible
actions include:
Facilitate access to family and individual counselling services.
Encourage neighbours, relatives and other community members to
provide moral support and social contact, for example, through
informal visits, sharing meals, invitations to community activities.
Establish peer support groups, for example, older people’s
associations.
Train home-based care teams to provide psychological and
emotional support during home visits.
Involve religious leaders and organisations in providing and
mobilising support.
Build the capacity of people living with HIV/AIDS groups to help
affected families.
Train government and NGO staff in counselling skills.
In India, Project CHILD recognised that it was often grandparents who were
taking responsibility for looking after children and that they had their own care
and support needs. Following consultation with older carers, the Project
established a support group to help them share experiences and problems, cope
with their responsibilities and take better care of their grandchildren.
Member of Asia Guides development group
The Vietnam Women's Union in partnership with Help Age International has
established clubs for older women who are caring for orphaned grandchildren.
These clubs are a forum for mutual support, sharing experience and knowledge
about HIV/AIDS and care of the sick, as well a source of loans for income
generation activities. Club members visit each other and other aff ected
families, and educate the community to reduce reduce discrimination.
Economic and Social Commission for Asia and the Pacific. HIV/AIDS prevention,
care and support: stories from the community, UN and AusAID
In Cambodia a network of volunteers led by a Buddhist monk carries out home
visits to give psychosocial and emotional support to affected families and
children. The Sangha Metta project in Thailand trains Buddhist monks and nuns
to provide emotional support, comfort and counselling to affected children and
families to help them cope with grief after death as well as ongoing problems.
Support is provided through home visits and temples, which are used as
counselling centres, and through instruction in meditation to reduce emotional
distress.
Member of Asia Guides development group
Temples are a particularly important source of support for older carers, helping
to reduce stigma, isolation and emotional stress and promoting peer support and
interaction between families.
Wesumperuma D, 2002. HIV/AlOS in Northern Thailand: a saga of resilience in
a human calamity. Help Age International
•
Help carers to give children psychosocial and emotional support. Possible
actions include:
Educate carers about stages of childhood development.
Offer training in parenting and communication skills.
Develop strategies to cope with children who are withdrawn,
depressed or aggressive.
Help children to deal with stigma, discrimination and rejection.
Encourage carers to mark children’s birthdays with cards or gifts or
a special meal.
•
Sensitise communities to children’s psychosocial and emotional needs,
using culturally appropriate communication channels.
•
Encourage communities to provide children with materials and
opportunities for play and recreation, and to promote social integration.
Possible actions include:
Offer training community groups in play therapy.
Establish a community “toy bank”.
Build a play area or children’s corner.
Organise sports, games and picnics.
Involve children in planning and organising community cultural
events and festivals.
In Cambodia, a project supported by CARE has organised a structured playgroup
for all children in the community, with activities including dance, drama, quizzes,
and competitions.
Member of Asia Guides development group
9
Also in Cambodia, the Lost Child Project works with street children and children
who have been exploited and abused. The project uses play as a starting point,
since many children have suffered great trauma and have given up playing. Using
creative methods such as drama and stories helps children to express
themselves and regain their sense of self.
Member of Asia Cuides development group
•
Use existing community structures and traditional methods of providing
psychosocial and emotional support to children. Possible actions include:
Encourage religious organisations, village elders, traditional
healers, community groups, and women’s and youth groups to
identify and counsel vulnerable children.
Sensitise health workers and teachers to the psychosocial and
emotional needs of children.
Advocate with local government authorities and NGOs to address
children’s psychosocial and emotional needs in their programmes.
Principle 4: SUPPORT FAMILY AND COMMUNITY MODELS OF CARE
Children develop better socially and emotionally in a caring family
environment. They also need to feel part of the community and to have
opportunities for social interaction. Approaches to providing care for orphans
should be socially and culturally acceptable and appropriate to the needs of
children. Institutional care is not in the best interests of children and should be
a last resort. Children in institutions do not get opportunities to learn life skills
or to prepare for adult life in the community in the way they would in a family
environment. The quality of care in some children’s homes is poor, and does
not provide the love, attachment and individual attention that children need.
Children who have been in residential care are often stigmatised and
discriminated against at school and in wider society (International Save the
Children Alliance. A last resort: the growing concern about children in
residential care).
A study in Cambodia found that while adults thought that orphanages were a
suitable solution for AIDS orphans, children in these orphanages disagreed,
saying they would prefer to live in foster families or communities.
KHANA, 2000. Children affected by HIV/AIDS: appraisal of needs and
resources in Cambodia
Strategies for action
•
Prioritise placing children in a family and community environment, for
example, with relatives, informal foster carers, formal foster or adoptive
families, or with Buddhist monks acting as guardians.
In Thailand, one strategy used to reduce the number of children living in
institutions is to place children with foster families while preparations are made
y
for them to return to their family or for adoption. Foster families are paid a
stipend by government and a social worker visits weekly to monitor the child's
care.
Save the Children UK, 2001. Research on available andpotential support systems
for children mfected/affected by HIV/AI05
The Vieng Ping Children's Home, also in Thailand, only places children in the home
as a last resort. Strategies used to prevent institutionalisation include family
support, reunifying children with their families, adoption or fostering within the
extended family or community, and paying for fostering by non-relatives.
