Social protection to reverse neglect of children affected by AIDS

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“Children have been short-changed in the response to AIDS,” Professor Linda Richter of the Human Sciences Research Council of South Africa told delegates at the 17th International AIDS Conference in Mexico today.

“They are visible in the photo opportunities and headlines, but mostly invisible in the response to HIV,” Richter said during a plenary presentation titled ‘No Small Issue: Children and Families.’

Latest UNAIDS figures estimate two million children aged between below 14 were living with HIV in 2007 - an eight-fold increase since 1990. 2007 alone accounted for a three-fold increase in new HIV infections and deaths among children. About 370,000 children became newly infected with HIV last year and 270,000 died.

Children from sub-Saharan Africa, where a further 12.1 million children have lost one or both parents to AIDS, accounted for about 90% of those cases.

While the global response to AIDS has bolstered the provision of prevention, treatment and care services, the needs of children continue to be overlooked. Richter’s was the first plenary talk devoted to the well-being of children affected by HIV and AIDS in the conference’s 23-year history.

The overwhelming majority of HIV-positive children are infected through mother-to-child transmission (MTCT) and despite recent progress, services aimed at preventing MTCT reach just a third of those women in need in low and middle-income countries.

Only 10% of children living with HIV receive antiretroviral therapy (ART). Last year, less than 8% of infants in low and middle-income countries were tested for HIV within two months of their birth and only one in every 25 babies exposed to HIV receive the vital antibiotic trimoxazole.

Little is known about infections among children aged between two and 15, despite household surveys in countries with high HIV prevalence in this age group. Conversely, population-based surveys in many African countries identify a relatively low number of child-headed households, and yet large amounts of money and attention are focused on these situations.

According to Richter, targeting interventions specifically towards orphans or AIDS-affected children is neither helpful nor efficient in hard-hit communities where there is widespread poverty and destitution. In these circumstances, orphans are seldom worse off than other vulnerable children and singling out specific groups of children can result in the stigmatization and abuse of those in need. All children in communities severely affected by HIV require support.

“Children orphaned by AIDS are, sadly, only the tip of the iceberg of HIV-affected children,” said Professor Richter. “Our primary focus in designing and implementing policies must be the actual needs of all children affected by HIV and AIDS, not whether they meet an agency’s definition of ‘orphan’.”

In some southern African countries more than 30% of families have an adult member living with HIV or have experienced a recent AIDS-related death. More than 60% of children live below the poverty line in countries already struggling with low incomes.

The support offered to individual children by local community members and organizations in these situations has been critical but has fallen woefully short of meeting their needs. Few interventions aimed at children have been formulated, resourced or implemented on a scale comparable to the epidemic’s impact on children and their families.

Child-focused responses comprise a number of ad hoc projects with limited outreach that are often imperfectly designed and under-funded. In the most severely affected regions, families and communities are left to bear the overwhelming burden of the epidemic, including about 90% of the associated financial costs.

Just 15% of households supporting vulnerable children globally receive any support from community-based or public sector programmes, according to Richter.

“Civil society organizations and faith groups provide most of the available support . . . But small, localized projects can only take us so far. To have a bigger impact requires larger and more systemic responses - responses which support families and address the pervasive poverty in which so many of them live,” Richter said.

During her speech Professor Richter laid out a new action agenda for the provision of social protection and universal access to some of the poorest families in low-income countries.

"Strengthening the capacity of families through systematic, public sector initiatives has been identified globally as one of the most important strategies in building an effective response for children. Institutional, orphanage and other forms of non-family care have well-documented problems and cost up to ten times more than family care."

Professor Richter also noted that reducing the impact of extreme poverty through social protection efforts was a crucial missing ingredient in services for children affected by HIV and AIDS.

“Every developing country, no matter how poor, can afford a social protection package for children affected by HIV and extreme poverty,” she said.

The International Labour Organization estimates that the cost of a small universal old age pension, universal primary education, free primary health care and a child benefit of US$0.25 per day at between 1.5% and 4.5% of the GDP of low-income African countries.

“Putting needed resources into the hands of affected families should be urgently considered in order to expand the impact of small-scale programmes currently reaching only very small numbers of children,” Richter said.

“Whatever approaches are taken, some form of income assistance for the neediest households is critical . . . In many high-prevalence countries in Africa, poverty is arguably the single biggest barrier to the scale-up of HIV treatment and prevention.”

“Further expansion of these services may not be possible without addressing individual and household incapacity, including financial incapacity, to access them.”

Keywords: AIDS children HIV IAC 2008

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