Universal Access

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Universal Access Children as the Missing Faces of
AIDS Asia-Pacific
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How many children are affected in Africa?
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How many children are affected in Asia?
?
Generalized
Source pg 199, 2004 Report on the Global AIDS,
UNAIDS
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Low-level
99 of the popula-tion in Asia are still HIV
negative. Lets just keep it that way. Peter
Piot to ADB President and staff in Manila, 22 Feb
2005
Low Prevalence
Low Prevalence East Asia Pacific
High Prevalence - Africa
Concentrated
High
Generalized
Source 2004 Report on the Global AIDS, UNAIDS
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Low-level
Low Prevalence
Low Prevalence
High prevalence Africa
Low Prevalence East Asia Pacific
Concentrated
High
Generalized
High
Generalized
Source 2004 Report on the Global AIDS, UNAIDS
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Low-level
India 0.9 5.1 million
Low Prevalence
Low Prevalence
High prevalence Africa
Low Prevalence East Asia Pacific
South Africa 21.5 4.8million
Concentrated
High
Generalized
High
Generalized
Source 2004 Report on the Global AIDS, UNAIDS
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(No Transcript)
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Estimated between Sub-Saharan Africa Asia

• HIV circulating within 3 major sub-populations
  IDU, SW MSM
• with pockets of generalized epi (ANC gt1)
• Recent trend ? clients of sex workers infected
• Increased of women - 23 (East Asia-Pacific),
  26 (South Asia)
• - 57 (Sub-Saharan Africa)
• Plus increased evidence of high risk of
  infection during pregnancy

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International OVC framework

• Strengthen the capacity of families
• Small scale projects, not at national policy
  stage except for Thailand Cambodia through
  income-generation, drug, food and school
  assistance
• Mobilize community-based responses to support
  affected families
• Thailand Cambodia (National models) India
  Papua New Guinea (NGO FBO)
• Ensure equal access to essential services
• Thailand, most recently Health Thailand
  30-Baht Scheme that also covers ARV (including
  2nd line regimen)
• Policy, legislation, standards and enforcement
• China 4 Frees 1 Care, Thailand, Cambodia
  Vietnam (legal review)
• Raise awareness to create supportive environment
  (from angle of children affected)
• Cambodia, China, Laos, Vietnam Thailand

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Knowledge, capacity, commitment leadership

• Defining the target pop. identifying
  beneficiaries
• PHIV prefers to remain anonymous, and children
  affected are invisible
• Stigma discrimination AIDS as Social Evil
• Approaches to programming
• Spectrum of care Info on families, foster care,
  adoption, and alternative types of residential
  care still not well examined (only Vietnam
  conducted a study)
• Integrating children affected by HIV/AIDS into
  broader community initiatives (selected
  countries Thailand Cambodia)
• Linking activities for children with other
  HIV/AIDS efforts (not much beyond PMTCT Prong
  III)
• Addressing fundamental needs food security
  nutrition, education, economic stability
  protection (Thailand Cambodia not much
  elsewhere)
• Prevention among the most vulnerable children
  youth

Source Lynn Sussman, Providing Support to
Children Affected by HIV/AIDS their families
in Low Prevalence Countries of India and
Cambodia Programmeing Issues, Policy Project,
Washinton DC, Jan 2006
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(No Transcript)
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Coming to grip not only with children affected
but also those Infected
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Growing up alone ????
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Children affected by AIDS an emerging issue

• Regional estimation conducted in 2005 1.5
  million in Asia-Pacific (10 of global total)
• National data not systemically collected
  largely derived from initial assessments
• Estimation of orphans compounded by stigma
  denial of deaths as related to AIDS
• Lack of clarity on definitions of vulnerable
  children spectrum of vulnerabilities
• Conservative estimates favoured in some
  instances due to budgetary implications
  subsidies to affected families with children