Member of Asia Guides development group
The organisation Friends in Cambodia works with street children. One of the
main objectives is to reintegrate children into schools, families and society. The
family reintegration programme provides counselling and support to encourage
reconciliation between children and their families.
Member of Asia Guides development group
In India, the 2001 Juvenile Justice (Care and Protection of Children) Act makes
provision for adoption as a way of rehabilitating children who are orphaned,
abandoned, neglected and abused. The new Act does away with previous
limitations on adoption and makes legal adoption by wider range of persons
possible.
Lawyers' Collective HI V/AlDS Unit. Positive Dialogue, issue 9, May 2001
Ensure that children who live in institutions receive care that addresses
their psychosocial and emotional needs and have opportunities to
integrate with society. Possible actions include:
Select well qualified and trained staff with an understanding of
childhood development and a commitment to children.
Encourage the community to involve children from institutions in
community events and activities
Principle 5: HELP CHILDREN TO HELP THEMSELVES
Programmes should strengthen the capacity of children to develop selfreliance and learn how to care for themselves. This means listening to
children and involving them in decisions. Encouraging children to participate
in decision making helps them to learn about cooperation, mutual
understanding and social responsibility. Strengthening children’s coping
capacity also means teaching them life skills and providing them with practical
as well as psychosocial and emotional support.
Strategies for action
Io
*
•
Provide children with information, counselling and skills, including
communication and negotiation skills. Possible actions include:
Establish child-friendly information centres and developing
appropriate educational materials.
Provide referrals to counsellors trained to help children.
Organise skills training for children.
Identifying adults in the community to act as mentors.
•
Promote peer support and counselling. Possible actions include:
Involve children in planning peer support activities.
Identify older children who can provide support to younger children,
and training them in counselling skills, especially bereavement
counselling.
Provide opportunities for children to develop strategies to deal with
stigma and discrimination.
Establish support groups for children.
In India, the Committed Communities Development Trust mobilised young people
aged 14 years and above living in families affected by HIV/AIDS to establish a
self-help group. At group meetings they share feelings and experiences, help
each other with care and support for their families, and develop posters and
stories to promote community support.
Member of Asia Guides development group
The community organisation Baan Lao established a peer support group in
Thailand for affected children.
Member of Asia Guides development group
•
Use creative ways to help children express themselves and their feelings.
Possible actions include:
Encourage children to draw their situation or to write poems, stories
or letters to deceased parents or absent siblings.
Organise role-play and drama to act out situations.
Use puppets or models to help children tell their stories.
Project CHILD in India promotes the psychosocial development of vulnerable
children though dance with a programme called Dancing Feat.
Member of Asia Guides development group
In Thailand, AID5NET helps children to express their feelings, thoughts, fears
and hopes through drawings and stories.
Member of Asia Guides development group
•
Provide children with opportunities to get away from their family and caring
responsibilities. Possible actions include:
1/
f
Establish community nurseries and day care for younger siblings.
Organise summer camps.
The Thai Youth AIDS Programme organises summer camps for affected and
infected children. These camps give children the chance to relax and get away
from their responsibilities, learn new skills, develop new friendships and build
peer support networks, and express themselves in a supportive environment.
Member of Asia Guides development group
Project CHILD also organises camps to help children develop the skills to cope
with difficult situations.
Member of Asia Guides development group
f?
Edited draft Asia Guide 5
SOCIAL INCLUSION
INTRODUCTION
Stigma and discrimination can affect both children with HIV and children
without HIV. Children who are not infected may be stigmatised because a
parent has HIV or has died from AIDS. Stigma and discrimination are the
result of fear and ignorance, and are characterised by rejection, hostility,
isolation and violations of rights to health care, education and employment.
•
•
Stigma - is an attribute that singles out an individual or a group of individuals
as different. They are regarded in a negative and judgmental way because
they possess this attribute. People with or affected by HIV are stigmatised
because HIV/AIDS is associated with taboo issues such as sexz death and
blood and behaviours such as promiscuity, sex work, drug use and
homosexuality.
Discrimination - is one of the ways that stigma is shown. It occurs when a
person or group of people is treated unfairly or unjustly on the basis of
belonging or being perceived to belong to a particular group. Stigmatised
people are often discriminated against in laws, policies, and social relations.
Stigma and discrimination increase the impact of HIV/AIDS on children.
People who think that orphans also have HIV or that their families have
brought shame on the community often discriminate against them, denying
them social, economic, emotional and educational support. HIV/AIDS worsens
the stigmatisation of children of sex workers or migrants, street children,
children in detention and those using drugs. Socially excluded children are
more at risk of HIV infection, because they lack information and emotional
support, and are vulnerable to sexual exploitation and abuse.
Stigma prevents people from disclosing their HIV status and seeking help
from support and care services. Affected children and their carers are often
unaware of their rights and of laws to protect them from discrimination.
Sometimes they are aware of their rights but are unable to demand better
treatment, have no one to advocate for them and no access to legal advice.
