Children and AIDS through different lenses

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Children and AIDS through different lenses

• Dr Sharlene Swartz

15 July 2009
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Outline

• Where do you stand?
• Important South African demographics
• HIV statistics focusing on children
• Terminology
• How have we failed children?
• What needs to be done?
• Two case studies for analysis

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Where do you stand?10 Agree 1 Disagree

• When it comes to AIDS programmes, special
  attention should be paid to orphans
• The use of terminology around HIV and AIDS is
  only of importance for specialists
• AIDS intervention programmes should focus on
  changing individual behaviour
• Cash transfer programmes creates dependence
  amongst poor families

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The Numbers

• Important South African demographics
• HIV statistics impacting on children
• Is there anything surprising?
• Especially interesting?
• Whats missing?

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Terminology around OVC

• OVC orphans and vulnerable children, orphaned
  and vulnerable children
• Children infected and affected by HIV/AIDS
• Children made vulnerable by HIV/AIDS and poverty
• Who are orphans and who is vulnerable?

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Terminology around OVC

• Who are orphans? (20)
• Maternal (3)
• Paternal (13)
• Double orphans (4)
• Child-headed households (0.6h/0.8c)

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Who are vulnerable?

• Living below the poverty line
• In a household without an employed adult
• Without a child support or foster care grant, and
  who are eligible
• In communities with high rates of unemployment,
  crime, violence, alcohol misuse
• Low school quality, poor health services
• High rates of HIV infection
• In homes with non-biological children
• Food insecurity
• Partial-parenting, low supervision, maltreatment

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How do orphans fare compared to other children?

• Dr Tsiliso Tamasane (PhD University of Cape Town,
  2009)
• Investigated the assumptions that
• Grandmothers are the main carers of orphaned
  grandchildren
• Care provided for these orphaned children is
  inferior to children who are not orphaned
• Care defined as number of meals eaten daily and
  school attendance
• A case study of Kopanong Municipality in Free
  State, as part of a larger household study

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Findings

• Extended family support for orphans is widespread
  in Kopanong.
• The bulk of the caring lies with grandmothers
• No evidence for inferior care by grandparents
• No difference in care grandparents care and
  parents care
• Care is a burden is Kopanong
• Challenges the appropriateness of orphanhood as a
  screening tool for welfare assistance
• Creates divisions between families who all need
  support whether they are caring for orphans or
  not

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How have we failed children?

• Prof. Linda Richter (HSRC, JLICA, 1st plenary
  speaker at XXV AIDS Conference 2008 on children
  and AIDS)
• 1. Prevention
• Most HIV children are infected through
  mother-to-child transmission.
• PMTCT is not reaching enough pregnant women or
  children under 2 months
•  Only 8 of infants in low/middle-income
  countries tested within two months WHO et al.
  2008)

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• 2. Treatment
• Children living with HIV have far less access to
  treatment than adults
• Only 10 of children globally received ART in
  2007
• Fewer than 4 of two-month-olds exposed through
  maternal HIV received prophylactic medication
  (WHO et al. 2008)

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• 3. Not only orphans are affected
• Orphans are the tip of the iceberg
• Singling out specific groups leads to others
  being passed over

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• 4. The lone burden or tax on affected families
• Little or no funding or assistance from
  governments
• Fewer than 15 of households supporting OVC are
  reached by either community-based or public
  sector support programmes (UN Secretary General
  2006).

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What needs to be done for children?

• 1. Policies, programmes and funding must be
  redirected to provide support for children to and
  through their families.
• Not institutional care
• Not children as islands

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• 2. Rethink policies for integrated
  family-centred services
• PMTCT
• Home care of the ill and dying
• ARV treatment
• Action for childrens wellbeing must include
  health, material needs, psychosocial wellbeing
  and cognitive development

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• 3. Since the backdrop to AIDS epidemic is
  extreme poverty, attention must be given to
  social protection for poor families
• AIDS-affected households, spend ¼ of annual
  income coping with the disease (Basaza et al.
  2007).
• Improve the ability of families to claim social
  protection entitlements
• Social protection packages are affordable
  between 1.5 to 4.5 of GDP for low-income
  African countries (estimate by ILO, in Pal et al.
  2005)

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• 4. Expand the use of income transfers
• Additional resources must go directly to the
  poorest families affected by HIV and AIDS
• Not via the many intermediaries

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What needs to be done A Summary

• Interventions for children through families
• Include families in existing strategies,
  integrate services
• Access to social protection
• Direct income transfers for poorest infected and
  affected families

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Peer education for OVCCase Study 1 What do
you think?

• Vhutshilo - A programme designed to help children
  made vulnerable by HIV and poverty...
• Connect with each other and older peers in order
  to access help
• Bridge the gap between formal education, social
  services and recreational programmes
• Circumvent cultural taboos such as adult-child
  death-talk and sex-talk

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FBO strategy for OVC Case Study 2 What do you
think?

• Care for Kids Run by a group of Anglican
  churches in Cape Town
• Works with local congregations in poor
  communities to assess needs of OVC
• Defines an orphan as a child who has lost both
  parents, and a vulnerable child, as one who is
  part of a household that takes care of orphans
• Provides educational, clothing, food,
  grant-access, and spiritual support to entire
  family, and psychosocial support to children
• Leaves congregations with a plan for ongoing
  intervention

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Children and AIDS through different lenses

• Dr Sharlene Swartz

15 July 2009