No Small Issue CHILDREN AND FAMILIES Universal Action Now

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No Small IssueCHILDREN AND FAMILIESUniversal
Action Now

• Linda Richter
• Human Sciences Research Council
• South Africa
• lrichter_at_hsrc.ac.za

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Children At last, their time has come
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Two successful symposia

• Envisioning the Future An International
  Symposium on Children (2006)
• Action Now Action How An International
  Symposium (2008)

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• Joint Learning Initiative on Children and
  HIV/AIDS (JLICA)

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Too small to count?

• Lack of data on children
• Maintained in several agencies
• Difficult to link programme silos
• Does not conform to CRC 0-18 years

2 million children were living with HIV in 2007,
90 in Sub-Saharan Africa
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Children living with HIV globally, 1990-2007
(UNAIDS, 2008)
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New infections among children globally, 1990-2007
(UNAIDS, 2008)
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Child deaths attributable to AIDS globally,
1990-2007 (UNAIDS, 2008)
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Children who have lost one or both parents to
AIDS in sub-Saharan Africa, 1990-2007
(UNAIDS/WHO, 2007)
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Where have we gone wrong?
1. HIV prevention is failing children 2.
Children have less access to treatment than
adults 3. It is not only orphaned children who
are affected 4. Families, many in extreme
poverty, support children without assistance
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1. HIV prevention is failing children

• Good PMTCT services reduce transmission to less
  than 2
• Coverage in poor countries
• - 10 in 2005 ? 34 in 2007
• Remains mainly monotherapy (single-does
  nevirapine)

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2. Children have less access to treatment than
adults

• lt 8 newborns tested in poor countries in 2007
• lt 4 of 1.5m exposed children received
  co-trimoxazole early
• 10 of 2 million children receiving ARVs

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3. Not only orphans are affected

• Children infected and affected
• AIDS orphan ??
• Few differences between orphans and very poor
  children
• Individualized a massive social problem

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of families affected by HIV illness and death,
2003 (Belsey 2005)
Adult member with HIV
Adult member with AIDS
Death of adult member from AIDS
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4. Families, many in poverty, support children
without assistance

• ALL children require support
• 60 of children in southern Africa live in
  poverty
• lt 15 receive support (2007)
• Families carry 90 of the cost

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Children have been short-changed

• We have done little and missed many
  opportunities
• PMTCT Plus
• Confusion about infant feeding
• Failed to link partners, child testing
  treatment, child development, family support

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What now needs to be done?

• Support children through families
• Develop comprehensive integrated
  family-centred services
• Create social protection for the poorest
  families
• Expand income transfers to poor families

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1. Support children through families

• Most children are in family care
• Families care best for children
• They are a critical entry point
• Families have responded at cost
• Family - rather than orphanage care
• Strengthen the capacity of families

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2. Family-centred services

• Family-focused prevention, treatment care, eg
  couples
• Adult ARV also benefits children
• Provide for material psychosocial needs
• Comprehensive approaches primary health care

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3. Social protection

• HIV and AIDS deepens poverty, in low- and
  high-prevalence settings
• SP is on the development agenda
• It is affordable and feasible
• AIDS activism ? entitlements
• Resources to households, not intermediaries

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4. Expand income transfers

• Provide relief, avert borrowing and the sale of
  assets
• Demonstrated effectiveness in poor countries
• Can take variable forms
• An entry point for large-scale integrated
  national responses

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• All children, including those affected by HIV
  and AIDS are best cared for in functional
  families with basic income security, access to
  health care and education, and support from kin
  and community
• Our work is to ensure these conditions for
  children and families

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Acknowledgements and Thanks

• Jerry Coovadia and Olive Shisana
• Julia de Kadt, Alastair van Heerden, Chris
  Desmond, Lorraine Sherr
• Bernard van Leer Foundation
• Coalition for Children Affected by HIV/AIDS
  (CCABA)
• Joint Learning Initiative on Children and
  HIV/AIDS (JLICA)
• Human Sciences Research Council (HSRC)