This Guide is divided into two sections:
•
Issues - considers how HIV/AIDS-related stigma and discrimination
impacts on children and why programmes supporting children affected by
HIV/AIDS need to address stigma and discrimination.
•
Principles and strategies - outlines the key principles of programming to
tackle stigma and discrimination and promote social inclusion of children
affected by HIV/AIDS, and describes possible ways of taking action to
support children affected by HIV/AIDS.
ISSUES
Children with HIV and children affected by HIV/AIDS may be stigmatised and
discriminated against in different places and in different ways. Children may
experience:
Discrimination at home - HIV-positive women are often highly
stigmatised and their children suffer discrimination as a result. In some
places, female children with HIV are more likely to be rejected by relatives.
Children living with adoptive or foster parents or with relatives may be
treated less well than other children in the household. They may receive
less food or attention or may be expected to perform household chores or
to work rather than being able to go to school.
•
Discrimination by the community - Children in households affected by
HIV/AIDS suffer when their families are socially ostracised by neighbours
and relatives. Often it is assumed that the children of HIV-positive parents
must have HIV infection themselves. Children from affected families or
with HIV may feel lonely and isolated, because they choose to stay away
from other children or because other children will not play with them.
Sometimes other parents refuse to allow their children to eat or play with
children from families affected by HIV/AIDS. Communities may also
discriminate against children because of the behaviour of their parents.
For example, the children of sex workers or drug users are often
stigmatised and socially excluded.
In one community in Nepal, an eight-year-old boy whose father had died of
AIDS faced high levels of community discrimination, including not being able to
go to school or play with other children. A 72-year-old man in Thailand
described what happened to his HIV-positive granddaughter, both of whose
parents had died of AIDS: "At the kindergarten in the village her friends would
still play with her, but their parents pulled their children away and told us to
stay away. People who used to know and greet us turned their faces away and
wouldn't come near us any more".
Help Age International, 2002. Coping mechanisms of poor older men and women
affected by HIV/AIDS. International NCO Forum on Ageing, April 6th
•
Discrimination at school - Children with HIV or who are from affected
households may be excluded from school because of the discriminatory
attitudes of head teachers and teachers. Sometimes their own parents
decide it is not worthwhile sending them to school. Sometimes parents of
other children refuse to allow infected or affected children to enrol at
school or force them to leave school. Children themselves may decide
they cannot face going to school because of rejection or teasing by other
children, because teachers treat them differently to other children, or
because they cannot afford uniforms or books like other children.
•
Discrimination by health services - Health workers may discriminate
against children with HIV, separating them from other children. They may
provide these children with poor-quality care and treatment, because they
are afraid of becoming infected or consider it a waste of resources or
because their carers are poor or marginalised. Failure to protect the
confidentiality of HIV-positive adults and children contributes to stigma and
discrimination. Sometimes the parents of children with HIV may
discriminate against them, deciding it is not worthwhile taking them for
health care.
The impact of stigma and discrimination on children includes:
Shorter lifespan for children with HIV because of neglect or lack of health
care.
• Psychological and emotional distress, withdrawal and depression, and
feelings of fear, shame and rejection.
• Social isolation including separation from the community and exclusion
from family gatherings.
• Lack of adult support, understanding and care.
• Loneliness, lack of friends and of opportunities to play.
• Difficult behaviour and limited social skills.
• Poor school attendance and performance, drop-out and loss of
educational opportunities.
• Physical neglect resulting in poor health and nutrition.
• Low social value, verbal and physical abuse.
• Risk of engaging in behaviours such as use of drugs and alcohol, violence
and crime, prostitution.
•
PRINCIPLES AND STRATEGIES
Principle 1: PROTECT THE RIGHTS OF CHILDREN AND AFFECTED
FAMILIES
Tackling stigma and discrimination requires a supportive legal environment,
with laws and policies that support the rights of children and make stigma and
discrimination illegal. It also requires a supportive community environment
where affected families and children are aware of their legal rights and can
access legal support.
The Convention on the Rights of the Child states that:
•
•
Children should not suffer discrimination in leisure, sport, recreation or
cultural activities because of their HIV status or that of family members.
Children’s rights to informed consent, confidentiality and privacy with regard
to their HIV status should be respected.
Strategies for action
•
Improve community awareness about the rights of children, for example, to
health care and education, and of the community’s responsibility to protect
children’s rights.
•
Promote rights-based approaches that include children’s participation in
decision-making, planning, implementation and advocacy.
•
Make sure that health services and NGOs have systems to protect the
confidentiality of children and families affected by HIV/AIDS, including at
community level.
•
Promote awareness of legal rights and access to legal support. Possible
actions include:
Promote networking between community workers and organisations
and lawyers working in human rights issues.
Establish links with centres providing legal aid and advice.
Conduct community education campaigns to promote awareness of
sources of legal support.
Ensure that children and their carers are aware of their rights
through radio campaigns, drama, songs and educational sessions
in schools.
•
Sensitise local government officials, health workers, teachers and police to
children’s rights and issues related to stigma and discrimination.
•
Advocate for legal protection against discrimination if existing laws do not
provide this.
Principle 2: TREAT ALL CHILDREN EQUALLY
All children should be treated equally regardless of their HIV status or that of
family members. In places where many families live in poverty, targeting
assistance to children affected by HIV/AIDS can cause resentment and
increase stigmatisation by singling these children out.
