HIV/AIDS

Protecting Africa's future: Livelihood-based social protection for orphaned and vulnerable children in East and Southern Africa

FAO REOSA policy brief 01

Despite greater access to antiretroviral (ARV) drugs in southern Africa, the current HIV epidemic continues to result in increasing numbers of orphaned and vulnerable children. In many countries in the region, as many as 50 per cent of all orphans under the age of 17 years had parents who died of AIDS-related illnesses. According to bodies like UNAIDS, this level of AIDSrelated orphanhood is expected to remain high until 2030.

Although noteworthy policy and investment in programmes aimed at responding to these children’s needs exist, too many programmes remain ill-equipped to cater for their needs in a sustainable and cost-effective way. This is partly as a result of gaps in OVC social protection policy and legislation.

This policy brief presents a series of Regional Inter-Agency Task Team for Children (RIATT) and FAO recommendations. 

Among them are:

  • Drafting stand-alone social protection policies to fill gaps in protection of orphaned and vulnerable children (OVC); and
  • Strengthening existing policy frameworks.

It also advocates for:

  • Livelihood-based social protection initiatives aimed at reducing vulnerability and providing social transfers to the poor; and
  • Protecting the vulnerable against livelihood risks and enhancing the social status of themarginalized.

SADC business plan on orphans and other vulnerable children and youth 2009-2015

SADC business plan on orphans and other vulnerable children and youth 2009-2015

Poverty and under development remain daunting challenges for the SADC region. The combined impact of these factors is evident in the increasingly high numbers of orphans and other vulnerable children and youth (OVCY) and the often acute violation of human and child rights. The SADC business plan links with other strategic frrameworks to provide a roadmap of the SADC approach to the care and support for OVCY. 

About two thirds of the population in the region live below the international poverty line of US1$ per day. Poverty in SADC is exacerbated by several factors among which are: (a) high levels of diseases in particular HIV and AIDS, Malaria and Tuberculosis.

These have resulted in unprecedented levels of morbidity and mortality among the people of productive and reproductive age; (b) social conflict and in some cases war; (c) natural disasters such as recurrent droughts and floods associated with climate change which impact negatively on food security; (d) unemployment; (e) and low industrial growth and productivity which is reinforced by high levels of migration of skilled labour from the region.

The recent global economic turmoil is compounding on the already dire situation in the region. Health, social and economic forecasts suggest that household poverty and orphaning will remain high in the foreseeable future. Vulnerable and poor households such as those headed by children, women, older people, people living with disabilities and HIV and AIDS and the unemployed bear the brunt of these numerous challenges, with often little or no options to cope. 

In view of these challenges, SADC developed specific interventions focusing on OVCY, elaborated through the Strategic Framework and Programme of Action for OVC, 2008 -2015 that was approved by SADC Ministers of Health and HIV and AIDS in November 2008 -2015. The Framework and this Business Plan, mark the first deliberate effort to mount a regional response on OVCY in SADC.

The premise of the SADC approach to the care and support for OVCY is the recognition that people in particular children and young people who comprise the demographic majority, are the real wealth of SADC Member States (MS). Thus, the fundamental purpose of development should be directed at enlarging their human freedoms and capabilities by expanding the choices that they have, to live full productive and creative lives, contributing to sustainable development in SADC.

Regional workshop on supporting effective aid responses to children affected by AIDS: Draft workshop report

Regional workshop on supporting effective aid responses to children affected by AIDS: Draft workshop report

The regional workshop on supporting effective aid responses to children affected by AIDS was aimed at stakeholders involved in channelling resources to vulnerable children and their carers, affected by HIV and AIDS in Southern and Eastern Africa to discuss the results of three regional studies undertaken in 2010.  The goal was to discuss the lessons from these studies to both improve their practises at country level and to provide an advocacy agenda of how to work collectively to improve aid effectiveness to children affected by AIDS.

The loss of the middle ground: the impact of crises and HIV and AIDS on 'skipped-generation' households

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Poject briefing no 33

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The loss of the middle ground: the impact of crises and HIV and AIDS on 'skipped-generation' households

HIV and AIDS has led to an increase in ‘skipped-generation’ households (SGHs) – households made up of the old and the young (Box 1). Such households as a result of negative shocks that fuel demographic changes by raising mortality and migration among the middle generation, including conflict, war, epidemics and natural disasters. With emergencies, particularly those associated with climate change, expected to increase and intensify, particularly in Africa, the concern is that the existing vulnerability of SGHs as a result of their structure/ composition, may increase. However, relatively little is known about a) the livelihoods and coping strategies of such households, b) how they are affected during emergencies, c) the role of community based support structures in assisting these households and d) how emergency preparedness and response could better address their needs.