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Children affected by AIDS an emerging issue
Source Various country assessments by MOPH,
UNICEF or UNCT
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Low Prevalence
Low Prevalence East Asia Pacific
High Prevalence - Africa
Concentrated
Generalized
High
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Diverse cultures, local practices governing
systems
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Diverse cultures, local practices governing
systems
Papua New Guina 800 languages
Tengatenga Care Centre for Children
Kartanim Care Centre
Kenan Care Centre
Peace Care Centre
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Universal Access

• Global campaign in the context of scaling up
• Asia-Pacific Universal Access Conference,
  Pattaya, Thailand, 14 16 Feb
• Review of National HIV/AIDS Strategic Plan are
  children given sufficient policy attention
  programme support?
• East Asia-Pacific Regional Consultation on
  Children and HIV/AIDS, Hanoi, Vietnam, 22 24
  March

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Universal Access

• Estimated resource needs for HIV/AIDS
  Asia-Pacific
• 4 billion - 2006
• 5 billion 2007
• Eg. Thailand, 85 on treatment and care,
  including ARV
• Current annual spending, including both public
  and private out-of-pocket expenditures, about
  700 million
• Region as a whole spends 100 billion a year on
  health care alone. Three-quarters (75) of each
  dollar spent on health care right now are private
  payments to private providers
• Long-term financing of care welfare support a
  major issue
• Competing priorities Recent threat of avian
  pandemic human influenza

.
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Programmes coverage
Source Coverage of Selected Services for
HIV/AIDS Prevention, Care and Support in Low and
Middle-Income Countries in 2003, USAID, UNAIDS,
WHO, UNICEf and the Policy Project, June 2004
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Universal Access

• Key messages children affected by AIDS shared
  with UNAIDS Sec-Gens Special Representative on
  HIV/AIDS in Asia Nafis Sadik
• National consultations taking place
• Indonesia Revised Presidential decree No.
  30/1994 on HIV/AIDS prevention and care to
  include children
• Myanmar National Strategic Plan should address
  children affected infected
• Vietnam Multi-sectoral response for children
  affected by AIDS (9 NAP currently place children
  under Community Response)
• Regional Consultation on Children and HIV/AIDS,
  Hanoi, Vietnam, 22 24 March
• First of its kind (regional) in Asia
• USAID/OGAC/FHI, WHO, UNESCO, Save the Children,
  UNICEF/UNAIDS
• Defining needs, emphasizing rights of
  marginalized children,
• International framework, coordination,
  integration partnership
• Hanoi Call to Action

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Hanoi Call to Action, 22 24 Mar 2006

• Develop country-specific targets and action plans
  for rapidly scaling up HIV prevention, including
  the prevention of maternal to child transmission,
  HIV testing and counseling, pediatric and adult
  antiretroviral treatment, family-oriented
  clinical care, psychosocial support and child and
  family protection services with accelerated
  effort targeted specifically for children by
  2010.
• Allocate a dedicated proportion of national
  HIV/AIDS budgets to the rapid scale up of
  responses targeted for children.
• A quantitative and qualitative assessment of the
  situation of children and HIV/AIDS in each
  country to strengthen and scale up the response.
• Establish systems for monitoring key indicators
  over time, including numbers of children infected
  and affected by HIV/AIDS and the core global
  indicators for monitoring the national response
  to children orphaned and made vulnerable by
  HIV/AIDS.

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Hanoi Call to Action, 22 24 Mar 2006

• 5. National multi-sectoral working group that
  focuses on child welfare and coordinates the
  scaled up response for children vulnerable to,
  infected and affected by HIV/AIDS.
• 6. Eliminate HIV/AIDS-related stigma and
  discrimination, financial and other barriers to
  ensure that all children have access to essential
  services, including a continuous basic education.
  
• 7. Expanded efforts to ensure that all children
  are provided with the most family-like care
  environment and that institutional care is used
  for children without caregivers only as a
  temporary measure or option of last resort.
• Over 200 government NGO representatives from
  17 countries in East Asia Pacific

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Thank you Wing-Sie Cheng Regional Adviser,
HIV/AIDS UNICEF East Asia Pacific Regional
Office Bangkok, Thailand Email wscheng_at_unicef.org