Strategies for action
•
Target support to all poor and vulnerable children and families.
•
Ensure non-discriminatory access to education and to health care.
•
Avoid testing children from affected families for HIV.
The Orchid Clinic daycare centre, which was originally started for children of
people living with HIV/AIbS, has taken a policy decision not to test children for
HIV, in order not to discriminate between HIV-positive and other children. The
centre now provides care for children from families living in difficult
circumstances, not only children from families affected by HlV/AIbS.
Member of Asia Guides development group
Principle 3: PROMOTE POSITIVE ATTITUDES AND COMMUNITY ACTION
A supportive community environment is essential to tackle stigma and
discrimination. This means educating communities, encouraging influential
community members to play an effective role and providing them with the
necessary training.
Strategies for action
•
Educate communities about HIV/AIDS to reduce fear and ignorance, and
tackle myths and misconceptions about HIV transmission.
The Cambodian N6O NAPA organises cultural events, such as drama, in the
community and in schools, with young children taking the lead, to reduce stigma
and discrimination. For example, a drama on International Women's bay focused
on the topic "HIV/AIDS is our problem".
Member of Asia Guides development group
In Thailand, a group of young people started the Puppet Show Youth Group,
touring villages to communicate about HIV/AIDS and promote positive attitudes
towards people living with HIV/AIDS. The group has subsequently expanded its
activities to include plays, exhibitions, broadcasting, sports and competitions to
maintain people’s interest. An important part of the process is talking to
communities to find out what they know and think, and using the activities
themselves to bring communities together to solve their problems.
UNDP, 2001. Sang Fan Wan Mai youth group: tiny steps by youth to battle the
AIDS crisis. UNDP South East Asia HIV and Development Project
Village rallies along traditional pilgrimage routes have been used in India to
promote community awareness and address fears and myths about HIV/AIDS.
Children, young people and teachers sing songs, use puppets and hold discussions
with communities as they go from village to village on their way to and from the
pilgrimage site.
Member of Asia Suides development group
•
Promote community-based care and support programmes, which have
been shown to reduce stigma and discrimination.
A Save the Children UK project in Nepal found that using community volunteers
resulted in increased acceptance of widows and children who have lost husbands
and fathers to HIV/AIDS.
SC UK, 2001. Mobilising marginalised communities in Nepal. Young people and
HIV/AIDS: responding to the new Asian crisis
•
Encourage community leaders, religious organisations, and village elders
to tackle stigma and discrimination, and to advocate for community
support for children with HIV and children affected by HIV/AIDS. Possible
actions include:
Use monks, for whom people in Buddhist societies have high
respect, to preach compassion and care for people living with
and children affected by HIV/AIDS.
Mobilise community leaders to challenge stigmatising and
discriminatory attitudes and to set an example to others by
showing compassion and care for affected families.
Identify community volunteers to advocate for children in
schools, health centres and other institutions.
•
Train and use people living with HIV/AIDS as community educators. This
can help to normalise HIV and reduce fear, stigma and discrimination by
showing that anyone can get HIV and that people can live positively with
HIV.
The Thai NGO, ACCESS, implemented a project call AAy Positive Life, to help
normalise HIV/AIDS. People living with HIV/AIDS who were willing to be open
about their status and to share their experience were involved in organising a
photographic exhibition showing their lives and telling their stories. The
exhibition is shown in schools and communities, and other awareness-raising
activities are conducted during the exhibition. ACCESS is considering expanding
the project to include the experience of children affected by HIV/AIDS, but
this will require careful handling of issues such as confidentiality and informed
consent.
i-
Member of Asia Guides development group
•
Promote integration between children affected by HIV/AIDS and other
children. Possible actions include:
Involve infected and affected children in community festivals,
events and activities.
Organise events that bring together affected children with other
children, for example, community entertainment using drama
and dance, to promote social interaction.
Establish community children’s clubs.
In Cambodia, Children in Distress runs playgroups that bring together children
affected by HIV/AIDS and other children, and uses art and puppets to educate
children about stigma and discrimination.
Member of Asia Guides development group
In India, women's groups organise a fun day with activities for children during
the festival of biwali, bringing children with and without HIV together for
games, competitions, entertainment, music and dance.
Member of Asia Guides development group
•
Support interventions in schools, including training for teachers and school
principals, to promote tolerance and care for people living with HIV/AIDS
and to reduce stigma and discrimination towards children from affected
families.
•
Discuss the impact of stigma and discrimination on children with health
workers and provide training in non-discriminatory approaches to care and
treatment.
•
Encourage and support local companies to establish workplace
programmes to reduce stigma and discrimination.
•
Work with the media to spread accurate information about HIV/AIDS and
the situation of children affected, to develop positive messages about
people living with HIV/AIDS, and to stop reporting that promotes fear and
reinforces stigma and discrimination.
Principle 4: STRENGTHEN THE CAPACITY OF CHILDREN AND
AFFECTED FAMILIES TO COPE WITH STIGMA AND DISCRIMINATION
Children and families need the skills and resources to challenge stigma and
discrimination and to deal with their experience of stigma and discrimination.