To address these gaps in knowledge, HelpAge International (HAI), the Overseas Development Institute (ODI) the United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on AIDS (UNAIDS), carried out a study to improve understanding on how these households cope during emergencies, and to provide recommendations on how emergency preparedness and response can better meet the needs of such households in the East and Southern African region. A literature review was followed by country case studies in Northern Uganda and Zimbabwe (Box 2) in which members of SGH households, both older people and children, and organisations involved in the emergency response were interviewed. This Project Briefing presents some key findings and policy recommendations from this study.

The practice and activities of psychosocial support by communities and families for children and adolescents living with HIV

The Southern African AIDS Trust (SAT) has launched a new resource on the requirements for Psychosocial Support for Children and Adolescents.

Organisations need to support caregivers, families and communities to create conditions that allow children and adolescents to experience being cared for and loved as part of their day-to-day experiences in their families and communities. Young children affected by HIV and AIDS, and other major disruptions in their lives, have critical psychosocial needs that are best addressed when embedded in their everyday lives – through responsive parental care, a return to normalcy (such as routines and opportunities to play), and social participation (such as returning to school and in other community activities).

Psychosocial care, support and rehabilitation are all best provided by families and communities, sometimes with assistance. When families are supported to be able to provide care, few children need specialised psychological or social programmes.

Programmes that can effectively meet the needs of children in the context of HIV and AIDS and poverty are those that acknowledge, support and strengthen the commitment and care of families and households. These responses must be supported by constructive national policies and the mobilisation of resources. Within the mix of required responses, activities to protect, support and promote the psychosocial wellbeing of children and families are urgently needed.

Other resources recently published by SAT include:

Counselling Guidelines for Voluntary Medical male circumcision (VMMC) - a booklet that specifically addresses counselling on Voluntary Medical Male Circumcision (VMMC) as an additional HIV prevention method.

Mainstreaming Gender in the Response to HIV and AIDS in Southern Africa - a guide for the integration of gender issues into HIV and AIDS response.

20 years of strengthening community HIV and AIDS competence: Lessons for the future - a reflection on the South-South learning over the past 20 years as experienced by SAT partners.  

These resources are available through the SAT website: www.satregional.org,  through any of their country offices in Botswana, Malawi, Mozambique, Tanzania, Zambia and Zimbabwe, or by writing to info@satregional.org.

Living with our Bibi: A qualitative study of children living with grandmothers in the Nshamba area of north western Tanzania

Living with our Bibi: A qualitative study of children living with grandmothers in the Nshamba area of north western Tanzania

The present report provides an update on progress in the global AIDS response since the 2001 special session, identifies critical challenges that must be addressed and makes urgent recommendations to strengthen efforts at the global, regional and country levels.

The report is based on data supplied by countries on the complete set of core indicators developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS) to monitor implementation of the Declaration of Commitment on HIV/AIDS. Nearly 120 country progress reports have been submitted that update the data provided by countries in 2003. These have been supplemented by over 30 reports from civil society, as well as by national and global surveys and coverage estimates for specific programmatic interventions.

Five years after the 2001 special session, the available evidence underscores the great diversity among countries and regions in implementing the response envisioned in the Declaration of Commitment on HIV/AIDS. While certain countries have reached key targets and milestones for 2005 as set out in the Declaration, many countries have failed to fulfil the pledges. The central message of the present report is that a quarter of a century into the epidemic, the global AIDS response stands at a crossroads. The important progress made against AIDS since the special session — particularly in terms of greater resources, stronger national policy frameworks, wider access to treatment and prevention services and broad consensus on the principles of effective country-level action — provides a solid foundation on which to build a comprehensive full-scale response. In effect, for the first time ever the world possesses the means to begin to reverse the global epidemic. But success will require unprecedented willingness on the part of all actors in the global response to fulfil their potential, embrace new ways of working with each other and be committed to sustaining the response over the long term.

