Children and AIDS through different lenses

1. Children and AIDS through different lenses Dr Sharlene Swartz 15 July 2009

2. 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

3. 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

4. The Numbers • Important South African demographics • HIV statistics impacting on children • Is there anything surprising? • Especially interesting? • What’s missing?

9. 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?

10. Terminology around OVC Who are ‘orphans’? (20%) • Maternal (3%) • Paternal (13%) • ‘Double’ orphans (4%) • Child-headed households (0.6%h/0.8%c)

11. 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

12. 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

13. 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

14. 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)

15. 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)

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

17. 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).

18. 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’

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

20. 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)

21. 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

22. 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

23. 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’

24. 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

25. Children and AIDS through different lenses Dr Sharlene Swartz 15 July 2009