■!
Strategies for action
•
Provide counselling for children affected by HIV/AIDS, to help them
develop strategies for dealing with stigma and discrimination. Possible
actions include:
Train traditional healers and elders to provide counselling for
children.
Train carers such as grandparents to provide support to children
who experience stigma and discrimination.
Integrate counselling into home-based care programmes.
Train older children as peer counsellors.
Sensitise teachers and health workers and training them in
counselling skills.
•
Establish self-help groups for children and families affected by HIV/AIDS,
to provide mutual support, share experiences and problems, and to lobby
for rights and non-discrimination.
Recognising that it is difficult for children and poor and marginalised families to
address stigma and discrimination individually, the India NGO Committed
Communities Development Trust established a forum for interested NGOs and
individuals, including young people and children, to discuss issues affecting
people living with HIV/AIDS and affected families and to lobby for their rights.
Member of Asia Guides development group
•
Promote child participation and child-centred approaches, to empower
children.
The CHETNA project, Children in Charge, promotes child-centred approaches,
which view each child as an individual and help children to develop the skills to
make decisions about their lives.
Member of Asia Guides development group
Edited draft Asia Guide 6
PROTECTION
INTRODUCTION
The HIV/AIDS epidemic increases the vulnerability of children to neglect,
abuse and exploitation. Poverty and family breakdown in families affected by
HIV/AIDS can result in children leaving home to seek work. Children who are
orphaned or abandoned and children with little education and few skills often
end up living on the streets. Children in the poorest families may be sold or
trafficked for sexual or labour exploitation. Children of migrants, sex workers
and other marginalised groups are particularly vulnerable.
These circumstances increase the chances that such children will in turn be
infected with HIV. Without adult care and support, access to information and
services, or legal protection, children are vulnerable to sexual exploitation and
abuse, involvement in prostitution or crime, and abuse of drugs and alcohol,
all of which increase their risk of HIV infection.
Programmes for children affected by HIV/AIDS need to develop strategies to
improve child protection, including strengthening the capacity of communities,
families and of vulnerable children themselves to prevent and cope with
situations where children are at risk.
This Guide is divided into two sections:
•
Issues - considers how the impact of HIV/AIDS increases the chances of
children ending up in risky situations, which in turn increase their
vulnerability to HIV infection, and explains why programmes need to
protect vulnerable and orphaned children.
•
Principles and strategies - outlines principles of programming to reduce
children’s vulnerability, and describes possible ways of taking action to
protect children.
ISSUES
Children end up in risky situations because of:
•
Poverty - Orphans and children from households affected by HIV/AIDS
migrate to urban areas seeking work because of family poverty and
unemployment in rural areas. Sometimes affected families end up living on
the streets because they have lost their home or land.
•
Family breakdown and abuse - The illness or death of a parent or
parents may lead to family break-up. Orphaned children who are
mistreated by relatives or foster carers may decide to run away. In many
cases, domestic violence or sexual abuse is the main reason for children
leaving home. Sometimes children end up living in on the streets after
being abandoned by relatives.
The NGO Friends works with street children in Phnom Penh, the capital city of
Cambodia. Many children have ended up living on the streets because of family
breakdown. For example, one boy aged 16 years has been living on the streets
for four years, since his father went to prison for murdering his mother. He
started using drugs a year ago, and earns a living through begging. Another boy
left home to live on the streets because of domestic violence and also started
using drugs because he felt lonely and hopeless.
Member of Asia Guides development group
Forced migration and trafficking - Many children end up in the sex
trade: sometimes families sell their children to brothels, sometimes
traffickers trick families and children with false promises of high-paying
jobs. Other children are trafficked to work in jobs that are dangerous or
where they work long hours for very low pay. The children of poor families
affected by HIV/AIDS and orphans in rural areas are most vulnerable to
trafficking and abduction.
•
In Cambodia, it is estimated that 30% of sex workers are under the age of 18.
At least half of these children are forced into the sex trade through deception
or being sold by their families.
World Vision, 2001. A safe world for children: ending abuse, violence and
exploitation
Many girls from poor rural areas of Nepal are trafficked to India to work in the
sex industry, while others are lured with promises of jobs as factory or
domestic workers. Similar cases occur in other countries. For example, girls in
the Philippines are persuaded to leave their villages to work in the city of
Manila, where many end up selling sexual services in bars.
Save the Children UK, 1996. Kids for hire: a child's right to protection from
commercial sexual exploitation
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•
Parental and community situation - Children of migrants are vulnerable,
especially if their parents are illegal migrants, because they lack access to
education and health care and often live in poor conditions. Children of sex
workers are at risk of being sexually abused by clients or of ending up in
the sex trade. Community violence or gang warfare is often reflected in
violence in the home.
Migrant children, especially those from ethnic minorities, living in border areas
are particularly vulnerable to trafficking for sex work and child labour.