Failure to urgently strengthen the AIDS response will mean that the world will achieve neither the 2010 targets of the Declaration of Commitment nor Millennium Development Goal 6. And without major progress in tackling AIDS, global efforts to achieve the Millennium Development Goals of reducing poverty, hunger and childhood mortality will similarly fall short of agreed targets. Countries whose development is already flagging because of AIDS will continue to weaken, potentially threatening social stability and national security.

Fishing Communities Policy Brief

KMCC_FINAL_Fishing_policy_brief.pdf

This Policy Brief is based on the findings of the Fishing Communities Synthesis Report. It contains  policy recommendations  on what can be done to help curb HIV rates among Ugandan fishing villages.

 

Fishing in Uganda provides jobs and income for over one million people. Fishing landing sites are hubs of dense local and regional sexual networks which can accelerate the spread of HIV into the wider population.

The following policy considerations need to be instituted:

 

  •  A well-coordinated targeted government response

  • Robust national data on fishing communities to inform effective HIV programming and policy
  • standardised research methodologies and implementation models

  • fora to share best practices and/or lessons learned

  •  Raise risk perception of the dangers of HIV among fishing communities
  •  Improve  access to HIV services for fishing communities

Literature review: Care and support for teaching and learning

Literature review: Care and support for teaching and learning

In 2004, UNICEF estimated that the number of children orphaned by AIDS globally would exceed 25 million by 2010, most of them in sub-Saharan Africa. HIV and AIDS, poverty and a variety of other factors in the physical, political, socio-economic and ecological environments would radically threaten survival and development opportunities of children. This projection was published in UNICEF’s 2004 Framework for the Protection, Care and Support of Orphans and Vulnerable Children, a document drawn up by a wide array of practitioners and representatives, government and non-government, in the international development field, with the purpose of providing global leaders and decision makers with a common agenda for an effective response to the problems of orphans and vulnerable children and youth.

At the time of reporting, 2004, according to the framework, few resources were reaching families, schools, communities and health care and welfare systems to help them cope with the impact of these hazards. Little attention was being given in national development agendas to help provide a front-line response and donors had not yet come up with comprehensive and targeted programmes. The framework stressed that governments and agencies needed to work together in co-ordinated ways to achieve an effective response to the problems presented by the epidemic and the related problem of poverty in underdeveloped regions of the world. Leadership, co-ordination and facilitation by governments were described as fragmented and weak, with programmes reaching a tiny minority of vulnerable children.

Over the last six years, since the publication of the 2004 UNICEF framework, the demand for an education sector response has been mounting and programme interventions to offer care and support to vulnerable children have been piloted and implemented. Increasingly Ministries of Education across Africa have risen to the challenge of providing large-scale interventions at a national level. This has been most evident in the sub-Saharan region, incorporating the SADC region, where widespread poverty and high HIV prevalence has had an unprecedented negative impact on millions of children. A review of the literature available suggests that more widely across
developed and developing nations, education-based interventions have concentrated on supporting children through HIV education and awareness-raising. Sub-Saharan Africa appears to lead the way in proposing and piloting more holistic and integrated models of care and support which focus on a broad spectrum of the needs of children, especially the most vulnerable.

The Southern African Development Community (SADC) region is afflicted by poverty, war, HIV and AIDS placing millions of children at risk. Providing care and support to vulnerable children is one of the greatest challenges currently facing the region. The education sector is just one sector in which there are negative repercussions: The majority of OVCY are of school-going age; however they are less likely to enrol at or attend school regularly and more likely to drop out of school than their non-vulnerable peers[2]. Thus, the growing number of OVCY is offsetting progress towards achieving the Education For All (EFA) goals and other international and national targets. There is however, a great deal of potential, for education systems to form a key part of the solution to providing care and support to OVCY.

Children spend a large portion of their lives at school. Sometimes a school is the only infrastructure in a small rural community and for parents and children alike represents the promise of learning which will secure a child’s future. The school brings together people who occupy a number of different roles (in the classroom, in the playground, in management and on governing bodies, in support services and other groups). The school has therefore been identified by many service provision agencies and organisations as an essential node for the delivery of care and support services to vulnerable children.

Schools are not the only centres for the provision of support services, however. Over the last ten to fifteen years, as HIV /AIDS has tightened its grip over communities across the southern African region, a plethora of non-government initiatives, operating independently of schools, have been set up to respond to the needs of children and families made vulnerable by the pandemic.