Save the Children UK, 2001. Small dreams beyond reach: the lives of migrant
children and youth along the borders of China, Myanmar and Thailand
These children are vulnerable to HIV because of:
•
Prostitution, sexual abuse and exploitation - Children with little
education and no qualifications have few employment opportunities, but
feel obliged to support their families financially or to help their families pay
off debts. For girls, selling sexual services may be the only option. Street
children are at risk of sexual abuse and exploitation, or may sell sexual
services to survive. Sometimes young street girls and boys provide sexual
services to older boys in exchange for affection or protection. Street
children have high rates of sexually transmitted infections and are at high
risk of HIV infection. Children, especially girls working as domestic
servants, are also vulnerable to sexual abuse by employers. Poor children
who are living with their families are also vulnerable to sexual exploitation
by adults, for example “sugar daddies” or “sugar mummies” or sex tourists.
•
Drug abuse and crime - Children who have lost their parents and are
suffering from psychological distress, and street children, may use drugs
or alcohol to cope with their situation. Drugs and alcohol reduce children’s
ability to refuse unsafe sex or to negotiate in risky situations. Children
living on the streets are at risk of getting involved in crime. Children who
end up in detention because of drug use or crime are vulnerable to sexual
abuse by police, prison officers or other prisoners.
•
Limited access to information and services - Vulnerable and
marginalised children often have limited knowledge about HIV/AIDS, few
ways to protect themselves from infection and little access to health
information and services. Street children, children of sex workers and
other marginalised and vulnerable children often face hostility from health
workers. Suitable rehabilitation and support services for street children,
children involved in sex work or with drug problems are limited. In many
cases, the only option available is institutional care, which children dislike
and which is not in their best interests. Children in institutions may be at
risk of neglect and abuse by adult carers.
•
Lack of legal protection - Many children are not aware of their legal
rights or of the protection from abuse that the law is supposed to provide.
Cases of sexual abuse are rarely reported to the police, because children
are afraid of the consequences or that they will not be believed, especially
if the abuser is a family member or employer. Children in the sex trade are
often powerless to report or change their situation. They may fear violent
reprisals or owe money to the brothel owner. They may feel they cannot
leave because they have nowhere to go, and that they cannot go home
because of the shame and stigma associated with sex work.
•
Low awareness of the situation of vulnerable children - In many
countries, the criminal justice system is not supportive of children who are
abused or exploited, so children remain in situations where they are at risk
of HIV. Children who get into trouble with the law may not get legal
representation and judicial systems are often inadequate to deal with
juvenile crime. The police are not sensitive to the needs of children living
on the streets, and may perceive them as a law-and-order problem rather
than as vulnerable children who need help.
PRINCIPLES AND STRATEGIES
Principle 1: PROTECT CHILDREN FROM EXPLOITATION AND ABUSE
Children have the right to protection. Programmes need to promote the
protection of children and their rights, and the idea that children are socially
valuable.
The Convention on the Rights of the Child states that:
•
Children should be protected from trafficking, forced prostitution, sexual
exploitation, sexual abuse, drugs and harmful traditional practices that put
them at risk of HIV/AIDS.
Strategies for action
•
Network and collaborate with organisations working to protect children
from exploitation and abuse, such as child rights groups, legal centres,
child welfare agencies, trades unions, anti-trafficking organisations.
•
Sensitise the police and social workers about child protection and the risks
faced by vulnerable and marginalised children.
•
Train legal workers on child rights, HIV/AIDS and child protection issues
such as sexual exploitation and child labour.
•
Strengthen the capacity of the judicial system and law enforcement
agencies to deal with child sexual abuse and exploitation.
•
Advocate for laws, or enforcement of existing laws, to protect children from
sexual abuse and exploitation, and labour exploitation. Possible actions
include:
Sensitise local authorities to the risks faced by vulnerable
children.
Work with local police to encourage them to enforce existing
legislation, to collaborate with communities and NGOs in
protecting children from trafficking and to follow up and
prosecute cases.
•
Promote community awareness of child rights and child protection issues.
Principle 2: PREVENT RISK SITUATIONS
Targeted support to the poorest and most vulnerable communities and
families can help address the reasons why children migrate in search of work.
Rural families and children in particular need information about the risks of
child trafficking.
Strategies for action
•
Advocate for government poverty reduction activities to target rural and
border communities where children are particularly at risk of trafficking and
migration.
•
Strengthen community and family economic coping skills and capacity to
generate local income.
•
Support orphans and vulnerable children, especially girls, to attend school
to expand their employment options.
•
Provide training for children who are already living on the streets to enable
them to develop alternative sources of income generation to prostitution,
crime or begging.
In Phnom Penh, Cambodia, the NGO Friends provides vocational training for
young women who have come to the city through the Young Migrants project. In
some cases, developing new skills enables young women to go home and earn a
living there.
Member of Asia Guides development group
•
Informing and sensitising families, communities, teachers and health
workers about child trafficking and the associated risks.
In Cambodia, Friends does outreach work in communities to prevent children
from ending up on the streets in the first place.
Member of Asia Guides development group
Also in Cambodia, Save the Children UK and a local NGO called Krousar Thmey
have been working to increase awareness among rural populations of the risks of
child trafficking and prostitution, using a travelling shadow theatre and poster
campaigns, and encouraging communities to protect children.