All approaches to the implementation of care and support interventions in the school appear to uphold above all a common commitment to putting the needs and interests of the child first and strengthening school communities to provide a more caring, supportive and inclusive environment for effective teaching and learning.

Mainstreaming care and support in school-based interventions involves a paradigm shift in the schools’ approach to the development and education of the child. Schools are no longer expected to hand down an education package from within a vertical ministerial stream. Rather, policies, services and programmes designed to support vulnerable children and their families need to be more diffuse and enacted in an integrated manner, rather than in programme isolation. Children’s developmental needs (health, education, protection, nutrition and poverty reduction, for example) must be addressed across policies, procedures, planning, budgeting, capacity building, human resource development, monitoring and evaluation and inter-sectoral networking.

This literature review aims to identify the core elements which are necessary for the provision of school-based care and support to teachers and learners in the SADC region. With a focus on particular studies and programmes, it aims to provide signposts for the development of the existing sub-regional research agenda, identifying lessons learnt from current practices.

Section 2 identifies the main documentation sources used in this literature review as well as the limitations associated with these.

Section 3 gives a brief overview of the institutional policy framework for a co-ordinated response to providing care and support for children rendered vulnerable by socio-economic and health factors at international, regional and national levels. International instruments have set targets for countries to draft and implement domestic policies to address the needs of vulnerable sectors. A review of progress in SADC Member States in achieving compliance in law and policy reform, together with progress in implementation, is being conducted separately.

Section 4 provides a brief overview of the SADC region focusing on demographic data that has a bearing on the ability of children in the Region to access quality education.  and the importance of the school system as entry points for the care and support interventions through partnership of government and non-government organisations across a wide spectrum.

Section 5 discusses the various modalities of care and support for teaching and learning observable in 14 programme interventions across the SADC region, touching on implementation achievements and challenges.

Section 6 provides a summary of the core elements of care and support for teaching and learning and demonstrated by the commonalities in the 14 programme interventions discussed in Section 5.

Section 7 draws out some of the information and research gaps evident in the literature and suggests potential areas for further research.

Child and youth participation in East and Southern Africa: Taking stock and moving forward

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Child and youth participation in East and Southern Africa.pdf

An analytical review of the literature and five case studies on child and youth participation in East and Southern Africa.

In response to the lack of evidence on whether and how child participation can lead to the empowerment of children at an individual, family, community and policy level in the context of HIV and AIDS RIATT commissioned this review. The objectives of the review were:

  • To document the methodologies involving children and youth participation focused on HIV and AIDS within the Eastern and Southern Africa region, focusing particularly on their involvement in relevant decision-making processes including at policy and programming levels, research, including monitoring and evaluation, and conferences.
  • To critically analyse these methodologies in light of how they promote a rights-based and ethical approach leading to the individual's empowerment, as well as those of the family and community and children in general.
  • To identify promising practices of how children and youth have been meaningfully involved by governments, and international/non- governmental/ community based organisations.

In deciding where to focus this review the decision was made to build on the number of existing reviews of child participation (see Appendices at end of Section One) by taking a more analytical rather than a descriptive approach.

This document is intended as a technical resource for organisations aiming to advance child and youth participation as part of a broader response to HIV and AIDS within southern and eastern Africa. The hope is that policy makers and programme managers will through reading this overview of the state of play, the outline of issues and some description of methods be helped to reflect on what the operational implications are for promoting child participation in their area of operation.

Section One of the publication is an analysis of the state of play of child participation in the region based on an extensive review of literature and on 18 interviews (see end of Section One) with representatives of children's organisations working in the region.

Section Two is a collection of five case studies that focus on different ways that children are participating in the region. The case studies examine the extent to which these projects benefit and empower children, their families, communities and how they have influenced policy

East African Community Regional HIV and AIDS Response Report 2013

EAC Regional HIV and AIDS Response Report-Popular Version.pdf

Related resource: 

HIV and AIDS/STI and TB Multisectoral Strategic Plan and Implementation Framework 2015 - 2020

Realizing the regional Goals in HIV and AIDS, TB and STI programming.

The East African Community Regional HIV and AIDS Response Report 2013 is a first-of-its-kind consolidated reference on the status, trends and response to the HIV and AIDS epidemic in the EAC region. It is envisaged as a tool to assess progress made in reaching national, regional, continental and global commitments on the HIV epidemic. 