5a ve the Children UK, 1996. Kids for hire: a child's right to protection from
commercial sexual exploitation
In Nepal, the NGO Matti Nepal, has worked with girl returnees, lawyers and the
police to raise awareness in rural communities of the risks to young girls
trafficked across the border to India. The NGO spreads messages using
traditional Nepali tunes and also provides training for alternative income
generating activities. Community committees have been formed to publicise,
control and report on trafficking. The project has led to increased vigilance and
assertiveness by families and better police cooperation.
5ave the Children UK, 1996. Kids for hire: a child's right to protection from
commercial sexual exploitation
The experience of IDA in Cambodia illustrates how sensitising communities,
networking and using legal mechanisms can help to protect children from
trafficking. In one case, a girl from a family affected by HIV living in a poor
area of Phnom Penh was deceived into leaving home by a trafficker. Her parents
reported what had happened to the IDA home-based care team, and IDA staff
accompanied them to the commune office to file a complaint against the
trafficker. The staff also reported the case to a human rights organisation.
Through these efforts the girl was returned to her family and action was taken
against the trafficker.
Member of Asia Guides development group
Principle 3: PROMOTE COMMUNITY ACTION TO PROTECT CHILDREN
Families and communities are key resources in fighting abuse and
exploitation of children. Programmes need to build the capacity of families and
communities to protect children who are at risk and to support children who
have experienced neglect, abuse or exploitation.
Strategies for action
•
Increase community awareness. Possible actions include:
Promote open discussion of the problem of child abuse and
exploitation.
Work with women’s groups, youth groups and children to
publicise the impact of community and domestic violence on
children.
Promote gender awareness and efforts to tackle the low status
of girls and women.
World Vision in Cambodia integrates training and awareness-raising on the
situation of girls and women and gender violence into all community development
programmes.
Member of Asia Guides development group
•
Encourage community actions to protect children. Possible actions
include:
Work with community groups, health and education systems,
civil society and religious organisations to protect children from
abuse and exploitation.
Work with local police to monitor the trafficking situation and
develop strategies to deal with traffickers.
Train community committees on child rights and child protection.
Establish community child protection groups to monitor and
protect children at risk.
•
Provide practical support for children at risk and victims of neglect, abuse
and exploitation. Possible actions include:
Set up free telephone helplines for children to report abuse or
request advice.
Establish places of safety or “safe spaces” for children and
community safety nets for abused children.
Identify and training community counsellors or trusted adults to
whom children can talk about their situation.
Organise temporary accommodation for abandoned children
and children from abusive homes.
Encourage community members to help neglected and
vulnerable children in partnership with home-based care teams.
In India, the Child in Need Institute, together with local youth club, runs a
drop-in centre for children of sex workers in Kolkota. The centre offers
protection, recreation and educational opportunities. Also in India, the
Committed Communities Development Trust runs project Ankur, a daycare
centre for 3-8-year-old children of sex workers. The centre provides nonformal education to prepare children to enter mainstream schools, vocational
guidance and skill training, education about rights and issues such as hygiene,
health care, and helps children to develop the skills to protect themselves from
abuse. CCbT also runs a night shelter for girls aged six-14 years.
Member of Asia Guides development group
In Cambodia, the NGO Hagar runs a programme where street children, orphans
and children from abusive homes are cared for by foster families. Similarly,
World Vision runs the Bamboo Shoot informal drop-in centre, which offers
short-term accommodation.
Member of Asia Guides development group
Also in Cambodia, IDA encourages the community to help vulnerable children as
well as providing support through the organisation's home-based care team. In
one case, an HIV-infected widow left with a large debt to pay off had no choice
but to go to work leaving her two children aged two and three years alone at
home often with no food. A neighbouring family reported the situation to the
home-based care team and also helped to look after these children.
Member of Asia Guides development group
•
Promote community approaches to rehabilitation of children who have
been exploited or abused.
Friends tries to reintegrate street children with their families, negotiating with
the family and addressing the reasons why children left home in the first place.
Member of Asia Guides development group
sexual abuse, and is performed for other street children and also for children in
villages, to increase awareness of the risks faced by children on the streets.
Friends also conducts awareness-raising among street children, especially boys,
about vulnerability to drug abuse. Outreach is used to identify children who are
newly arrived on the streets and to make them aware of the risks of sexual
exploitation, including HIV infection.
Poverty meets the cheat, 2002. With 5am/anh/Friends and member of Asia
Guides development group
•
Involve children themselves in developing policies and programmes to
protect children and guarantee their rights, and in developing strategies to
reduce their vulnerability to sexual abuse and exploitation.
In Sri Lanka, an NGO worked with children to develop activities to reduce their
vulnerability to sexual abuse and exploitation by families, employers and
tourists. They used street theatre to raise community awareness of the risks
they face, including developing a play to highlight the role of alcohol in sexual
abuse by fathers. Working together allowed these children to have a voice and
to inf luence community attitudes. Support was provided to establish children's
clubs, offering a safe place for discussing their problems and experiences.
Realising that others share the same difficulties helped the children to feel less
isolated.
•
Help children to give each other peer support. Possible actions include:
Establish support groups, clubs and drop-in centres where
children can meet.
Train children in counselling skills.
•
Support children’s access to general health services as well as to sexual
health services providing counselling, condoms, diagnosis and treatment
of sexually transmitted diseases. Possible actions include:
Train and sensitise health workers to provide child-friendly and
youth-friendly health services.
Run mobile and outreach clinics.
Encourage health centres to offer special sessions for street and
working children, with opening hours that are convenient for the
children.
•
Provide comprehensive services that reduce children’s vulnerability and
address their priorities.
Friends has developed a range of activities in response to needs expressed by
street children. It provides children with a safe place to stay, runs a drop-in
centre that provides counselling and health services, helps children to stop using
drugs, and offers training to develop skills, for example in motorcycle repair.
World Vision runs a centre in Cambodia for girls who have been sexually
exploited. Where appropriate, they reunite the girls with their families. Where
this is not feasible or desirable, the girls are supported to live in small group
homes or independently in the community. A key part of the rehabilitation
process is restoring the girls' self-esteem, using creative activities, as well as
developing literacy and vocational skills.
Member of Asia Guides development group
Principle 4: STRENGTHEN CHILDREN’S CAPACITY TO PROTECT
THEMSELVES
Provide children with the protective mechanisms and support they need to
protect themselves within their own environment. It may not always be
feasible or in the best interests of the child to remove them from their
environment. Ensure children are involved in decision-making about their lives
and design interventions with children’s participation and according to their
situation. For example, different strategies are needed to address the different
situations of street children. Some street children are living on the streets with
their families, some without families, and some spend time on the streets but
go home.
Strategies for action
•
Increase children’s awareness of their rights. Possible actions include:
Establish children’s rights networks or links with existing
children’s rights organisations.
Use formal and non-formal education to increase children’s
knowledge of their rights, and participatory approaches to
develop materials about children’s rights.
Make sure that children know where to obtain legal support and
where they can go for help in cases of abuse and exploitation.
•
Provide children with information and skills. Possible actions include:
Educate children in rural areas and migrant communities about
the risks of trafficking.
Encourage schools to teach life skills.
Pay particular attention to activities to empower girls.
Conduct outreach and peer education with children who are not
in school.
Teach children self-defence techniques.
Discuss the risks of sexual abuse with children and what to do if
they are abused, as well as how to deal with potentially
exploitative situations.
In Cambodia, though the Lost Child Project, Friends has developed a play called
"Poverty meets the cheat" with a group of 60 children who are living on the
streets. The play is about their situation and vulnerability to exploitation and
sexual abuse, and is performed for other street children and also for children in
villages, to increase, awareness of the risks faced by children on the streets.
Friends also conducts awareness-raising among street children, especially boys,
about vulnerability to drug abuse. Outreach is used to identify children who are
newly arrived on the streets and to make them aware of the risks of sexual
exploitation, including HIV infection.
Poverty meets the cheat, 2002. With Samlanh/Friends and member of Asia
Guides development group
•
Involve children themselves in developing policies and programmes to
protect children and guarantee their rights, and in developing strategies to
reduce their vulnerability to sexual abuse and exploitation.
In Sri Lanka, an NSO worked with children to develop activities to reduce their
vulnerability to sexual abuse and exploitation by families, employers and
tourists. They used street theatre to raise community awareness of the risks
they face, including developing a play to highlight the role of alcohol in sexual
abuse by fathers. Working together allowed these children to have a voice and
to inf luence community attitudes. Support was provided to establish children's
clubs, offering a safe place for discussing their problems and experiences.
Realising that others share the same difficulties helped the children to feel less
isolated.
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Help children to give each other peer support. Possible actions include:
Establish support groups, clubs and drop-in centres where
children can meet.
Train children in counselling skills.
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Support children’s access to general health services as well as to sexual
health services providing counselling, condoms, diagnosis and treatment
of sexually transmitted diseases. Possible actions include:
Train and sensitise health workers to provide child-friendly and
youth-friendly health services.
Run mobile and outreach clinics.
Encourage health centres to offer special sessions for street and
working children, with opening hours that are convenient for the
children.
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Provide comprehensive services that reduce children’s vulnerability and
address their priorities.
Friends has developed a range of activities in response to needs expressed by
street children. It provides children with a safe place to stay, runs a drop-in
centre that provides counselling and health services, helps children to stop using
drugs, and offers training to develop skills, for example in motorcycle repair.
Member of Asia Guides development group
In India, a YWCA project aims to reduce the vulnerability to HIV/AIDS of girls
aged 10-19 years who are working and living in the slums of Delhi. These girls
have low literacy and many of those involved in activities such as rag-picking are
migrants from Bangladesh. They are vulnerable to sexual abuse and exploitation,
and have little family support to protect them from abusive situations. The
project empowers these girls through literacy, life skills and livelihood skills
education, and reduces their risk of sexual and other exploitation through
awareness-raising and counselling. Life skills education is conducted in small
groups, using methods such as games, videos, discussion, role play, songs, stories
and picture books; group work also helps to promote peer education and support.
In addition, the project provides one-to-one counselling, operates Safe Space
Centres in the community, and offers health care and recreational activities.
YWCA is also sensitising parents and the wider community, training community
health workers, organising foster care, and providing family counselling.
Member of Asia Guides development group
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