This report is designed to generate evidence which will form the basis for re programming the EAC response to the HIV and AIDS epidemic in pursuit of an early achievement of zero new infections, zero AIDS deaths and zero stigma and discrimination, and, to provide information necessary to support the region’s advocacy and resource mobilization efforts in this regard.

Paediatric advocacy toolkit: For improved paediatric HIV diagnosis, care and treatment in high HIV prevalence countries and regions

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Pediatric advocacy toolkit: For improved pediatric HIV diagnosis, care and treatment in high HIV prevalence countries and region

This Paediatric HIV Treatment Advocacy Toolkit was developed by members of the UNICEF Interagency Task Team on Children and AIDS (IATT-CABA) paediatric working group to support efforts in advocating for increased commitment to, and resources for, paediatric HIV diagnosis, care and treatment in high HIV prevalence countries and regions.

The use of this toolkit is aimed at generating a commitment among Ministries of Health (MOH) and relevant policymakers and partners to prioritize paediatric HIV treatment, and for these policymakers to take measureable actions to increase access to and quality of paediatric HIV treatment coverage.

East African Community Regional HIV and AIDS Response Report 2013

EAC Regional HIV and AIDS Response Report-Popular Version.pdf

 

Related resource: 

HIV and AIDS/STI and TB Multisectoral Strategic Plan and Implementation Framework 2015 - 2020

Realizing the regional Goals in HIV and AIDS, TB and STI programming.

The East African Community Regional HIV and AIDS Response Report 2013 is a first-of-its-kind consolidated reference on the status, trends and response to the HIV and AIDS epidemic in the EAC region. It is envisaged as a tool to assess progress made in reaching national, regional, continental and global commitments on the HIV epidemic. 

This report is designed to generate evidence which will form the basis for re programming the EAC response to the HIV and AIDS epidemic in pursuit of an early achievement of zero new infections, zero AIDS deaths and zero stigma and discrimination, and, to provide information necessary to support the region’s advocacy and resource mobilization efforts in this regard.

Don't let children fall off the map: Children in Eastern and Southern Africa affected by AIDS

Don't let children fall off the map.pdf

Whilst some progress has been made towards these goals, the reality is that most affected countries, including those in Eastern and Southern Africa still have a long way to go in terms of fulfilling the many commitments and goals. In Eastern and Southern Africa children, their families and their communities continue to live with the harsh impacts of HIV and AIDS.

Conducting a situation analysis of orphans and vulnerable children affected by HIV/AIDS: A framework and resource guide

Conducting a situation analysis of orphans and vulnerable children affected by HIV/AIDS: A framework and resource guide.pdf

This framework and resource guide is intended to help people involved in programs assisting orphans and vulnerable children conduct a situation analysis. It is hoped that this guide will bring about a better understanding ofthe essential elements and outcomes of a situation analysis in order to promote realistic, effective, and feasible interventions to protect and improve the well-being of the children and families who bear the greatest impact of the AIDS epidemic. The guide serves as a tool for collecting and synthesizing in-country and sub-national information. Examples of situation analyses and related research are provided throughout the document to draw upon the variety of approaches, and their components, that communities and institutions have undertaken to assess their particular situation. We hope that these will be used as applicable lessons from actual experience.

Community responses for children affected by AIDS: Challenges for the future! RIATT-ESA satellite – ICASA 2011

Community responses for children affected by AIDS: Challenges for the future! RIATT-ESA satellite – ICASA 2011.pps

The RIATT-ESA held a very successful satellite session at ICASA 2011. Focusing on Strengthening families, Increasing effectiveness of resources, and Child participation, The key note address was presented by Dr. Chewe Luo, and looked at future challenges in the community response for children affected by AIDS. 

Dr. Luo is a Paediatrician and Tropical Child Health specialist from Zambia, currently working as Technical team leader for Country programme scale-up and Senior programme Advisor for HIV at UNICEF, New York. She has over 15 years of experience in HIV/AIDS and child health as a clinician and researcher at the University Teaching Hospital in Zambia; as a clinician in the UK, and working with UNICEF at country, regional and headquarter levels. She has a Masters of Medicine in Paediatrics from the University of Zambia and a Masters in tropical Paediatrics and a PhD from Liverpool School of Tropical Medicine in the UK